bluuebunny/crossref_metadata_2025 huggingface dataset:
The developing role of children’s nurses in community palliative care
Authors: O’Brien Irene , Duffy Anita
Published: May 2014

This article addresses some of the contemporary issues in relation to providing palliative care for children in Ireland, particularly focusing on the creation of the specialist palliative care nursing outreach posts. The recent publication of an Irish national policy on palliative care for children with life-limiting illness is welcome news for paediatric nurses in Ireland. Children are valued members of society and have a right to receive quality health care and support appropriate to meet both children and the families’ precise needs. However, community services for children with life-limiting illnesses remain inadequate, with many parents and families struggling to provide palliative care for children in the home. Currently, community nurses, who are not always registered children’s nurses, are providing palliative care for children at the end of life. These nurses may not fully understand the specific needs of critically or chronically ill children and their families. In addition, there are no specific palliative care educational programmes in Ireland with regard to end-of-life care for children. The challenges of providing palliative care to children and their families in relation to symptom control, controversial ethical and legal issues, and emotional and practical support, mean that advanced knowledge is required in order to progress the agenda and thus provide excellence in children’s palliative care in Ireland. It is important that the agenda is moved forward so that children and their families requiring palliative care and nursing support do not suffer from a lack of professional provision for their needs
Managing anaemia of chronic kidney disease
Authors: Murphy Fiona , Bennett Lesley , Jenkins Karen
Published: May 2014

Chronic kidney disease (CKD) is a multi-faceted disease which has a number of associated complications. Anaemia is one of the most common complications that develops early in the course of the disease process. It is associated with increased mortality, increased hospitalization rates, and reduced quality of life. Low haemoglobin levels may increase risk for progression of CKD, cardiovascular morbidity and mortality. This article aims to address the importance of early recognition and management of anaemia in CKD, and the role of the health professional in this regard. Issues that will be discussed include causes, screening, guidelines, current research and recommended treatments of anaemia in CKD, along with recommendations for future practice in this pivotal area of renal care
Sternal wound infections: improvements made to reduce rates
Authors: Aziz Ann-Marie , Isalska Barbara
Published: May 2014

Wound infections from surgical sites account for 15% of all healthcare-associated infections (National Institute for Health and Clinical Excellence (NICE), 2008). There is evidence that the care provided before and after the operation is paramount to minimize the risk of surgical site infection. Sternal wound infections lengthen hospital stays (or prompt readmission) and carry a high mortality rate. In August 2009 a Manchester Hospital discovered a cluster of three patients with sternal wound infections. A review of clinical data for patients having cardiac surgery from 1 December 2008 and 9 October 2009 revealed an increased incidence of patients with sternal wound infections. The data did not reveal a significant problem, but one that should be kept under observation. During the investigation no single pathogen had been identified as responsible and no obvious source of environmental infection was identified. Implementing additional infection prevention and control practices helped the hospital team to improve the care given to patients. A host of factors, ranging from providing more information on wound care to patients, improving audit scores, and adhering to NICE guidelines, contributed to the reduction in this type of surgical site infection.
Challenges facing tissue viability in 2010
Authors: Ousey Karen
Published: May 2014

Tissue viability is a speciality that truly encompasses the holistic needs of individuals with a wound. As practitioners involved in tissue viability it is not just the wound that requires assessment, treatment and prevention strategies, but also the assessment of nutrition, pain, stress, mobility, altered body image and any underlying disease process prior to choosing the most appropriate dressing and pressure-redistributing devices. Additionally, tissue viability practitioners are expected to develop business cases to support the speciality, and to liaise with members of the multidisciplinary team who are involved in the care of the patient. Although tissue viability tends to be nurse-led, there are numerous professional groups that will also be involved in this care, including healthcare assistants, podiatrists, physiotherapists, medical staff, occupational therapists and dieticians. It is therefore important that all those involved in tissue viability understand the importance of the quality agenda that will affect their day to day delivery of care.
Infection control: everybody’s business
Authors: Weston Debbie
Published: May 2014

There has been a marked change of culture within the NHS in recent years with regard to the prevention and control of healthcare-associated infections (HCAIs), and the buzz words are ‘no avoidable infections’.
The Vitala™ Continence Control Device
Authors: Swan Elaine
Published: May 2014

The Vitala™ Continence Control Device (CCD) is a pouchless ostomy device that seals against the stoma and prevents release of stools from the stoma, while permitting the release and deodorization of flatus. This will enable many end colostomates to control their continence. It is the first non-invasive product to temporarily meet the ostomate need of faecal continence
An overview of stoma bridges and a case study on their management
Authors: Cronin Elaine
Published: May 2014

Over recent years, very little appears to have been written on stoma bridges or rods, which are additional supportive mechanisms for loop stomas. Within St Mary’s NHS Trust, bridges are commonly used following the construction of a loop stoma (ileostomy, colostomy, and loop transverse colostomy), and the author has become accustomed to their presence. However, in conversing with other stoma care nurses across the country, it has become apparent that not all institutes, trusts, or other hospitals use bridges, and it would seem that some have not done so for many years. Intrigued by these devices, the author decided to take a closer look at their use, appearance and purpose. This will provide other stoma care nurses, as well as general nurses, with a better understanding of what they are and why some surgeons still use them. A short case study is also presented, discussing how a bridge was managed in the post-operative period when an appliance became insecure and the bridge was immobile and tight against the abdominal surface/plane.
Arterial catheters: indications, insertion and use in critical care
Authors: Scales Katie
Published: May 2014

This article provides an overview of arterial catheters and their use within critical care. The indications for arterial catheterization are presented and the insertion techniques are discussed. The nursing care of patients with an arterial catheter is explained, with a focus on safety, haemodynamic monitoring and arterial blood sampling. The procedure for removal of an arterial catheter is described in a step-by-step guide. Post-procedure care and complications are also discussed and evidence-based strategies for the prevention of complications are suggested.
The Injectable Medicines Guide website
Authors: Keeling Susan , Burfield Robin , Proudlove Christine , Scales Katie
Published: May 2014

National Patient Safety Agency Alert 20 (2007) requires that information on how to prepare and safely administer injectable medicines is available at the point of care. This article describes the development of the Injectable Medicines Guide website, which is recommended in Alert 20 as a suitable source of information. Historically, individual hospitals have produced local guidelines resulting in much duplication of effort. The website was developed by liaising with a large number of hospitals across the UK to produce standardized information on intravenous (IV) medicine administration. The website can be tailored to reflect local needs, which would include those sections that are absolutely essential for safe administration of the medicine; but access to the full monograph can still be easily obtained. In addition, organizations can link locally-produced IV medicine-related guidelines to individual monographs. For organizations that produce their own locally-prepared injectable medicines guide, it is possible to add it to the website in such a way that it can be viewed with an appropriate link in place to the Injectable Medicine Guide website monograph. The Intensive Care Society (2010) has issued a statement supporting the adoption of standard concentrations for 16 medications commonly used in critical care and the website is being updated to reflect this statement. Specialist mental health pharmacists are preparing monographs on medicines commonly administered by intramuscular (IM) injection in mental health practice. These are planned for release in the autumn of 2010. Currently, a robust source of funding is not available to underpin the production of the website. Appropriate funding would allow it to become universally available across the UK, without the need for password-protection. The website could then more easily become embedded in computerized prescribing systems
Building the future: children's views on nurses and hospital care
Authors: Fletcher Terri , Glasper Alan , Prudhoe Gill , Battrick Cath , Coles Lesley , Weaver Katy , Ireland Lorraine
Published: May 2014

Healthcare policies such as standard 7 of the National Service Framework for Children, Young People and Maternity Services and the new NMC standards for pre-registration nursing programmes emphasise the need for universities and their partner trusts to engage with patients and the public in developing both nurse training courses and services. This article describes a two-arm study into the views and experiences of children with regard to hospitals. Conducted as part of an ongoing commitment to the reconfiguration of children’s services and the development of a new undergraduate children’s nursing programme, the study collected data from 61 children in two children’s hospitals in the south of England and from eight members of a city youth parliament.

Aims:

The study sought to involve child users in service planning through two objectives: 1) to ascertain the views of children and young people on what skills, knowledge and attitudes, children’s nurses of the future will need to care for sick children and their families; and 2) to seek the views of young people on what children think about before being admitted to hospital, and subsequently as inpatients.

Method:

The study used a draw and write/tell technique. The main outcome measures were description and analysis of those attributes which children believe nurses of the future should possess, and of those factors which inhibit or enhance childhood hospital admission.

Results:

A number of themes emerged from analysis of the data: notably that children’s nurses of the future should be skilled in both verbal and non-verbal communication, as well as having fundamental clinical skills. Issues relating to children about to be admitted to hospital included being scared or worried, and fear of the unknown, while concerns after admission to hospital related to the care environment, social needs, and individual/ personal needs and requirements.

Conclusions:

This patient and public involvement study revealed a number areas that children and young people believe to be important for the future training of children’s nurses. Additionally, the factors which children consider inhibit or enhance the experience of hospital admission have been identified.
Reducing haemodialysis access infection rates
Authors: Dorman Amanda , Dainton Marissa
Published: May 2014

Infections are the second most common cause of vascular access loss in the long-term haemodialysis patient, and recent years have seen an increase in healthcare-associated infections (HCAIs) associated with vascular access ( Suhail, 2009 ). There have been a number of drivers including publication guidelines (Department of Health, 2006; 2007 ) and local protocols providing evidence-based recommendations that, when implemented, can reduce the risk of these infections. In England, the selection of bloodstream infections caused by methicillin resistant staphylococcus aureus (MRSA) as a significant clinical outcome has led to a vast amount of work in this area. Root cause analysis of individual infections (by the clinical teams when these occur) in many specialities identified areas where practice could be improved, including practice relating to vascular access within the renal setting. Manufacturers have also supported this work by focusing on developing products that are designed to reduce the likelihood of infections occurring. One product identified and used within the NHS is Chloraprep.
Demonstrating and measuring achievement
Authors: Glasper Alan
Published: May 2014

Professor Alan Glasper discusses the Government's listening exercise and consultation into the modernization of the NHS, launched at the beginning of April 2011.
Improving staff engagement and patient care: use of novel initiatives
Authors: Thompson Sara
Published: May 2014

Staff engagement and patient care are two key aspects of the healthcare system. Sandwell and West Birmingham Hospitals (SWBH) NHS Trust is focused on achieving excellence in these areas and has used innovative initiatives to realize these aims. Listening into Action (LiA) is a comprehensive outcome-orientated approach which is aimed at harnessing the ideas of frontline staff. LiA has led to improvement in results from staff surveys and the fostering of a more collaborative approach. The Trust has started to use a Foley catheter tray with the aim of improving catheter procedures. The Foley catheter trays, which include all the necessary equipment for an aseptic catheterization, were introduced across the Trust over a 4-week period. Uptake and implementation were excellent with the use of the Foley catheter tray, and were associated with a reduction in catheterization time.
Management of psoriasis and its comorbidities in primary care
Authors: Aldeen Taha , Basra Mohammad
Published: May 2014

Psoriasis is a common chronic disfiguring skin disease. Its management depends on the extent of disease, sites affected, comorbidities, and patient's background or lifestyle. In the UK, psoriasis treatment starts in the primary care with range of topical applications, including steroids, vitamin D analogues and coal tar. However, psoriasis is associated with physical, psychological and metabolic comorbidities which could not be improved by topical therapy. The aim of this review is to address the challenge in managing these comorbidities within primary care.
A new paradigm in patient safety
Authors: Tingle John , Gibson Linda , Ferrante Maria L.
Published: May 2014

John Tingle, Linda Gibson and Maria Ferrante discuss a new framework for the patient safety agenda.
The snapshot pre-registration assessment tool. Part 2: Data, discussion and future directions
Authors: Tolley Kim , Ooms Ann , Marks-Maran Di , Acton Lesley , Rush Sue
Published: May 2014

This paper is the second of a two-part article presenting a new assessment tool (the snapshot) for pre-registration nurses in clinical practice that is being used at Kingston University/St George's University of London during year 3 of the Diploma and BSc programme. Part 1 of this article presented background to the snapshot tool and the research approach used in the evaluative research study. Part 2 will present the data collection, findings and discussion which show that the snapshot is perceived positively by students in terms of the criteria, documentation and process. However, mentor understanding of these factors varied with some mentors having an inadequate understanding and additional questions of assessment validity also arose and need to be addressed. Both parts of this article make a contribution to the practice assessment agenda and to the continuous clinical assessment methods currently in use that tests students' competence against agreed criteria. The snapshot reflects the reality of practice and assesses skills in a realistic environment.
Meet the needs of older people
Authors: Tingle John
Published: May 2014

John Tingle discusses the Care Quality Commission's national report on dignity and nutrition.
Homeostasis 3: nurses as external agents of control in hypothyroidism
Authors: Clancy John , McVicar Andrew
Published: May 2014

The role of healthcare practitioners in reversing homeostatic imbalances essentially makes them external agents of homeostatic control—they are replacing the usual assessment, controlling and effector aspects that operate intrinsically in health (homeostasis) but have failed in ill‐health (homeostatic imbalances). This article examines the homeostatic imbalance of hypothyroidism, using a case study to draw analogies between the components of homeostatic theory and those of the nursing process. After reading this article, nurses should be able to explain: how the components of homeostasis are associated with health, and how failure of one or more of these components of homeostasis is associated with illness; that illness arises from a cellular, and therefore chemical, homeostatic imbalance; that hypothyroidism is a cellular imbalance of low levels of thyroid hormone, which is identified by signs and symptoms (i.e. other homeostatic imbalances) related to these low levels; and understand how primary care nurses looking after people with hypothyroidism are acting as external agents of homeostatic control.
Developing leadership in nursing: exploring core factors
Authors: Curtis Elizabeth A. , de Vries Jan , Sheerin Fintan K.
Published: May 2014

This article provides an introduction to the issue of nursing leadership, addressing definitions and theories underpinning leadership, factors that enhance leadership in nursing, and the nature of leadership content taught in undergraduate programmes. Highlighted are differences between leadership and management, and the notion that leadership can be ‘learned’. The authors also point out that there is a discrepancy between how leading undergraduate nursing programmes prepare students primarily in the transition of education to practice, and the suggestion from a number of nursing publications that leadership in nurses should be fostered throughout their education.
Can nurses enhance spiritual care in end-Of-life settings?
Authors: Gasper Alan
Published: May 2014

Professor Alan Gasperdiscusses the Department of Health's review into spiritual care at the end of life, which recommends training in spiritual care and identifies a range of qualities required of nurses working with this vulnerable patient group.
NHS failing to meet basic standards of care for older people
Authors: Tingle John
Published: May 2014

John Tingle discusses a recent report by the Health Service Ombudsman on ten investigations into NHS care of older people.
Writing for professional publication. Part 9: using client case studies
Authors: Fowler John
Published: May 2014

The previous articles in this series of writing for professional publication focused on the preparation you need to do before starting to write an article, the practicalities of writing the abstract, creating interest in the reader's mind, and how an article for publication differs from an academic essay. Recently we considered the importance of selecting the correct journal for submission. In this article, John Fowler, an experienced nursing lecturer and author, discusses how client case studies can be used within your article.
Homeostasis 4: nurses as agents of control in myocardial infarction
Authors: Clancy John , McVicar Andrew , Hubbard Julia
Published: May 2014

The role of health practitioners in attempting to reverse homeostatic imbalances essentially makes them external agents of homeostatic control—they are replacing the assessment, controlling and effector mechanisms that operate during health (homeostasis), but have failed in ill-health (homeostatic imbalances). Myocardial infarction (MI) is the homeostatic imbalance examined in this article, which aims to apply the analogy between the components of homeostatic theory and the components of the nursing process ( Clancy and McVicar, 2011b ) to the condition. After reading the article, nurses should be able to understand that: the components of homeostasis are associated with health, and the failure of one or more of these components results in illness; illness arises from a cellular, hence chemical, homeostatic imbalance(s); MI results from a cellular imbalance leading to a restriction in blood flow to the myocardium, and is identified by signs and symptoms (i.e. other homeostatic imbalances) related to the ischaemia; when caring for people with MI, coronary care nurses are acting as external agents of homeostatic control.
Writing for professional publication. Part 11: writing conference abstracts
Authors: Fowler John
Published: May 2014

The previous articles in this series of writing for professional publication have focused on preparing the content and presentation of an article. Different types of articles have been examined, including case studies and project reports. In this article, John Fowler, an experienced nursing lecturer and author, discusses the writing of conference abstracts.
Who cares for the carers? A student's experience of providing carer support and education
Authors: Roy Dionne , Gillespie Mark
Published: May 2014

As the incidence of dementia increases with age and people are generally living longer, the number of people requiring care will continue to rise. There are approximately 820 000 people in the UK with dementia and more than 500 000 carers who are not part of the health and social care workforce. These unpaid carers provide support to people with dementia, often sacrificing their own work commitments, social and family life. As part of the ‘Partnerships in recovery’ module studied in the third year of the pre-registration mental health nursing programme at the University of the West of Scotland, the first author (DR) chose to use a pycho-education intervention to benefit the needs of a carer and client with vascular dementia. Providing support and education increases the likelihood of both carer and client engaging in a life that is meaningful and hopeful.
French national wound management survey: choice criteria of dressings
Authors: Meaume Sylvie , Barrois Brigitte , Faucher Nathalie
Published: May 2014

Across Europe, wound care management is organized differently, and in some countries such as the UK or Denmark, wound healing centres have been implemented. In France, a large number of health professionals are not sufficiently educated in wound care management during their vocational training. The rapid evolution of dressings has changed wound management practices and has given rise to new professional recommendations. This national survey was carried out in France in 2009, including 465 health professionals, to determine the criteria they use to choose a dressing and their habits of care with acute or chronic wounds. Around 73% of respondents were nurses and, on average, participants took care of 43 wounds per month. It was also found that 89% of the health professionals who took part prefer the sequential treatment of the wound based on its appearance. Regardless of whether the wound is acute or chronic, the priorities for wound care and the choice of dressing are the management of the exudate and the prevention or treatment of infection. These results put into evidence the adequacy of the recommendations by these practitioners and the good correlation between the choice of dressing and the local therapeutic goal. To reach the same level of expertise, the professional training for health professionals who are less frequently involved in wound care is necessary.
CINV in the UK: a prospective audit of patient experience
Authors: Vidall Cheryl
Published: May 2014

Chemotherapy induces nausea and vomiting in a significant number of cancer patients across the world each day. Unfortunately patients tend to be at home and away from the specialist oncology centres when the symptoms are at their worst. This leads to a disconnect between what health professionals predict will happen to patients and what patients actually experience, especially in the delayed phase of chemotherapy-induced nausea and vomiting (CINV) ( Grunberg, 2004 ).

Following feedback from a European forum (see preceding article, p. 22-8) that CINV is still poorly managed, the UK Oncology Nursing Society (UKONS) is proposing a nation-wide, multi-site audit of the patient-reported CINV experience by reviewing specially-designed CINV diaries. Each cycle of treatment will be recorded and side effects closely monitored for several days after treatment. Furthermore, the audit will assess the clinical prescribing habits, use of international CINV guidelines and variations in local protocols for these patients. An online survey will be undertaken by the clinical teams on what they predict a group of chemotherapy patients will experience by way of CINV. This audit will then be compared to the reported side effects experienced by the patients. It is proposed that this audit will provide evidence of how NHS and private oncology teams manage CINV within the UK.
Reducing pain during the removal of adhesive and adherent products
Authors: Denyer Jacqueline
Published: May 2014

Silicone Medical Adhesive Removers (SMARs) have proved a valuable addition to formularies. In the absence of SMARs, trauma following removal of adhesive dressings, ostomy products, retention tapes and monitoring equipment can lead to skin stripping or extension of existing wounds. Those at increased risk of skin stripping include groups such as older people, premature infants and neonates and those with skin fragility syndromes. Appeel® Sterile Sachet (CliniMed) is a sterile SMAR in liquid form supplied in a single-use sachet. The addition of this sterile product to the existing Appeel range of wipes and aerosols provides an adhesive remover suitable for use on broken skin. Unlike delivery from an aerosol, Appeel Sterile Sachet does not feel cold on application, a sensation which can be confused with pain. This article discusses the value of SMARs and in particular the advantages of using the single-use Appeel Sterile Sachet.
Addressing the problems of long-term urethral catheterization: part 2
Authors: Wilson Mary
Published: May 2014

This is the second of a two-part article and addresses the problems encountered throughout the life of a catheter from those relating to its insertion, through the time when it is in situ, to those associated with its removal. Catheters can cause discomfort and reasons for this are discussed including latex allergy, atrophic changes in women, blockage or bypass. The draft National Institute for Health and Clinical Excellence infection control guidance is discussed with reference to catheter maintenance solutions. Sexuality can be an unvoiced concern to patients with catheters in situ and clinicians are encouraged to discuss such issues with the patient, where relevant. Issues including catheter expulsion, bladder spasm and difficulties in catheter removal, including the non-deflating balloon and cuffing are addressed. The article concludes that although every patient is an individual with a unique set of problems, learning how to address one series of difficulties will help when dealing with subsequent challenges.
An exploration of palliative care provision in Scottish care homes
Authors: Reid Lorna , Snowden Austyn , Kydd Angela
Published: May 2014

This paper suggests that there is an imbalance between the ideal and the actual palliative care provision for some older people living and dying in care homes in Scotland. Successive studies demonstrate that care home residents are increasingly frail and disabled. Many experience challenging physical and psychosocial symptoms which could benefit from a palliative approach to alleviate suffering and promote comfort. However, palliative needs for people with non-malignant conditions, such as dementia, can be complex, and not easily identified or managed. A range of challenging factors currently impact palliative care provision for care home residents in Scotland including: the insufficiency of robust NHS healthcare support, the skill mix of the care home workforce, and the promotion of palliative tools as the primary means of improving the quality of palliative care in non specialist settings. Issues highlighted in this paper give cause for concern on a number of levels, particularly as the demand for palliative care in care homes is likely to increase in the near future. Therefore, sustained collaborative effort from leaders in the health, social and care home sectors is recommended if practical solutions are to be found for this vulnerable population.
Sexually transmitted infections in men who have sex with men
Authors: Peate Ian
Published: May 2014

For the first time in 10 years, there has been a fall in the number of diagnoses of sexually transmitted infections (STIs) in England; new diagnoses fell by 1%. Infection rates continue to grow among gay men and other men who have sex with men. Men who have sex with men are at more risk of developing an STI than other men in the population. This article considers the overall trends and diagnoses of STIs in England. A focus in particular on men who have sex with men is provided with an emphasis on lymphogranuloma venereum. Data is presented in order to provide the nurse with an overview of trends and the burden of STIs on this group of people; STIs are still on the increase in men who have sex with men. This article makes recommendations for action and emphasises the important role of the nurse in making men who have sex with men a priority for targeted HIV and STI prevention and health promotion work.
Opening ceremonies celebrate nurses
Authors: Lynch Kath
Published: May 2014

The opening ceremonies of what many consider the greatest show on earth took place on Friday 27 July and hundreds of nurses took part. Many were chosen for a special sequence dedicated to NHS workers. Others, however, were chosen to interact with audience members as a result of some of the same attributes that make nurses uniquely qualified to deliver patient care. Kath Lynch, a clinical lead nurse at the Royal Free Travel Health Centre, was one of the selected few and was even honoured for her enthusiasm with four real Olympic medals.
Hand hygiene compliance: is there a theory-practice-ethics gap?
Authors: Mortell Manfred
Published: May 2014

Practice is usually based on tradition, rituals and outdated information; there is often an additional gap between theoretical knowledge and its application in practice. This theory-practice gap has long existed ( Allmark, 1995 ; Hewison et al, 1996 ). It often arises when theory is ignored because it is seen as idealistic and impractical, even if it is practical and beneficial. Most research relating to the lack of integration between theory and practice has concluded that environmental factors are responsible and will affect learning and practice outcomes. The author believes an additional dimension of ethics is required to bridge the gap between theory and practice. This would be a moral obligation to ensure theory and practice are integrated. To implement new practices effectively, healthcare practitioners must deem these practices worthwhile and relevant to their role. This introduces a new concept that the author calls the theory-practice-ethics gap. This theory-practice-ethics gap must be considered when examining some of the unacceptable outcomes in healthcare practice ( Mortell, 2009 ). The literature suggests that there is a crisis of ethics where theory and practice integrate, and practitioners are failing to fulfil their duty as providers of healthcare and as patient advocates. This article examines the theory-practice-ethics gap when applied to hand hygiene. Non-compliance exists in hand hygiene among practitioners, which may increase patient mortality and morbidity rates, and raise healthcare costs. Infection prevention and control programmes to improve hand hygiene among staff include: ongoing education and training; easy access to facilities such as wash basins; antiseptic/alcohol handgels that are convenient, effective, and skin- and user-friendly; and organisational recognition and support for clinicians in hand washing and handgel practices. Yet these all appear to have failed to achieve the required and desired compliance in hand hygiene.
Facing the final year and reflecting on the journey
Authors: Botten Emma Louise
Published: May 2014

Emma Louise Botten, a student nurse at King's College Hospital, reflects on the first two years of training and considers what the future holds, in terms of the final year, and her fast-approaching career as a qualified nurse.
The Patients Association wake-up call to primary health care
Authors: Tingle John
Published: May 2014

John Tingle discuses a recent report by the Patients Association charity on the relationship between patients and GPs.
Acute leukaemia: making sense of a complex blood cancer
Authors: Meenaghan Teresa , Dowling Maura , Kelly Mary
Published: May 2014

Acute leukaemia represents a diverse group of blood cancers that affect both children and adults. Treatment schedules for these haematology cancers are often prolonged, with many associated side effects and complications. Nurses caring for patients with acute leukaemia require an anticipatory approach, where care is aimed at minimizing the side effects of treatment and being constantly vigilant for any impending adverse effects. Moreover, patients require support for the psychosocial issues that can arise for patients during their illness. This article provides an overview of acute lymphoblastic leukaemia and acute myeloid leukaemia. Nursing considerations in the care of patients being treated for acute leukaemia are also explored.
How national policy affects the care of patients who suffer a heart attack
Authors: Green Meryl
Published: May 2014

In October 2008 the Department of Health published the National Infarct Angioplasty Project (NIAP), reviewing its guidance on the treatment of a heart attack. This was framed to update previous 2000 guidance from the National Service Framework for coronary heart disease, and highlighted the need for specialised services and 24-hour care. Recommendations included the need for appropriate assessment/investigation and immediate transfer to a cardiac catheterisation laboratory for primary angioplasty within 120 minutes of calling for professional help. Cardiac services are currently undergoing review, and a significant number of new cardiac catheterisation laboratories are being established throughout the country to accommodate the needs of this client group. This article discusses whether 24-hour care is feasible, cost-effective and realistic for the NHS to manage, as well as analysing policy guidelines in relation to the treatment of heart attack.
Regulating cosmetic surgery: a scalpel where it is needed
Authors: McHale Jean V
Published: May 2014

This paper considers the recent controversies around the regulation of cosmetic surgery procedures. The author suggests that any review considering reform of the law in this area should not only look at issues concerning the safety of the procedures and competence of the practitioners, but should also address the question of which procedures should be allowed. In particular, the author advocates that there should be a review as to the whether cosmetic procedures should be made available to those under the age of 18 years. The paper also discusses analogous legislation in Queensland, Australia and explores whether this could be a useful model for legislative reform.
Effectiveness of Dose Adjustment for Normal Eating (DAFNE)
Authors: Owen Claire , Woodward Sue
Published: May 2014

This literature review examines the evidence base behind Dose Adjustment for Normal Eating (DAFNE), an educational programme for the self-management of type 1 diabetes. The Cumulative Index to Nursing and Allied Health Literature (CINAHL), British Nursing Index (BNI), Embase and Medline databases were accessed to locate relevant studies. Twelve studies were found to meet the review criteria. These provide evidence that DAFNE can help people with type 1 diabetes to achieve better glycaemic control and improve their quality of life. However, DAFNE-induced improvements in glycaemic control tend to reduce as time elapses since programme attendance and literature on the long-term effectiveness is limited. More research is needed to determine whether the benefits last in the long term and to identify how its positive effects can be maintained.
Recovery from cancer through sport and activity
Authors: Wright David , Roberts Hannah
Published: May 2014

In the previous issue, we introduced the 2012 BJN Olympics Series with a comment about the health service provision for the 2012 Games. This issue begins the official countdown to the Games with an article about an initiative that encourages the rehabilitation of people living with cancer through sport and physical activity. David Wright and Hannah Roberts discuss the On Track project inspired by the 2012 Olympic and Paralympic Games.
How to choose and apply for the perfect job
Authors: Daylan Agyness
Published: May 2014

Agyness Daylan is approaching the end of her nursing diploma and offers some advice to fellow students on finding the job that is right for them. She will be starting her new job on an intensive care unit in April.
Challenges in patient safety and health quality
Authors: Tingle John
Published: May 2014

John Tingle discusses two recently published reports that raise important issues in NHS patient safety, clinical negligence litigation and health quality.
Maintaining nursing mentor skills in a climate of skill-mix austerity
Authors: Glasper Alan
Published: May 2014

Professor Alan Glasper considers the role of the mentor in terms of the relationship between the Nursing and Midwifery Council and the Care Quality commission
Exploring placement pathways in nurse education
Authors: McClimens Alex , Kenyon Lynn , Cheung Heidi
Published: May 2014

As community-based care has developed in line with current policy towards integrated care, some hospital placement capacity for student health professionals has been lost as a result of service reorganisation. However, student nurses and allied health professionals need to gain a broad range of experience to prepare them for the complex and rapidly changing environments they will be entering as qualified professionals. Placement pathways constitute a means of offering the knowledge and skills to enter the profession in challenging times. This study explored, by means of a literature search and interviews with key stakeholders, the challenges and opportunities offered by placement pathways. The findings are presented and the work being done as a result, including an the introduction of an electronic placement pathway tool, are discussed.
Progressive learning: structured induction for the novice nurse
Authors: Maguire Dee
Published: May 2014

A consistent specialty induction framework within the acute care hospital facility is essential to the development of both generic and specialty knowledge and skills that transfer to different domains. Providing a structured and progressive learning pathway with accessible resources applicable to the context in which learning is applied supports cross-specialty demands in clinical practice today. A broad consultative process among stakeholders at the facility is essential so that patient governance and human capital investment are collectively monitored and evaluated. This article describes the structure, content and delivery of a 6-week novice nurse surgical induction programme using a newly implemented knowledge and skills framework. While the programme is conducted at a tertiary referral hospital in Sydney, Australia, the subject is transferable to other countries.
Children's nurse education—what is important to the service user?
Authors: Summers Kathryn
Published: May 2014

This paper provides an overview of service user involvement of a group of children and young people with palliative care needs from a Children's hospice in the design and development of the BSc (Hons) Children's Nursing programme at Canterbury Christ Church University (CCCU), Kent. It will specifically describe the children and young people's service user involvement in three key areas: programme development and contribution to the curriculum, selection of students and participation in the assessment of the students' clinical experience. The introduction of the new Nursing and Midwifery Council Standards for pre-registration nurse education (2010) has led for the need to involve service users at the planning and development phase of new nurse educational programmes to ensure the delivery of high-quality care. The following key themes were identified as being important to the children and young people: communication, accessing mainstream education and transitioning. These have been incorporated and strengthened within the new children's nursing curriculum, creating a contemporary children's nursing programme in response to the needs of children and young people.
Writing for publication: science and healthcare journals
Authors: Glasper Edward Alan , Peate Ian
Published: May 2014

This article is designed to help authors write scholarly articles for publication in science and healthcare journals. A comprehensive model based on 11 steps and detailing the structure expected for a journal is suggested for the writing of a range of papers. This is in keeping with the recognised style of a number of academic journals. The article encourages authors to submit their papers for publication with the intention of enhancing the quality and safety of care provided to patients, clients and service users.
Improving health care for the vulnerable elderly in society
Authors: Glasper Alan
Published: May 2014

Professor Alan Glasper discusses the Department of Health's latest initiative to improve health and care for the vulnerable elderly in society.
Integrative health care: implications for nursing practice and education
Authors: Little Christine V
Published: May 2014

The significance of complementary and alternative medicine (CAM) to contemporary health care is reflected in the relatively recent integrative health care (IHC) movement. Having emerged in response to the public's sustained use of CAM, IHC reflects the evolving needs and expectations of modern-day service users, making it consistent with today's culture of patient-responsive health care. IHC therefore carries important implications for nursing practice but, to fulfil their responsibilities with regard to these implications, nurses need a fundamental knowledge of CAM concepts as well as an understanding of the ways in which CAM and conventional health care might affect one another. An educational strategy that embeds IHC and makes explicit its relation to nursing practice is desirable if nurses are to engage with patients who use CAM. Evidence suggests, however, that neither CAM nor IHC are adequately represented in nursing curricula. This paper considers ways in which IHC could be incorporated into nursing curricula as a means to prepare nurses for this important challenge.
Pain management in Jordan: nursing students' knowledge and attitude
Authors: Khalaileh Murad Al , Qadire Mohammad Al
Published: May 2014

Pain management requires knowledgeable and trained nurses. Because nursing students are the nurses of the future, it is important to ensure that students receive adequate education about pain management in nursing schools. The purpose of this study is to evaluate nursing students' knowledge and attitudes regarding pain management. A cross-sectional survey was used. The sample comprised 144 students from three nursing colleges in Jordan. Sixty-one percent were female and the average age was 21.6 years (SD 1.7). The students' Knowledge and Attitudes Survey Regarding Pain was used.

The rate of correct answers ranged from 11.1% to 64%. Students showed a low level of knowledge regarding pain management—the average score was just 16 (SD 5.11) out of 40. Students were weak in their knowledge of pain medications pharmacology (actions and side effects). Less than half of students (47.9%) recognised that pain may be present, even when vital signs are normal and facial expressions relaxed. Finally, students showed negative attitudes towards pain management, believing that patients should tolerate pain as much as they can before receiving opioids; almost half (48%) of students agreed that patients' pain could be managed with placebo rather than medication.

In conclusion, Jordanian nursing students showed lower levels of pain knowledge compared with other nursing students around the world. This study underlines the need to include pain-management courses throughout undergraduate nursing curricula in Jordan.
Managing high-output stomas: Module 3 of 3
Authors: Slater Rebecca , Gabe Simon
Published: May 2014

Enterocutaneous fistulae (ECF) and high-output stomas are challenging to manage, owing to the large volume of loss that may result in severe dehydration, electrolyte imbalances, malnutrition and sepsis. It is imperative that this group of patients receive adequate nutrition, as malnutrition and sepsis are the leading cause of death. Treatment is complex and based on various situations, treatment can be medical/conservative management or surgical. Depending on the site of the fistula and the length of residual intestine contributing as the cause of a high output stoma with the nutritional status of the patient, clinicians have to decide whether parenteral nutrition (PN) or enteral nutrition (EN) should be established. As previously discussed in module 1 and 2 ( Gabe, 2013 ; Gabe and Slater, 2013 ) the theme of nutritional management and appliance/accessory selection to manage patients with ECF and high output stomas was outlined. The aim of providing an understanding of the nutritional needs and the practicalities of maintaining appliance adherence, and in turn, a reduction in the breakdown of the peri-stomal skin was described. Module 3 aims to provide understanding for the reader that may encounter patients undergoing surgery for the management of their ECF or high-output stoma. Lastly it was felt necessary to discuss the subject of intestinal transplantation. This complex surgical option is not available to all patients with intestinal failure and only undertaken at a couple of recognised centres. The process of referring patients that are deemed suitable for intestinal transplantation will be addressed and what the surgery entails with long-term outcomes and the quality of life for the patient.