bluuebunny/crossref_metadata_2025 huggingface dataset:
Implications of ultrasound scanning for midwives
Authors: Gargan Phyl
Published: May 2014

Obstetric ultrasound has revolutionized the management of pregnancy and gynaecological conditions for women worldwide, leading to its acceptance as the imaging modality of choice (Goldberg, 2000). However, alongside technical advances in imaging equipment, there has been a serious increase in medical litigation with obstetrics claims accounting for 60-70% of total (malpractice) sums paid by the NHS Litigation Authority. While midwives seek to extend the limits of their own practice to meet the needs of a constantly changing health service, the wider ramifications of this adjustment to practice need to be considered with regards to preparation for that role, and will be discussed in this review.
Workforce planning in midwifery: an overview of 8 years
Authors: Ball Jean , Washbrook Marie
Published: May 2014

Birthrate Plus is a specifically midwifery-focused workforce planning methodology, which was designed to assess the numbers of midwives required to match the standard of providing all women with a minimum of one-to-one care from a midwife during labour. It uses a number of workforce planning strategies, such as a classification system for intrapartum care, recording of actual midwife hours required per category, further recording of all other maternal/midwife activity within hospital and community services, including home births, and uses a professional judgment and ‘expert group’ approach to assessing midwife hours per defined client need or activity. This article provides an outline of the theoretical framework and an overview of the results of Birthrate Plus studies within the NHS and beyond since 2001.
Urinary catheterization in labour: best practice for midwives
Authors: Velinor Angela
Published: May 2014

This article aims to provide a brief overview of the use of urinary catheters in the intrapartum period including the indications and possible complications that may occur. To undertake this intervention a working knowledge of the female genital anatomy and clear rationale are essential as well as the use of an appropriate anaesthetic, antiseptic and lubricating gel.
Zimbabwe appeal for health workers abroad to come home
Authors: Dean-Osgood Laura
Published: May 2014

Health officials in Zimbabwe are hoping to relieve the short supply of doctors and midwives in the country by asking workers abroad to return home on sabbatical.
How well do midwives use skills and knowledge in examining newborns?
Authors: Lanlehin Rosemary , Noble Helen , McCourt Christine
Published: May 2014

Physical examination of the newborn (PEN) was established as part of postnatal care in the late 1960s. The role of discharging babies within the first 72 hours of birth was traditionally undertaken by junior doctors. Currently midwives, nurses, advanced nurse practitioners, and health visitors are being trained to undertake the PEN ( NHS Screening Programmes, 2010 ). However, only a fraction of midwives utilize their acquired skills in clinical practice. A survey by Townsend et al (2004) showed that 2% of babies in England were examined by midwives while 83% were examined by junior doctors.This study aimed to evaluate how well midwives who undertook the PEN course between 2002 and 2005 (n = 40) at a large London University utilized the skills acquired on the course. Questionnaires with a series of open and closed questions were sent out by post followed by phone and email reminders. The eight that responded were midwives. All respondents said they were appropriately trained and felt well prepared for their role to examine babies. However, they felt they were not provided with opportunities to use the skills. Guidelines based on this extended role are available in the workplace but only a few midwives seemed to have negotiated time to implement these and may need greater managerial support for the role.
The consequences of pregnancy and birth for the pelvic floor
Authors: Steen Mary , Roberts Taniya
Published: May 2014

This article will describe and discuss the anatomy and physiology of the pelvic floor and the important role it plays during childbirth. It will also consider damage that can be caused to the pelvic floor and in the genital/rectal region. Urinary and faecal incontinence, perineal injury (naturally occurring or surgically induced) and haemorrhoids can cause a lot of distress and pain for many women following childbirth. Alleviating the distress and pain associated with these problems is vitally important and will be explored.
Maternity and mental health services working collaboratively for women
Authors: Warriner Sian , Byrne Gerry , Graham Dan
Published: May 2014

Through the collaboration and partnership working of key professionals within maternity services, Child and Adolescent Mental Health Services (CAMHS), health visiting, GP services and Oxford Primary Care Trust (PCT), an innovative new service has been established which addresses the needs of women with mild to moderate mental health problems in pregnancy and the perinatal period—the Infant Parent Perinatal Service (IPPS). The partnership model of working has created firm pathways across service providers and has resulted in a forum for ongoing opportunity and creativity which continues to seek and develop new ways of improving mental health care for vulnerable women in pregnancy and the perinatal period. It is now well recognized that not only the physical but also the mental and emotional health of a woman while pregnant and in her infant’s early years will have a lifelong effect ( Department of Health, 2011 : 10). The IPPS project has been recognized nationally, receiving second place in the 2009 British Journal of Midwifery awards for ‘team of the year’ and a highly commended second place in the Royal College of Midwives 2010 awards for excellence in partnership working.
Establishing perceptions of a good midwife: A Delphi study
Authors: Nicholls Lynn , Skirton Heather , Webb Christine
Published: May 2014

There have been a number of studies addressing specific aspects of midwifery competence, but none have addressed the overarching question ‘What makes a good midwife?’. A Delphi study was used to investigate this. The expert panel comprised postnatal women, midwives and midwifery educators (n = 226). These experts were asked to rate statements about being a good midwife, using a 7-point Likert scale. For each statement, the mean and standard deviation was calculated to assess the level of agreement. The three statements with the highest mean scores were: ‘Good midwives continue to learn throughout their careers’, ‘Good midwives tailor care to women as individuals’ and ‘Good midwives have good communication skills’. There was agreement between the three sections of the panel. The implications are that being a lifelong learner and development of good interpersonal skills are as important as technical competence in making a good midwife.
Risk, recognition and repair of perineal trauma
Authors: Steen Mary
Published: May 2014

The risk of perineal injury during childbirth continues to affect the majority of women. Morbidity associated with perineal injury and repair is a major health problem for women. Therefore, it is vitally important that midwives are educated and trained to recognise risk factors and the extent of perineal injury. Education and training has been shown to assist midwives to gain confidence and clinical skills to suture competently and keep themselves up-to-date with the best available evidence on which to base their care. This article provides an overview of the literature relating to risk, recognition and repair of the perineum during the childbirth continuum.
Understanding survey research: Applications and processes
Authors: Roberts Taniya
Published: May 2014

Survey research enables information to be derived from a large sample on a topic under investigation to ascertain and measure the respondents' knowledge, attitudes, values, opinions, actions, intentions, behaviours and beliefs. It follows the quantitative approach, is considered non-experimental and requires data analysis to be conducted by statistical tests. Data can be collected by structured interviews (face-to-face or by telephone) or questionnaires (postal or internet). This article focuses on the postal questionnaire which is popular with midwifery researchers as it can provide valid and statistically significant results from a large target population pertinent to midwifery care, and help inform and educate midwifery practice of factors affecting consumers, midwives and student midwives.
The complexity of decision-making in midwifery: A case study
Authors: Barber Katy
Published: May 2014

This article explores decision-making in midwifery practice. A case study is presented of a tripartite decision made in clinical practice. A selection of decision-making models are analyzed and appropriately selected to facilitate critical analysis of the tripartite decision being made. The article aims to consider the complexity of decision-making in maternity care, the importance of involving women in decision-making, the value of ethical consideration and the role of the midwife in decision-making.
A simple guide to a complex problem—maternity bed occupancy
Authors: Jones Rod
Published: May 2014

The average occupancy applicable to different sized maternity units is shown to be calculated by Erlang's equation. This equation has been used with great confidence for nearly 100 years to calculate the resources required to meet the incoming demand in a huge variety of service situations ranging from the capacity of telecommunications satellites to bed occupancy in hospitals. Larger maternity units can operate at higher average occupancy and as such smaller units face greater cost pressures due to their inherent inability to avoid the lower occupancy (and hence higher unit costs) that is associated with smaller size. The implications to the operation and design of maternity units are discussed.
Perinatal perspectives on chronic fatigue syndrome
Authors: Christley Yvonne , Martin Caroline J Hollins , Martin Colin R
Published: May 2014

Chronic fatigue syndrome (CFS) is a severe, systemic, acquired illness which presents with overpowering tiredness that cannot be relieved by rest and is deteriorated through physical and mental activity. Due to the window of prevalence (20–40 years), some women diagnosed with CFS become pregnant. Given that CFS targets women in their reproductive years, responsibility is placed upon midwives to educate, support and provide families with advice. To equip midwives with knowledge about CFS, the objectives of this paper are to provide an overview of: how CFS impacts on reproductive health; the effects of pregnancy on CFS symptoms; CFS-related pregnancy complications; intrapartum management of women with CFS, and postpartum recovery of women with CFS. To date, only a handful of studies have explored the relationships between CFS and childbearing, and associated complications. A greater understandings of CSF interactions with physical, psychological and social reproductive processes are required.
Risks and rewards of early musculoskeletal assessment: An evidence-based case report
Authors: Miller Joyce , Fontana Marcella , Jernlås Karin , Olofsson Henny , Verwijst Ida
Published: May 2014

Objective: To evaluate the need, benefits and risks of a musculoskeletal screen in the newborn. Methods: Search strategy was designed to capture peer-reviewed biomedical literature related to birth injury and musculoskeletal assessment of the injuries. Results: Thirty-seven relevant articles were located, most indicating mild to moderate birth injuries. Up to 73% of infants had one or more asymmetry stemming from birth (61% of those were head asymmetries, 42 % were facial and 16% were torticollis). In terms of moderate birth injuries, clavicle fractures accounted for 0.4-10%, overall. Conclusion: The evidence suggests that infants may receive musculoskeletal injuries through both traumatic and non-traumatic births. Currently there is no complete screen for musculoskeletal conditions of the newborn in the UK. A musculoskeletal screen may be of benefit to find conditions which might affect discomfort in some positions and pain syndromes of infancy. Furthermore, the musculoskeletal screen can be considered safe for the infant.
Baby Milk Challenge: Changing secondary school student?' attitudes to breastfeeding
Authors: November Lucy
Published: May 2014

Interventions to improve breastfeeding rates are aimed primarily at couples in the perinatal period. However, many parents make decisions on infant feeding before pregnancy. In this study, a school-based intervention is evaluated for its effect on attitudes to breastfeeding in male and female secondary school students in single-sex and mixed-sex groups. After a period of qualitative feedback and intervention adjustment, significant changes in attitude scores were seen in both single-sex and mixed-sex groups, with the students’ attitudes becoming more positive towards breastfeeding. The author recommends that this intervention should be used as part of a longer-term public health strategy to improve rates of breastfeeding initiation, taught by facilitators confident with the material and experienced in breastfeeding interventions.
Women’s perceptions of a midwife’s role: An initial investigation
Authors: Cooper Tracey , Lavender Dame Tina
Published: May 2014

The role of the midwife has evolved over the years, influenced by a number of social, political and educational factors ( Department of Health and Social Security (DHSS), 1970 ; Her Majesty’s Stationery Office (HMSO), 1984 ; Tew, 1986 ; Donnison, 1988 , Department of Health (DH), 1993 ; Kitzinger, 2005 ; DH, 2007 ; National Institute for Health and Clinical Excellence (NICE), 2008 ). However, little is known about how the contemporary role of the midwife is perceived ( Lavender and Chappie, 2002 ). Some changes were not based on any evidence or health economics (DHSS, 1970; HMSO, 1984). Health costs have predominantly been based on the cost of service provision, rather than costs of unnecessary intervention being considered. The Birthplace study did take into account health economics including intervention costs (Shroeder et al, 2012); therefore, if service changes are made to reflect the benefit of health economics with the new maternity pathway payments (DH, 2012), this may impact on how the role of the midwife is perceived in the future. This qualitative study was conducted to gain understanding of women’s perceptions of the role of the midwife. Four focus groups were conducted (n=9) to identify perceptions of the midwife’s role from women experiencing care from different care providers; women in different periods of their childbearing experience; women who had previous experience of childbearing; and those who had no previous experience of childbearing. Thematic analysis of the transcripts identified four themes: empowerment influence of midwives; influences of media, friends and family; role of monitoring and technology; and influence of doctors. The conclusion was that the model of care and care provider influenced women’s perceptions of the role of the midwife. Women experiencing a consultant-led model of care viewed the role differently to those experiencing amidwifery-led model.
Investigating access to and use of maternity health-care services in the UK by Palestinian women
Authors: Alshawish Eman , Marsden Janet , Yeowell Gill , Wibberley Christopher
Published: May 2014

Objective: To investigate access to and use of health services, particularly maternal and child health care, in the UK by Palestinian women. Design: A qualitative study using a pragmatic approach for exploration and description. Data were transcribed ad verbatim and analysed using framework analysis and the NVivo 9 computer program. Setting: Interviews were conducted in participants' homes, the researcher's home and in Arabic schools. Participation: Twenty-two interviews were conducted. Participants were living in different geographic areas in Manchester, and were recruited through Arabic schools and the main mosque in the city. Findings: Four themes emerged from the qualitative interviews, which were: ‘cultural variations’; ‘knowledge of the NHS and the UK health-care system’; ‘health care services and their utilisation, focusing on maternal and child health-care services’; and ‘communication, information provision and needs’. Conclusion: Culturally competent care is required to reduce the inequity of maternal and child health-care services; this study recommended the following points: In delivering the information for BME groups, it is inappropriate to implement a ‘one-size-fits-all’ programme; culturally appropriate care could be satisfactorily achieved through effective and continuous training programmes based on culture, ethnicity and religion for all health professionals; and effective interpretation services are vital so there is no need to rely on family members and friends as was clearly the case for the participants in this study.
Should a postnatal birth discussion be part of routine midwifery care?
Authors: Fryer Joanna , Weaver Jane J
Published: May 2014

There is currently a lack of clear guidance on postnatal psychological care in midwifery and research suggests that there is little continuity in postnatal care between maternity units. Research papers and current National Institute for Health and Care Excellence (NICE) guidelines recommend that all women should be given the opportunity to discuss their birth experience postnatally with a midwife. However, it seems that this is not routinely provided in current midwifery care. A commonly occurring discovery throughout the literature around debriefing, counselling and other interventions of this type has been that the majority of women want to talk about their birth experience and, given the opportunity to do so, report positively on it. This article reviews the literature around this subject area and makes evidence-based recommendations for changes in practice, with the aim of improving postnatal midwifery care.
Applying the four principles of ethics to continence care
Authors: Stanley Robert
Published: May 2014

Sixteen years ago the United Nations designated 1981 as the International Year of Disabled Persons. The key words for the year were equality and participation. These describe the four ethical principles of respect: autonomy, beneficence, non-maleficence and justice, and they are still applicable today. The nurse supporting continence-based needs in the client with learning disabilities needs to demonstrate equality and participation in his/her practice. Applied ethics as practised by the nurse is the application of values, rules, standards or principles that should guide decisions about what we ought to do. It gives meaning to the individual and collective experience of an illness. Nurses do not typically inform their practice by reflection upon their philosophy, and thus do not have insight into what illness or disease means for them or their clients.
Incapable adults and informal admission: lifting the veil of deceit
Authors: Griffith Richard , Tengnah Cassam , Grey Robert
Published: May 2014

Since 1959, informal admission has been used for the admission of non-resisting adults to hospital for treatment of their mental health problems. The Court of Appeal has ruled this practice unlawful. As a consequence, certain issues in relation to the admission and management of these patients will have to be reconsidered and while there will be positive repercussions for the management of patients there will also be some negative effects. This article considers the implications.
Does the specialist nurse enhance or deskill the general nurse?
Authors: Marshall Zoe , Luffingham Nikki
Published: May 2014

Much conflict and confusion surrounds the title and role of the specialist nurse, leading in some instances to disharmony between general and specialist nurses. It has been suggested that too many highly specialized nurses in a general area may lead to a deskilled workforce and fragmented care. Attempts to define the key concepts of specialist practice as described by the UKCC has resulted in elitism, conflict and abuse of the title. One suggestion to eliminate this conflict is for specialist nurses to achieve key competencies that encompass the role of the clinical expert. These key competencies should be devised by specialist nurses, in the absence of national guidelines, and be agreed by employers. They should incorporate the key roles of: change agent, expert clinician, educator, researcher and coordinator. It is contended that if all concerned have a clearer definition of the title, role and what is expected from the specialist nurse then this will result in reduced conflict and improved quality of care.
Relative concerns associated with genetics and surrogacy
Authors: Kirk Maggie
Published: May 2014

Assisted reproductive technologies, incorporating artificial insemination and in-vitro fertilization techniques, are widely practised across Europe. Concern about surrogacy prompted the UK Government to commission a review and consultation on surrogacy arrangements. The ensuing document was concerned primarily with the questions of payment to the surrogate, and the regulation of agencies involved in surrogacy arrangements. This author feels that more fundamental issues should first be debated by both health professionals and society. Genetic aspects of surrogacy merit special attention, particularly regarding the genetic contribution to parenthood and the ownership and use of genetic information. Health professionals need to be fully aware of the ethical implications of advances in genetics and technology when they are applied to assisted reproduction.
Wound assessment: measuring the area of a leg ulcer
Authors: Charles Hildegard
Published: May 2014

As part of an holistic and systematic assessment, the area of a leg ulcer can be a useful measurement for evaluating the wound repair process. The treatment of a chronic leg ulcer can, if not monitored, become a sequence of dressings and bandaging. Thus, a timely recognition of improvement or deterioration of the wound condition may be overlooked. Area change often depends upon the original size and pathology of the ulcer as well as the treatment method. Perhaps the most important factor which can be derived from area measurements is the rate of area change. Measurements taken at regular intervals give a good indication of a wound's healing progress. Computer technology can be used to assist in accurate area measurement. This information gives the clinician vital information on the treatment's efficacy and the data can be used for further statistical or case study analysis.
The link between Down's syndrome and Alzheimer's disease: 1
Authors: Soliman Alison , Hawkins Debbie
Published: May 2014

This article, the first of two parts, considers the link between Down's syndrome and Alzheimer's disease and how this link has been a significant factor with regards to research into the aetiology of Alzheimer's disease. It describes some of the suggested causes of Alzheimer's disease in people with Down's syndrome. The diagnosis, signs and symptoms of Alzheimer's disease are briefly discussed. The second article concludes with the implications of Alzheimer's disease in people with Down's syndrome for family carers, services and nurses.
Role of dopamine in schizophrenia and Parkinson's disease
Authors: Birtwistle Jon , Baldwin David
Published: May 2014

The neurotransmitter dopamine (DA) and the dopaminergic neurones play an important role in schizophrenia and Parkinson's disease (PD). A decrease in DA in the substantia nigra of the brain has been implicated as the cause of PD. By contrast, it is argued that a functional excess of DA or oversensitivity of certain DA receptors is one of the causal factors in schizophrenia. These factors are reflected in the treatment of both conditions; drugs aimed at increasing DA are prescribed to patients with Parkinson's disease, while most antipsychotic drugs block and reduce the effects of DA. In schizophrenia the antipsychotic effects of traditional ‘neuroleptic’ drugs such as chlorpromazine are highly correlated with their ability to block DA receptors and reduce the effects of DA. This article examines the role of DA in these two conditions.
The relationship between caring and nursing
Authors: Castledine George
Published: May 2014

The word ‘nursing’ seems to be slipping out of use in today's health service. For example, many healthcare trusts seem reluctant to refer to it in their brochures, preferring instead to emphasize their surgical, medical and general healthcare prowess. The UKCC also fails to emphasize the word in many of its guidelines and documents; this is probably because of its legal position with regard to having to regulate nursing, midwifery and health visiting. Alternative words to nursing that are in common use include: professional practice, general care, commonsense, support and helping.
Physiology of the skin and prevention of pressure sores
Authors: Russell Linda
Published: May 2014

Historically, pressure sores have been seen as a nursing problem, and still are to a certain extent today. Nurses therefore need to have a comprehensive understanding of the physiology of the skin to assist them in preventing and treating pressure sores. Despite a great deal of research on the aetiology of pressure sores, their origins are still not fully understood. This article discusses the physiology of the skin and the aetiology of pressure sores. Influences on pressure sore development are multifactorial and tend to be divided into three main categories: extrinsic (e.g. environmental pressure, shear and friction), intrinsic (e.g. general health, age, mobility, body weight, incontinence and nutrition), and external factors (e.g. long trolley waits in accident and emergency departments or before admission following a long period collapsed on the floor, hard chairs, and immobilization with traction).
IV-related phlebitis, complications and length of hospital stay: 1
Authors: Campbell Linda
Published: May 2014

This article, the first of two-parts, addresses the growing problem of intravenous-related phlebitis in hospitalized patients, and the resultant personal and financial costs to both patient and hospital. Literature on the various types of phlebitis, the factors that increase the patient's risk of developing phlebitis, clinical indicators and severity grading scales, and the complications of phlebitis are examined. Awareness of such factors is considered instrumental in minimizing the incidence of intravenous-related phlebitis. The second article in this series will present a study of 90 patients from a large teaching hospital, which was conducted to determine the incidence and severity of intravenous-related phlebitis, risk factors, associated complications, and the related length of hospital stay. The impllcations of the results for current and future nursing care of patients receiving IV therapy will be discussed, and recommendations for safe practice will be made.
IV-related phlebitis, complications and length of hospital stay: 2
Authors: Campbell Linda
Published: May 2014

Review of the literature on the various types of phlebitis, risk factors, clinical indicators, severity grading scales, and associated complications of phlebitis, in the first article in this series (Vol 7(21): 1304–12), indicated that an awareness of such factors could reduce the incidence of intravenous (IV)-related phlebitis. This article presents a quantitative study, of longitudinal design, conducted to determine the incidence and severity of IV-related phlebitis in 90 patients from a large teaching hospital over a 2-month period. The study concluded that although there were multiple risk factors for the development of phlebitis, routine IV site observation and the use of phlebitis severity measurement scales could reduce the incidence and severity of phlebitis. Complications arising from phlebitis can have long-term effects on patient care, satisfaction, and length of hospital stay. If not controlled, these risk factors can increase the personal and financial costs to patients, encourage litigation, and ultimately increase the overall costs to the hospital.
Stoma care: exploring the value of effective listening
Authors: Metcalf Chris
Published: May 2014

This article discusses how nurses can effectively utilize listening skills during interactions with patients. Listening is a core skill for all healthcare professionals with studies demonstrating that nurses perceive themselves to be much less skilful in the use of facilitative interpersonal skills which involve listening than practitioner-centred authoritative ones. Listening effectively allows nurses to respond more completely to patients' needs but there are many obstacles which unfortunately can interfere with this process. Stoma care nurses utilize listening skills to ensure that both the physical and psychological needs of their patients are met. The author suggests that listening skills can enhance intuitive nursing practice.
Legal aspects of clinical supervision 2: professional accountability
Authors: Dimond Bridgit
Published: May 2014

The previous article considered the employment issues that arise in relation to clinical supervision (Vol 6(7): 393–5). This article examines legal issues arising from professional accountability, the rights of the patient, and records and record keeping. Reporting concerns, giving negligent advice and the duty of care to the patient are described from the point of view of both the supervisor and supervisee. Patients' rights may fall in abeyance when clinical supervision is in progress and the patient should be notified that this is taking place. Access to records by the employer, the courts and the patient needs to be clarified. It is by no means certain that clinical supervision represents the best use of limited resources.
An investigation of the benefits of Aquacel Hydrofibre wound dressing
Authors: Williams Clare
Published: May 2014

Aquacel wound dressing, produced by ConvaTec, uses the main ingredient of the hydrocolloid dressing in a new way to produce a hydrofibre dressing. Aquacel is designed for use in moderate to heavily exuding wounds as it absorbs exudate directly into its fibres. It has been shown to be effective in pressure sores, leg ulcers and surgical wounds, producing warm, moist, local wound conditions for optimum wound healing. Aquacel can lock exudate away thus protecting the surrounding skin.
Clinical nurses urgently need a career structure
Authors: Castledine George
Published: May 2014

The more I attend conferences organized by groups representing various types of ‘specialist’ nursing practice the more I am haunted by my prediction 20 years ago that unless a clinical career structure was forthcoming in nursing there would be chaos in the nursing profession. The development of specialist and sub-specialist nursing groups have either acted as safe havens for nurses hoping to develop their clinical expertise or have provided the platform for frustrated clinical nurses to get out of general nursing.
Efficacy and cost-effectiveness of the Thermo contour mattress
Authors: Hampton Sylvia
Published: May 2014

Use of air mattresses in reduction of pressure sore incidence is an important part of quality patient care. However, there will never be enough air mattresses to match the demand as increased education and an increase in the general provision of air mattresses can lead to an unrealistic expectation of obtaining air mattresses when required for patients. This raises the demand for air mattresses and increases costs within hospital trusts. This study examined a way to redress the balance through use of an alternative, cost-effective type of mattress (thermoelastic polymer) in the prevention of pressure sores. Prime consideration was given to the comfort of the patient. The claims of the manufacturers, Barrington Healthcare, that ‘patients with Waterlow scores of 23 can be nursed safely on this product’ were explored as part of the study. A total of 407 patients took part over a 6-month period. Twenty-four Thermo contour mattresses were loaned to one ward for the study and patients were allocated to the mattress through admission to the experimental ward. Patients were then split into two groups on two wards. Group B were allocated to a Thermo contour mattress and group A were nursed on air mattresses and foam mattresses generally used throughout the trust. Results showed that more patients were comfortable on the Thermo contour mattresses than on all other mattresses. Patients with Waterlow scores under 25 did not develop pressure sores on the Thermo contour mattress. However, the sample of patients with a Waterlow score of between 20 and 25 was small and therefore further research is required.
Managing and maintaining a safe environment in the hospital setting
Authors: Parker Lynn J
Published: May 2014

On entering hospital, patients and visitors assume that they are in a safe environment. Maintaining a safe environment in hospitals depends on not only the infrastructure, but also the equipment and materials that are used on the premises. Complaints about hospitals often include comments on the environment, its lack of cleanliness, poor food and the general look of debilitation. Key legislation for managing a safe environment is the Health and Safety at Work Act 1974. Complementary guidance includes the Control of Substances Hazardous to Health Regulations 1999 and the Environmental Protection Act 1990. The incorporation of such legislation into local policies and guidelines ensures that healthcare staff can set standards to maintain the integrity of the patient's environment. This article will consider aspects of hospital life involved in maintaining a safe environment.
A survey of specialist and advanced nursing practice in the UK
Authors: McGee Paula , Castledine George
Published: May 2014

This article is the result of a 1-year research project which aimed to develop a contemporary account of the expectations of senior personnel in NHS trusts throughout the UK with regard to the roles of specialist nurses (SN) and advanced nurses (AN). A questionnaire was sent to the chief nurses in 490 NHS trusts throughout the UK. Findings highlight the distinctions made by senior personnel regarding the roles of SNs and ANs, employment issues, fields of practice, work activities, advantages and disadvantages of employing SNs and ANs and ways in which all of these factors have changed since the last survey in 1996. Differences were highlighted between the roles of SNs and ANs in terms of fields of practice and the strategies used to evaluate the effectiveness of their posts.
Reasons for prolonged hospital stays following heart surgery
Authors: Naughton Corina , Prowroznyk Arsenyj , Feneck Robert
Published: May 2014

Improvements in cardiac surgery techniques and after care have resulted in a reduction in postoperative stay. Ten years ago the average length of stay following surgery was 13–15 days (Sanchez et al, 1994). Today it is more likely to be 4–7 days (Bernat, 1997). A recent audit provided information on postoperative hospitalization in a cardiac population that was deemed suitable for immediate high dependency care rather than intensive care. The authors carried out retrospective examination of patients' notes in order to detect the possible causes for delayed discharge. The audit was conducted over a 3-month period and information was collected on 210 postoperative cardiac patients. The study population was restricted to all cardiac patients transferred directly to the hospital's ‘overnight intensive recovery’ unit. These patients are regarded as low- to medium-risk cardiac patients. Thirty seven per cent of the study population experienced a prolonged hospital stay, i.e. greater than 7 days. In the majority of cases the reasons for delayed discharge were non-cardiac in origin. The authors reviewed the literature to identify strategies that may reduce the incidence of preventable complications leading to prolonged hospitalization. They concluded that nurses have a fundamental role to play in reducing the incidence and severity of postoperative complications through patient education, motivation and early identification of potential problems.
Nurse's accountability in relation to nurse-led services
Authors: Knape John
Published: May 2014

A central feature of the Government's health policy is the introduction within the NHS of innovative services which utilize the special skills that registered nurses, midwives and health visitors bring to health care. These encompass telephone-led services such as NHS Direct and nurse-led walk-in clinics. The UKCC supports the development of these initiatives as they place nurses, midwives and health visitors firmly at the vanguard of the new NHS and recognize the contribution of the professions not only to the delivery of care but also to the design and management of the services themselves.
Peripherally inserted central catheters and their use in IV therapy
Authors: Todd Joanne
Published: May 2014

Peripherally inserted central catheters (PICCs) can adequately and safely meet the needs of patients who require short- to long-term therapy in many clinical settings. Moreover, PICCs have been successfully used in the delivery of IV therapy in the patient's home. There is evidence available which indicates that a PICC can minimize the trauma to patients who undergo multiple, repeated cannulations. PICCs can also reduce catheter-related risks such as thrombophlebitis, infection and insertion-related complications. The use of PICCs has been shown to be clinically effective as well as cost-effective. In many centres nurses are leading developments in IV therapy. In order to ensure that high quality, clinically effective patient care is developed, patients must undergo thorough assessment before device selection.
What are personality disorders and are they treatable?
Authors: Flood Chris
Published: May 2014

The recently published report of the Fallon inquiry (Fallon et al, 1999) has reopened the debate on how best to treat people with personality disorders. Currently, the treatment varies depending on whether patients are in an NHS setting or inpatient psychotherapeutic unit, a special hospital or the penal system. Personality disorder is prevalent in approximately 10% of the population and some evidence suggests a 50% prevalence rate for all psychiatric patients. It is a heterogeneous disorder that is often misunderstood by professionals. There is some consensus within the literature about what constitutes effective treatment. Treatment includes behavioural therapy, cognitive behavioural therapy, psychopharmacological treatment, the development of a therapeutic programme including offence-focused work, addressing substance misuse, interpersonal training and a triumvirate/collegiate method of team nursing, where nurses share the responsibility for patients.
Pressure sore formation in the operating theatre: 2
Authors: Pope Ron
Published: May 2014

The incidence of pressure sores is seen as a key quality indicator by the Department of Health (1993). The effects of pressure are dependent on its intensity and duration and are widely acknowledged as contributing to pressure sore formation. Therefore, all patients undergoing surgery should be regarded as being at risk. The first article in this two-part series, outlined the pathophysiology of pressure sores and the contributory factors present within the operating theatre (Vol 8(4): 211–17). This article suggests nursing interventions to reduce the incidence of pressure sore formation during the perioperative period.
The DIAL-log study 2: support in the early stages of dementia
Authors: Keady John , Gilliard Jane , Evers Clive , Milton Steve
Published: May 2014

In the previous article (Vol 8(6): 387–93) the background information and study aims/limitations of the Dementia Information and Advice Lines (DIAL-log) project were outlined. This article introduces the main findings of the project and suggests that the transition into dementia is experienced through rising degrees of uncertainty and anxiety. People with the early experience of dementia also requested strategies for coping with memory loss and uncertainty over the meaning and purpose of memory testing. Building on the main findings of the project, the article concludes with a five-stage framework to help shape future research and service support.
Sexual health 1: sexuality and nurses' role in sexual health
Authors: Crouch Shirley
Published: May 2014

This article, the first of two, looks at the issue of sexuality in health care. Sexuality underpins much of what a person is and has significance in everyone's life. Through sexuality, people express their most intimate feelings of individuality and their need for emotional closeness with other human beings. Sexuality is not just about sexual intercourse, it is about the concept of people as men and women — about their manliness or femininity. Sexuality also affects the way people see themselves or would like to be seen, their appearance and behaviour, and their desire to attract those who matter to them. It is about the fears and fantasies people have about themselves and others. Nurses need to have an understanding of sexuality as they may have a crucial part to play in its dynamic progress.
Aerobic capacity: Weight gain and psychotropic medication
Authors: Ward Les , Mason Tom
Published: May 2014

The relationship between physical health and psychological wellbeing is a complex one, with each impacting upon the other to one degree or another. Psychiatric patients are often reported to be not as physically healthy as their counterparts in the general population, with reports of increased weight gain and decreased activity. This study of two classifications of psychiatric patients in a high security psychiatric establishment was an attempt to ascertain if such a relationship existed between physical fitness, psychopathology, weight gain and medication levels. Using standardized tests to assess two parameters of health-related fitness — Harpenden skinfold callipers to estimate percentage body fat (BF), and a submaximal cycle ergometer ride for aerobic capacity (VO2 max) — results were compared with the general population using the Allied Dunbar National Fitness Survey (Sports Council and Health Education Authority, 1992) as a reference. The results indicate significant differences in aerobic fitness between the two groups (P<0.01) and such differences could be a cause for concern and may constitute a threat to both physiological and mental wellbeing.
Quality of life and leg ulcers: will NHS reform address patient need?
Authors: Anderson Irene
Published: May 2014

The present Government has made much of its commitment to gaining patients' views on the health services they receive. Qualitative studies of patients with leg ulcers have highlighted the fact that patients feel healthcare professionals do not always empathize with their plight and sometimes appear to lack the skills to help them. Quality of life in chronic wound care has, thus far, eluded definition but strenuous efforts are being made to quantify the impact that issues such as pain, isolation and frustration can have on leg ulcer patients. If healthcare professionals are able to demonstrate empathy with patients they may be able to maximize the cooperation needed for the management of ulcers. By reflecting on gaps in their knowledge and becoming more assertive in their demands for appropriate training, nurses can improve the outlook for patients' quality of life.
Enabling disabled people: responsibilities of nurse education
Authors: Scullion Philip
Published: May 2014

This article examines some evidence concerning the approach nurse education takes in relation to disability issues and considers whether it is ‘disabling’ or ‘enabling’. The role and purpose of education and training, along with an analysis of simulation as a teaching method and skills development, are explored. It is argued that nursing curricula has a key responsibility in ensuring that nursing practice is enabling rather than disabling in relation to patients with impairments who may be classed as disabled people by themselves or within society more generally.
The use of holistic assessment in the treatment of leg ulcers
Authors: Jones June E
Published: May 2014

Leg ulcers are costly to both patients and also the NHS. It is therefore of paramount importance that the treatment regimen is based on a holistic assessment to determine the underlying aetiology. It is only then that an appropriate treatment plan can be formulated. This article reviews the issues involved in the holistic assessment of leg ulcers.
Systematic approach to community risk assessment and management
Authors: Arshad Pernia , Oxley Helen , Watts Sue , Davenport Sarah , Sermin Nicola
Published: May 2014

A move from institutional to community health care means that health service staff are increasingly requested to visit patients in their own homes. This undertaking is not without risk, particularly where the patient or the locality is unknown. There are no nationally available guidelines for formally assessing potential risk to a health worker before the home visit. A protocol for risk assessment and a safety schedule before making a home visit was therefore developed and is described in this article. The difficulties in carrying out a comprehensive risk assessment are outlined. Several ways in which the assessment of risk before home visits could be made more effective are suggested.
Divided opinions over benefits of NHS Direct
Authors: Chiam Molly
Published: May 2014

NHS Direct is now 2 years old and, according to the second interim report by the Medical Care Research Unit at Sheffield University (MCRU, 2000), it ‘may now be begining to achieve the policy objectives for which it was designed.’
Developments in wound care for difficult to manage wounds
Authors: Ballard Kate , Baxter Helena
Published: May 2014

Research and development in wound healing has ensured that issues relating to chronic wound management remain high in the nursing agenda. Since the advent of modern wound dressings, which retain a moist wound healing environment, work has continued to progress into more advanced, interactive products which aim to alter the wound bed in order to promote a suitable environment for cell migration and growth. Rapid wound healing is advocated and necessary to reduce morbidity and mortality in patients with large chronic wounds and to reduce the financial and manpower implications of long-term wound care in the hospital or community setting. Vacuum-assisted closure, artificial skins, growth factors and larval therapy are discussed in order to give an overview of some of the emerging practices being adopted for difficult to manage wounds.
A celebration of 100 years' achievement in child health
Authors: Davies Ruth
Published: May 2014

This, the second of a two-part article, will reflect upon the gains made in the health and welfare of children within the UK over the last 50 years of the 20th century. It will show how government reforms covering health, welfare, and education have continued to improve all aspects of children's lives. It will also show how nursing, midwifery, and health visiting have tried to continue to meet the changing needs of children and their families. Lastly, it will highlight the increasing rate of change during this time and predict what may await children and young people in the first part of the new millennium.
Volunteers in prisons should be encouraged
Authors: Norman Ann E , Parrish OBE Alan A
Published: May 2014

Prisons are often thought of as having little impact on the wider community. This view is outdated. Most prisoners only spend a short time in custody. This transient stay gives the prison service the chance to expose prisoners during their time in custody to opportunities and experiences of which they may not be aware. They are also encouraged to take an objective look at themselves, and to go back into the community as better members of society.