bluuebunny/crossref_metadata_2025 huggingface dataset:
Asbestos: Manage or remove?
Authors: Guest Ian
Published: May 2014

Three-quarters of all schools are thought to contain asbestos but opinion is split on whether removal or management is the best policy. Specialist Ian Guest offers some advice
A tale of 30 Ofsted reports
Authors: O'Connell Suzanne
Published: May 2014

With its focus on leadership, teaching, achievement and behaviour, the new Ofsted framework is leaving no-where to hide. Suzanne O'Connell looks at 30 recent Ofsted reports to find out what lessons we can learn
What to do with our excluded children?
Authors: O'Connell Suzanne
Published: May 2014

Pupil exclusion is a messy business with enormous implications for a child's long-term prospects. Suzanne O'Connell looks at what the government is proposing for our most challenging children
The great outdoors
Authors: Donohoe Tom
Published: May 2014

Tom Donohoe has been organising residential trips at his school for 20 years. He describes how they have evolved and offers some advice on making them an unforgettable experience
Wellbeing in schools
Authors: Bryant Giles
Published: May 2014

Giles Bryant is the head of a research team that has conducted a two year study into wellbeing in schools. Here he talks us through his conclusions
Teaching Schools – The primary pioneers
Authors: Bannister Nick
Published: May 2014

Teaching Schools were trumpeted as a major step forward in CPD for teachers and leaders when launched last autumn. Eight months on, Nick Bannister talks to two primary heads who are running two of the first primary Teaching Schools
Entrepreneurship in primary schools
Authors: Bigland Brenda
Published: May 2014

Business and enterprise education can be particularly rewarding and effective at primary level. Former headteacher Brenda Bigland offers some advice based on the experiences of her former school
Creating a friendly school library
Authors: Trueman Gill
Published: May 2014

Finalist in the School Librarian of the Year 2012, Gill Trueman offers her advice on how we can create friendly and inspiring library environments
Academy status – to be or not to be?
Authors: Bannister Nick
Published: May 2014

Whether or not to convert to an academy is one of the fundamental questions facing primary leaders across the country today. Nick Bannister speaks to three heads about the factors that made them go for, or reject, academy status
Effective consultation with your parents
Authors: Lepkowska Dorothy
Published: May 2014

With recent changes to the Ofsted framework giving greater prominence to the views of key stakeholders, schools need to find new ways of gathering and responding to feedback. Dorothy Lepkowska reports
Team motivation: Hitting the ground running in September
Authors: Bannister Nick
Published: May 2014

Today, team motivation is seen as a key responsibility of modern headship, and it is especially important that as the new school year begins the whole-school team hits the ground running. Nick Bannister looks at the experiences of one primary headteacher
Every school needs a bereavement policy
Authors: Butler Heather
Published: May 2014

When a bereavement affects a pupil in your school, it is vital to act quickly and appropriately. Heather Butler, the author of a new book on the subject, offers crucial advice on how both staff and pupils can be supported at these difficult times
My 51-hour Ofsted inspection diary
Authors: Frostick Helen
Published: May 2014

It lasted for just 51 hours – from initial phone call to final farewells. Headteacher of St Mary Magdalen's Catholic Primary School, Helen Frostick, chronicles their last Ofsted inspection, which saw the school judged to be outstanding in all areas
Achieving Ofsted outstanding for the Behaviour and Safety of Pupils
Authors: O'Connell Suzanne
Published: May 2014

The behaviour and safety judgement is one that underpins Ofsted inspection. In the first of a four-part series focusing on the four core inspection judgements, Suzanne O'Connell talks to five schools who are ‘outstanding’ when it comes to their behaviour
Improving pupils' memory
Authors: McKeown Sal
Published: May 2014

Children with poor working memory can be a barrier to achievement and a particular challenge for teachers. Sal McKeown looks at how some schools are tackling the problem
Encouraging boys to read
Authors: Floyer Sally
Published: May 2014

For 40 years, the charity Beanstalk has been providing trained volunteers to help encourage primary school children to read. We asked volunteer Sally Floyer for some tips on engaging boys with reading
Ask Brenda: A to-do list for new headteachers
Authors: Bigland Brenda
Published: May 2014

QUESTION: Where do I start as a new headteacher? What is critical and essential in your opinion? What questions do I ask of myself and of others?
Planning for performance-related pay
Authors: O'Connell Suzanne
Published: May 2014

Revised pay and conditions arrangements, including plans for performance-related pay, come into force from September 1. They represent a huge change for our schools. Suzanne O'Connell looks at the implications for schools
Are you faking it? The behaviour benefits of artificial surfaces
Authors: Donohoe Tom
Published: May 2014

After 20 exclusions in one year, headteacher Tom Donohoe decided upon an unlikely solution – an all-weather, artificial grass pitch. He explains its impact
Singing from the same music sheet?
Authors: Burke Mark
Published: May 2014

Are schools tuned-in to the range of support that is now available for music education? Mark Burke reminds schools of what the new National Music Hubs have to offer…
Measuring impact: Using the Premium
Authors: Twist Liz
Published: May 2014

Schools everywhere are looking for the most effective Pupil Premium strategies and for the best methods of showing the results of their spending decisions. Liz Twist looks at what the evidence shows to be the best approaches
Effective teacher-to-teacher mentoring
Authors: Coskeran Sarah
Published: May 2014

Teacher mentoring can be a powerful tool for CPD and school improvement – if it is done properly. Sarah Coskeran offers guidance for schools.
Helping children and families in hardship
Authors: Bannister Nick
Published: May 2014

As austerity continues to bite, the UK's primary schools have developed a major role in supporting struggling families in some of the country's most disadvantaged communities. Nick Bannister looks at the inspiring work of two schools
Conducting the perfect teaching job interview
Authors: Mydat Darryl
Published: May 2014

What is the best way to get the most from interviews with prospective teachers looking for a job at your school? Darryl Mydat provides some interview guidance for schools looking to recruit new staff
Using ICT to support pupils with behavioural difficulties
Authors: Farmer Mary
Published: May 2014

Using handheld technology can prove effective in helping pupils with behavioural, emotional and/or social difficulties, who often avoid written or literacy work because of a fear of failure. Primary ICT co-ordinator Mary Farmer explains
Innovations in primary language teaching
Authors: Comfort Therese , Oliver Eva
Published: May 2014

An imminent best practice case study publication is to bring together a range of innovative languages projects being pioneered by Teaching School Alliances. Therese Comfort and Eva Oliver look at some examples
Primary pupils Learning to Lead
Authors: Powell Andy
Published: May 2014

Learning to Lead is a pupil leadership project originally developed by two teachers in Somerset. Now in more than 100 schools, both secondary and primary, Sir Tim Brighouse recently visited participating primaries to find out more. Chairman of the scheme,
The law when dealing with difficult visitors on the school site
Authors: Woollard Roy
Published: May 2014

What legal ‘armoury’ can a school use to defend itself when excluding difficult parents, unwanted visitors or other trouble-makers? Legal expert and former headteacher Roy Woollard explains
Ask Brenda – How do I engage parents?
Authors: Bigland Brenda
Published: May 2014

I am a new head in my first headship at a small primary school and am finding it very hard to engage the parents with my new ideas for the school. What can I do to bring them with me? Or should I perhaps slow down the pace of change?
Improving patient safety: risk analysis of the glaucoma process
Authors: Ayala Marcelo , Parmer Eva , Landstedt Gunilla , Karlen Hedvig , Bjarman Eva
Published: May 2014

Objective

To improve the quality of care provided for glaucoma patients.

Methods

A multidisciplinary team consisting of a hospital doctor, nurses and a secretary performed a prospective risk analysis of the process of care provided for glaucoma patients. The design of the study was the Healthcare Failure Mode and Effect Analysis (HFMEA). Failure modes were defined and classified according to their criticality, in order to identify priority actions for improvement. Criticality indices were calculated by multiplying occurrence and severity scores.

Results

The most critical failure modes were the lack of specialist doctors and/or delayed appointments.

Conclusions

Using HFMEA, we were able to identify the most critical failure modes of the complex process of care provided for glaucoma patients and suggest subsequent improvement measures. Follow-up indicators were defined to assess implementation.
Examination lenses: examining the eye with a diagnostic lens
Authors: Johnson Paul
Published: May 2014

For those ophthalmic nurses, technicians and other healthcare professionals involved in the examination, monitoring and treatment of patients with eye conditions the use of diagnostic lenses is a crucial part of their skills set.
Examining the eye using a direct ophthalmoscope
Authors: Gibbons Helen , Purcell Yvonne
Published: May 2014

Direct ophthalmoscopy is a useful skill to develop for all practitioners, especially for those patients who are unable to be examined on the slit lamp.
Frequency doubling technology — a non-conventional way to test the visual field
Authors: Martin Lene
Published: May 2014

Visual field examinations are essential in eye care, and measurements are commonly carried out by ophthalmic nurses, optometrists and technicians. The results can have a significant effect on the management of patients.
The first 6 months as an ophthalmic nurse: the nurse's perspective
Authors: Tavengwa Regina
Published: May 2014

This article aims to share my experience as a new nurse in ophthalmology and my thoughts during the _first 6 months. It also addresses the impact of best practice on the reduction of avoidable complications and blindness in ophthalmology, and highlights specific nursing objectives and how these goals were attained to become valuable in my newly chosen career pathway.
Intracameral antibiotics for the prevention of endophthalmitis in cataract surgery
Authors: Legg Kerrie
Published: May 2014

Aim:

To determine if there is enough evidence to support the use of intracameral antibiotics for the prevention of endophthalmitis post cataract surgery.

Method:

A systemic review of English language articles was conducted by performing a broad search using Medline/ProQuest, Science Direct, the Cochrane Library and Embase. The search was restricted to articles published between January 2005 and October 2010. The terms endophthalmitis and intracameral antibiotics were used to initiate the search but the term cataract was used for further exclusion. The population base incorporated adult patients undergoing cataract surgery. Limitations include one author as a reviewer of the titles resulting from the literature searches. A team review would give a more robust methodological quality.

Results:

Of the 493 results that were identified in the literature search 451 citations were excluded after screening titles and abstracts. Forty two publications were included for this review and were identified as being relevant after scrutiny. Publications showing retrospective data far exceeded the number of prospective case controlled studies negatively affecting the number of high quality articles reviewed. A randomized controlled study released by the European Society of Cataract and Refractive Surgeons (ESCRS) published results in 2006 showing a near _fivefold decrease in the rates of post-operative endophthalmitis with the use of intracameral cefuroxime. This study was discontinued due to ethical considerations. The study observed a clear benefit from the use of intracameral cefuroxime. Moxifloxacin has not been truly evaluated and has a potential for bacterial resistance. Topical antibiotics are unreliable relying on patient compliance and requiring frequent administration. From this review an effective solution for endophthalmitis prevention remains unclear.

Conclusion:

Intracameral cefuroxime administered at the time of surgery seems to work well for reducing the incidence of post-operative endophthalmitis as it is a broad spectrum and cost-effective antibiotic. The major barrier to its clinical use is the lack of a commercial preparation which increases the threat of dilution errors, which is known to be toxic to human endothelial cells.
A practical guide to getting published
Authors: Gilsenan Irene
Published: May 2014

The gold standard in healthcare is evidence-based practice but what if the evidence is not yet published? The step that often gets left out is that of sharing the work we are involved in with a wider audience. Making this next step into getting work published requires some knowledge of the publication process and a determination to see your work in print. This article will outline some practical tips about getting published.
Case report: acanthamobea keratitis presenting as herpetic keratitis in a contact lens wearer
Authors: Tallouzi Mohammad
Published: May 2014

The aim of this article is to present a concise review of the literature regarding acanthamoeba keratitis by exploring the pathophysiology, diagnosis, examinations and management strategies of this ocular condition. Acanthamoeba keratitis is a sight-threatening condition which progress rapidly if left untreated and is a real emergency that requires immediate and intensive assessment and treatment. As there is a potential increase in the number of cases of acanthamoeba keratitis among young contact lens wearers and the possibility to confuse the symptoms of acanthamoeba keratitis with those of other corneal diseases, there is a need to understand the pathophysiology of the acanthamoeba. This article will stress the necessity and create awareness about the importance of early diagnosis and treatment of acanthamoeba keratitis. The main focus is contact len-related acanthamoeba keratitis where the author will present two cases that attended the eye emergency department where they were diagnosed with acanthamoeba keratitis. This article will also send a message to all healthcare practitioners to suspect acanthamoeba keratitis in those patients with contact lenses and severe microbial keratitis or herpes simplex keratitis.
Resources for ophthalmic nurses in the developing world
Authors: Marsden Janet , Machin Heather
Published: May 2014

Knowledge acquisition is much more difficult for nurses in the developing world due to the constraints of funding, resourcing and language. This paper describes an initiative to assist ophthalmic nurses to access comprehensive, relevant and current information in order to help them to update and develop their practice for the ultimate benefit of their patient populations. A network of ophthalmic nurses coordinated by ORBIS, an international ophthalmic charity, have developed a number of accessible resources which are available in both cyber and paper formats. The work is ongoing and colleagues are encouraged to contribute to its development.
Case report: classic infectious crystalline keratopathy in an immunosuppressed cornea
Authors: Burke Nuala , Marsden Janet
Published: May 2014

This article presents a case study of a patient with infectious crystalline keratopathy; a unique clinical entity characterised by bacterial replication within the cornea with very little or no inflammatory response. It considers the predisposing and complicating factors in relating this refractory condition, and goes on to describe this particular patient's care and treatment throughout this episode.
Eye drop administration: improving patients’ skills to make the procedure easier and reduce side-effects – a Rotterdam Eye Hospital project
Authors: Ooms Nora
Published: May 2014

The consequences of incorrect administration of eye drops can be severe, and more patients experience these than is necessary. The Rotterdam Eye Hospital has developed written and illustrated instructions on how to administer eye drops and eye ointment for patients and caregivers. We started with instructing glaucoma patients. To investigate the quality of our instructions, we evaluated the skills of eye drop administration before, immediately after and one month after patients had received instructions in eye drop administration. Patients’ skills in administrating eye drops improved significantly after receiving instructions. Patients were very satisfied with the instructions. Applying eye drops correctly was found to be a bigger issue than had been originally assumed. The next step at the Rotterdam Eye hospital was the launch of the Eye Pharmacy, which provides eye drops and instructions for their administration. This article discusses: the techniques for administering eye drops and eye ointment; how best to instruct patients; and solutions to specific problems. The article can be used as a guideline so that eye healthcare professionals can better help their patients.
Setting up a patient support service to provide information and psychological care
Authors: de Board Louise , Thombs Jasmine
Published: May 2014

Visual impairment is associated with a higher than normal risk of depression. This reduces quality of life and can affect a person's ability to make the most of rehabilitation. Most people newly diagnosed blind or visually impaired need information, and want to talk to someone about their fears and concerns. However, few UK eye clinics offer such a service. A review found social work and counselling provision at Moorfields Eye Hospital was limited. In response to this, the Patient Support Service was set up; as well as providing information and psychological care, it ensures integrated working between hospital, primary care and voluntary services. Attention was paid to team cohesion when the service was set up. A launch event, in which all team members were involved, promoted the service to staff and patients. Plans include providing evidence-based research on the effects of psychological support and information, and setting up patient support services and counselling at more clinics.
Issues and factors affecting chalazion recurrence percentages post nurse-led surgery
Authors: Horsfall Brian , Corbett Laura
Published: May 2014

Chalazia, also known as meibomian cysts, when surgically removed can recur for a minority of patients. Current advice to give to a patient is that their chance of experiencing a return of the same lesion is under one in 10. Causes, reasons and factors affecting cyst development are discussed in this paper, with the aim of exploring how the practitioner can be advantaged by having solid recurrence percentage figures at hand to give to the patient.
Worldwide wish: better care for the dying
Authors: Sweeney John
Published: May 2014

Frankly frill free, this site offers a meeting place for those who provide and are interested in palliative care from around the world. It addresses the growing awareness that the difficulties of providing palliative care in the developed world pale into insignificance when compared to the experiences of patients and workers in other countries. While an invitation is made within the site to join the International Hospice Institute and College (IHIC) much of the information on the site is available to the casual visitor and so allows easy investigation of what this group can offer.
The use of oesophageal, self-expanding, metal stents
Authors: King Maureen , Matthews Grace
Published: May 2014

Self-expanding metal stents have become increasingly popular in the effort to relieve the distressing symptoms associated with malignant oesophageal disruption. Despite numerous medical reports on the effectiveness of oesophageal stents, an extensive literature search revealed no nursing research on this subject. Through personal experience and reflection, the authors identified some distressing complications associated with oesophageal stenting. Their concerns resulted in a retrospective audit to assess the relief of dysphagia and identify any complications experienced by 37 patients who had received oesophageal stents. The results of this audit are inconsistent with previous medical studies, and question the effectiveness of these devices in the relief of symptoms associated with oesophageal disruption. In fact, the authors were perturbed by the number of complications identified after stenting, especially haematemesis, malaena and haemoptysis. The authors recognize that this subject requires a larger, multi-centre study. They have identified that a thorough nutritional assessment of patients with stents would be beneficial, and that education of both nursing staff and patients about these stents was a necessity.
Needs assessment in palliative care
Authors: Smyth Dion
Published: May 2014

The changing emphasis of palliative care has meant that many more people now see palliative care as applicable and appropriate to their needs, and not just the preserve of patients with cancer.
Practicalities of spiritual assessment
Authors: Jones Lousie
Published: May 2014

Death is a moment; conception is a moment. What is that essence of a person that is lost or gained in these fragments of time? How can we understand the central concept of loss of life that is taking place in our practice every day?
An overview of the end-of-life discussion
Authors: Edwards Phil
Published: May 2014

Good communication with patients can be a powerful tool in palliative care. However, discussing fears and anxieties at length is also something that many nurses find difficult. This article provides an overview of one approach to using the power of communication, the end-of-life discussion. Practical issues are considered, as well as suggestions as to what to include in such a discussion. Concepts of loss and meaning for the person with advanced disease are looked at. The article also considers some of the key communication skills that are especially valuable, such as active listening, ways of encouraging disclosure and the handling of silences.
The law regarding assisted dying for the terminally ill in the UK
Authors: Dimond Bridgit
Published: May 2014

This article outlines the Assisted Dying for the Terminally Ill Bill in the UK. The conditions that must be satisfied before an attending physician can assist a patient to die are highlighted and information regarding the declaration is provided. It is not certain that the Bill will obtain legislative approval and, if it does, there are statutory provisions for monitoring each assisted death.
Providing total patient care: the power of reflection
Authors: Cooley Candy , Aranda Sanchia
Published: May 2014

One of the tasks that many of us undertake at this time of year is to reflect on the out-going year. Some will be glad that 2005 is over and hope that 2006 will be better, others will reflect on a year, which included some really positive experiences. For the majority of us, it will be a year in which there were both high and low points. However, for many of the people that we care for in the palliative setting, this may be a year in which they find it difficult to see the positive aspects. Those who have moved from curative treatment to palliative care, those whose symptoms now limit their quality of life and those who mourn the passing of loved ones, may find it difficult to articulate that anything good happened within the year.
Lymphoma resources for health professionals and patients
Authors: Smyth Dion
Published: May 2014

There are more than 200 types of cancer. Haematological cancers constitute a considerable amount of cases of the most commonly occurring types: non-Hodgkin’s lymphoma is the sixth most common type of cancer in the UK; leukaemia the thirteenth; and multiple myeloma the seventeenth. This month’s web words returns to the theme of haematological cancers, and examines three more sites that provide practical materials for practitioners and patients — this time regarding lymphoma.
Developing a nurse education network across Europe
Authors: Larkin Philip
Published: May 2014

The European Association for Palliative Care (EAPC) was founded in 1988 to promote the development of palliative care through national and international collaboration, education and research. Today, the EAPC represents the voice of 50000 palliative care professionals and volunteers in 40 countries through either individual membership, or 30 national collective member organizations in 20 European countries.
Hospice care is a human rright
Authors: Praill David
Published: May 2014

We know that millions of people around the world living with a terminal illness suffer unnecessary pain and distress, either unaware of, or unable to access, the care they need. About 60% of the world population that are dying would benefit from the specialist care provided by hospice staff to alleviate pain and suffering in their final days (Doyle et al, 2003). If you include families and carers, that’s about 100 million people worldwide, at a conservative estimate, who could benefit from palliative care services every year. That number is likely to increase as more people are affected by life-threatening conditions, such as cancer and acquired immunodeficiency syndrome (AIDS), and have serious chronic illness towards the end of life.
Yoga: A guide to online information and resources
Authors: Smyth Dion
Published: May 2014

Yoga has been defined as the union of the individual essence with the universal soul and has been a means of achieving spiritual enlightenment for thousands of years.
Out-of-hours medical cover in community hospitals: implications for palliative care
Authors: Kerr Chris , Hawker Sheila , Payne Sheila , Lloyd-Williams Mari , Seamark David
Published: May 2014

Background The new General Medical Services contract in England means many GPs have transferred out-of hours work to their primary care organization, with implications for continuity of palliative care in community hospitals.

Aim To examine existing arrangements for out-of-hours medical cover in community hospitals, focusing on palliative care.

Methods Telephone survey of community hospital managers/senior nurses across England and Wales.

Results Interviews (n=62) revealed nursing staff were satisfied with existing out-of-hours care. Concern was expressed about the future of out-of-hours medical care from GPs as new services will cover larger areas, meaning unknown doctors may attend, taking longer to arrive.

Conclusion Arrangements for out-of-hours medical cover in community hospitals are in transition, threatening the continuity of care for dying patients.
The legacy of Chernobyl: Palliative services making a difference in Belarus
Authors: Becker Robert
Published: May 2014

Improved palliative care services in the Belarus capital of Minsk have made a real difference to families affected by the Chernobyl disaster. However, a fully integrated and functional system of care is yet to be realised.
Book Reviews
Authors: Walsh Helen
Published: May 2014

I came to this book with almost 20 years experience of working in palliative care, primarily with cancer patients. I’m not really sure what I expected, but I found a text that was sensitively written, successfully applying the principles of palliative care to a much neglected client group. Particularly pertinent was the application of palliative care principles in the early stages of the disease, especially in relation to encouraging patients to plan for their future care.
Taking on a critical new role for hospices
Authors: Payne Sheila
Published: May 2014

It is with excitement and some trepidation that I reflect on my new role as the first Chair in Hospice Studies in the UK, funded by the charity Help the Hospices. I am sure people will have differing expectations of the role.
Racial differences in perceptions held by caregivers of long-term ventilator patients at end-of-life
Authors: Kelley Carol G , Daly Barbara J , Douglas Sara L , Standing Theresa
Published: May 2014

Aim: The purpose of this pilot study was to describe and compare perceptions of preparation for death and satisfaction with end-of-life care in African American and Caucasian caregivers of long-term ventilator (LTV) patients.

Design: A comparative descriptive design was used to pilot test items from specific domains from the After-Death Bereaved Family Member Interview. Interviews were conducted on 37 bereaved caregivers of LTV patients who participated in a large experimental study.

Findings: There was a statistically significant association between African American and Caucasian caregivers in the area of being informed of the patient’s condition. African American caregivers felt more informed than Caucasian caregivers. Over half of African American and Caucasian caregivers reported feeling ‘fairly to very confident’ about what to expect when their loved one was dying.

Conclusion: Health care providers should be sensitive to potential differences between African American and Caucasian family caregivers in providing end-of-life care.
Conferences and courses: a guide to online information
Authors: Smyth Dion
Published: May 2014

As we look forward to all the New Year brings us we may want to plan our diaries and attempt to attend some of the many conferences or courses available to us, to show and share different perspectives on palliative care practices. This months web words provides details of some of the websites that list the various conventions and congresses being held worldwide.
Watch with me: a chaplain’s perspective
Authors: Edmeads Andrew
Published: May 2014

This article is a reflection of the importance and the difficulty of being present to, and with, terminally ill patients within a palliative care setting. It is offered as a reflective and interpretive piece on the work of a chaplain within the palliative care team. It includes an examination of the way in which the death of a patient reminds us of our own mortality and of the often-unacknowledged terror of death. Questions are asked about the distinctive role of the chaplain and what is it that the chaplain and other professionals within the palliative care team share. The article is written from a Christian perspective.
Allowing the voice in writing
Authors: Nyatanga Brian
Published: May 2014

One of the most frequently asked questions in publishing is whether to write from the first or third person perspective. I often privately wonder, whatever happened to the second person? The debate on writing styles has been ongoing for some time now, including as recently as last month at the European Association for Palliative Care (EAPC) congress in Budapest. Publishing houses and editors of journals, books and other materials decide on their preferred style, and then guide prospective authors accordingly.
Exploring nurses’ attitudes to, and use of, an online palliative care resource
Authors: Tieman Jennifer , Rawlings Deb
Published: May 2014

Aim: The internet provides access to information and evidence that can support palliative care practice. This study aims to evaluate the use and utility of a palliative care website with particular regard to its use and issues for nurses. Study details: A survey of online visitors and a postal survey of staff working in palliative care services were conducted; 134 visitors completed the survey and 371 staff in palliative services responded. Findings: Users of the site found the content credible and over 95% would recommend the site to others. Over 90% of specialist palliative care nurses use online resources and half use the CareSearch website. Awareness of the resource was much lower for registered nurses than specialist nurses working in palliative care. Conclusion: Understanding attitudes to, and use of, online palliative care resources by nurses working in palliative care services could help to develop these resources to more effectively meet their needs and circumstances.
A retrospective audit of non-malignant admissions to a regional hospice in 2003 and 2006
Authors: Griffin Morag , Conway Rosie
Published: May 2014

Aim: There is increasing pressure to provide palliative care to patients on the basis of need, not diagnosis. Additionally, there is a paucity of literature describing how the palliative care community is rising to this challenge. Methods: This retrospective audit investigated the number of patients without cancer admitted to a regional hospice in Dundee, Scotland, in 2003 compared with 2006 and whether these patients had different characteristics to patients with cancer. Results: There was a significant rise in the number of patients admitted with non-malignant conditions; 6/328 patients were admitted during 2003 with non-malignant conditions compared with 23/340 in 2006 (P=0.0037). There were no differences in age (P=0.5), length of stay (P=0.57), outcome of admission (P=0.59) or reason for admission (P=0.7) when those without cancer were compared with a contemporaneous group of 60 consecutive patients admitted with cancer. Discussion: Local increases in non-malignant admissions mirror national figures. Underlying reasons for the local increase were unable to be studied in this retrospective audit and would require further study. More needs to be known about how patients, their carers and staff feel about hospice care for those with advanced non-malignant conditions and where, how and by whom palliative care for all should be provided.
The use of biographies and stories in paediatric palliative care education
Authors: McNeilly Patricia , Read Sue , Price Jayne
Published: May 2014

Paediatric palliative care has emerged as a distinct specialty over recent years and, as a consequence, robust and innovative educational programmes are required to further develop the exisitng attitudes and skills of practitioners working within this field. Understanding the experiences of children and families is key to providing quality care in this context and a number of teaching and learning activities have been reported in the literature. This article discusses one such learning activity – the use of parent biographies and stories by students undertaking the paediatric palliative care programme at Queen’s University Belfast, UK. Feedback from students indicated that this was a positive learning experience that was both interesting and useful from a practice perspective.
Podcasts: online information and resources
Authors: Smyth Dion
Published: May 2014

A ‘podcast’ is a digital media file disseminated via the internet, which is available by ‘streaming’ play in real-time or alternatively downloaded to a personal computer and consequently stored or transferred to a portable media player for listening to at your leisure. Podcasts may be accessed as one-off events or series may be subscribed to with new content downloaded automatically. As a means of developing and distributing audio and video materials concerning topics such as contemporary health-related matters, cultural issues, news and views, the podcast is an excellent technology to master and enjoy.
A passage to Switzerland
Authors: Nyatanga Brian
Published: May 2014

Debate on legalizing assisted dying (AD) seems to be gaining yet more momentum (at least in the UK), despite numerous setbacks to the Assisted Dying for the Terminally Ill Bill. This may be due to recent media coverage of high-profile cases of people travelling abroad for assisted dying. For example, Dan James, a 23-year-old rugby player, who was paralyzed after a scrum collapsed on him; Craig Ewert, a 59-year-old university lecturer with motor neurone disease; Dr Anne Turner, suffering from progressive supranuclear palsy, died with assistance 3 years ago, but her final moments were dramatized in ‘A short stay in Switzerland’ on BBC 1 early this year. As I write, Sir Edward Downes, one of Britain’s greatest conductors, and his wife, Joan Downes, ended their lives with the help of the Swiss organization Dignitas in Zurich.
Evidence-based practice guidelines: a survey of subcutaneous dexamethasone administration
Authors: Walker Jackie , Lane Pauline , McKenzie Clare
Published: May 2014

Searching for good evidence to develop clinical practice guidelines can be challenging, as research may not be published or available. A simple question set the authors on a journey to find evidence related to the nursing administration of subcutaneous dexamethasone in the palliative setting. This article outlines the search for evidence and discusses the survey results to gather expert opinion about the nursing administration of dexamethasone. Survey results indicated that only 39% of community services gave dexamethasone via a bolus injection and 88% gave it via a continuous infusion, mainly for site preservation. The diluents used were water for injection or normal saline. Many procedural aspects were supported by current guidelines, with several services using the New Zealand Waitemata District Health Board’s (2008) clinical guidelines. Developing and implementing procedural recommendations for nurses to administer this subcutaneous medication will form the next stage of the project.
The genetics era: educating on non-malignant matters
Authors: Smyth Dion
Published: May 2014

A recent report by the UK Nursing and Midwifery Council, Fit for Practice in the Genetics Era, emphasized that genetics had become such a fundamental issue that nurses could no longer ignore its significance to their practice. This may be in meeting the current needs of the patients and their families, the work with those who are predisposed to a genetic condition, or in preparing to practice in a period when the probability of genetics transforming health care is no longer the stuff of science fiction. This month’s Web Words examines the internet for materials that inform and educate on non-malignant matters.
Development and implementation of regional guidelines for malignant spinal cord compression
Authors: Hutchison Cathy , Armstrong Mairi
Published: May 2014

Malignant spinal cord compression (MSCC) is believed to occur in approximately 5% of all patients with cancer and is a major cause of morbidity. Early identification of the condition and prompt referral for investigation and treatment are paramount in improving patient outcomes in terms of quality of life as well as survival. However, delays in time to referral, diagnosis and treatment, as well as inconsistencies in care, are common (Levack et al, 2001; McLinton and Hutchison, 2006). To address these issues, the West of Scotland Regional Cancer Group developed multi-professional guidelines with the aim of providing clear referral and investigative pathways for patients with suspected or actual MSCC; encouraging prompt referral and treatment; encouraging staff to involve patients in the early identification of MSCC; and to assist with appropriate patient selection for treatment. This article discusses the development and implementation of the guidelines across the region, within the context of the wider MSCC policy and care agenda, and will highlight the challenges which were mainly concerned with the scope of practice (multi-professional and geographical), as well as in some cases the lack of available evidence. The work is now part of a Scotland-wide approach to education and audit.
A learning and development strategy for Children's Hospices across London
Authors: Billings Jenny , Jenkins Linda , Black Rachel
Published: May 2014

Over recent years there have been several political imperatives in the UK directed toward children's palliative care and ensuring that services are high-quality, coordinated, family-centred, and able to meet the needs of children with complex disabilities. In addition, in 2010 the health and social care regulation authority in England—the Care Quality Commission (CQC)—aligned hospices with regulation and inspection requirements. This context has acted as a driver for the creation of effective education and training to ensure a skilled and expert workforce. Against this backdrop, this paper describes a project to develop a learning and development strategy for Children's Hospices across London (CHaL). CHaL educators worked with a research team to develop a unified strategy that was based on evidence of good practice, embedded in required CQC outcomes, and validated with a wider audience. The resultant strategy contains a set of four key learning and development principles that are applicable and transferable across different hospices.
ICDs and patients in palliative care: the clinical experience turned into clinical policy
Authors: Maher Kate
Published: May 2014

As the global population grows and ages, an increasing number of patients are being referred to specialist palliative care services with multiple comorbidities. A parallel increase in interventional cardiology technology, techniques, and availability means that an increasing minority of these patients are having an implantable cardioverter defibrillator device (ICD) in place. It is essential that issues relating to these devices are discussed early in patients’ planning for end-of-life care, as the discharging of a device in a patient who has chosen not to be resuscitated will be contrary to their wishes. These issues are explored here by presenting two case studies with vastly different outcomes that were experienced at a hospice in Australia. Examination of these case studies by the hospice staff culminated in the development of a policy for the home-based palliative care team and the hospice inpatient unit for deactivation of ICDs according to patients’ and caregivers’ wishes at a variety of stages of their palliative care journey. Elements of this policy are also presented here as guidance for others looking to implement similar processes.
Evaluation of a training programme to teach a guided self-help psychological intervention to hospice staff
Authors: Galfin JM , Watkins ER , Harlow T
Published: May 2014

Aims: A recent trial demonstrated that a brief guided self-help intervention reduces anxiety in palliative patients. This study investigated whether training palliative nurses to deliver a guided self-help intervention would improve their routine management of psychological distress.

Design: A randomized controlled cluster trial compared a team of nurses who attended training (n=5) with a team allocated to a no-training control condition (n=5) on self-reported behaviour and confidence in addressing psychological distress. Ratings of patient psychological distress at routine clinical assessments were also examined pre- and post-training to assess the impact of training on patient distress.

Results: As predicted, patients cared for by the trained team demonstrated a significantly greater reduction in distress post-training than patients cared for by the untrained team. However, there was no significant difference in self-reported behaviour and confidence.

Conclusion: These findings suggest that brief workshop-based training improves clinical outcomes on psychological distress and may be a means to increase the accessibility of effective psychological interventions in palliative care.
End of life in an Icelandic nursing home: an ethnographic study
Authors: Emilsdóttir Anný Lára , Gústafsdóttir Margrét
Published: May 2014

Aim: To examine care of the dying elderly in a nursing home in Iceland. Methods: An ethnographic study design was adopted. The study sample comprised all of the nursing home residents, their relatives, and all of the staff working in the nursing home, but with a particular focus on the 11 registered nurses (RNs) on the site. Data was collected through participant observation, semi-structured group interviews with the RNs, and an examination of the nursing home's official records. Underlying themes were discovered using interpretative phenomenology. Findings: Two main themes emerged: that palliative care is the most important element of care in the home, and that RNs are the pillars of caring for the dying elderly in the nursing home. Conclusions: The findings suggest that RNs’ professional knowledge can greatly contribute to the care of dying elderly residents in nursing homes. There seem to be many parallels between the condition and wellbeing of very frail nursing home residents and patients in specialized palliative care units for the elderly. Public awareness of palliative care of the elderly in Icelandic nursing homes should be encouraged.
Subcutaneous infusion in palliative care: the neria™ soft infusion set
Authors: Gabriel Janice
Published: May 2014

Patients approaching the end of their life may be unable to tolerate the administration of oral medication owing to their underlying disease and/or symptoms, such as nausea and vomiting. Subcutaneous infusion is an alternative route of administration that offers several advantages over oral and intravenous routes. This product focus article provides an overview of subcutaneous infusion, including how the selection of the most appropriate infusion device can greatly contribute to the overall comfort of the patient. This in turn minimises the potential for premature device loss, which can lead to repeated insertion procedures for the patient, increases the potential for infection, and has resource implications. The article then describes the neria™ soft infusion set, as well as providing case studies of its use.
Identifying and treating depression at the end of life and among the bereaved
Authors: Handsaker Scott , Dempsey Laura , Fabby Carole
Published: May 2014

Depression is a common psychological condition among patients at the end of life, and it can also affect a patient's family both before and after their loved one's death. It is estimated that around 25% of palliative care patients are diagnosed with depression during their illness, and that a majority experience depressive symptoms. If left unrecognized and untreated this may lead to more severe illness symptoms, poor communication with family members and, ultimately, reduced quality of life and a poor prognosis. Early assessment and management using appropriate tools as a guide are essential for enabling early treatment so that patients can be comfortable and meet unfulfilled goals during their end-of-life care. Palliative care staff play an essential part in recognizing and treating depression in patients, and by focusing on those at risk they can help to reduce the number who will go on to develop the condition. This article provides an overview of the nature of the problem in palliative care patients and bereaved families, looking at how targeted monitoring and intervention can help to alleviate the burden in the former and how support can benefit the latter.
Politics and palliative care: Sweden
Authors: Smyth Dion
Published: May 2014

Dion Smyth's review of the internet for palliative nursing
Development of a standardised pro forma for specialist palliative care multidisciplinary team meetings
Authors: Gallagher Jennifer , Forman Margaret Louise
Published: May 2014

A pro forma of the caseload of the community palliative care clinical nurse specialists in the Central Lancashire Community Specialist Palliative Care Team was devised to provide a brief overview of each patient's plan of care for use in the multidisciplinary team meetings and as a consequence of preparing for the UK Department of Health's peer review process. The pro forma was also designed to be used in everyday clinical practice in Gold Standards Framework meetings in the community. It has been evaluated by the team and found to be helpful for highlighting key issues in clinical practice, such as symptoms, psychological and emotional needs, and Preferred Priorities of Care. Over the past 2 years, it has also complemented the organisation's drive to become ‘paperless’. This article looks at how the pro forma was developed, how it has evolved over time, and how it works today. Consideration has also been given to its benefits and limitations.