bluuebunny/crossref_metadata_2025 huggingface dataset:
One to One midwives: First-year outcomes of a midwifery-led model
Authors: Collins Maureen , Kingdon Carol
Published: May 2014

New models of maternity service provision are currently emerging across the NHS. One to One (North West) Limited was the first Any Qualified Provider (AQP) of midwifery care throughout the maternity continuum, with midwives providing community-based care for women across the risk spectrum. It was also the first non-NHS maternity organisation to gain independent insurance for intrapartum care. One to One commenced a 3-year contract with NHS Wirral in November 2011. This article discusses the care the organisation's midwives offer, and presents routinely collected clinical outcome data and women's testimonies from One to One's first full year of operation. Between 1 November 2011 and 31 October 2012, 711 women were booked, 414 of whom gave birth with One to One. The spontaneous vaginal birth rate was 76% for all births, while the home birth rate was 31%. The article highlights the successes, challenges and opportunities a reconfigured NHS offers for those receiving and providing midwifery care.
Full-time supervisor of midwives: Is this the future for supervision?
Authors: Nipper Bernie , Roseghini Manjit
Published: May 2014

This article provides an insight into the role of a full-time supervisor of midwives (SoM) at Barking, Havering and Redbridge University Hospitals NHS Trust (BHRUT). The role was the first of its kind in London and was introduced in response to concerns raised by a Care Quality Commission review (CQC) of maternity services in October 2011. The report made 79 recommendations to the Trust, 15 of which related to maternity services. It was evident many SoMs were overwhelmed with day-to-day difficulties, working in their own time to ensure the statutory function of supervision was being provided to all midwives. Day-to-day supervision needed to be improved for junior inexperienced midwives needing support, and the ratio of SoMs to midwives needed to reflect those recommended in Nursing and Midwifery Council (NMC) 2012a ) guidance. An explanation of how the role evolved is given, highlighting the challenges and benefits encountered. The article concludes by evaluating the role to date.
Weight gain during pregnancy linked to childhood obesity
Authors: Bainbridge Jane
Published: May 2014

Research has found that women whose weight gain is significant during pregnancy increase the risk of their children becoming obese
Challenges and practices in infant feeding in Islam
Authors: Zaidi Fawzia
Published: May 2014

Breastfeeding is referenced in the Islamic religion with the Holy Qur'an and the Hadith recommending that the mother breastfeeds for 2 years, if possible, and provides guidance on its practice. This paper aims to introduce midwives to the infant feeding practices with a specific focus on breastfeeding by Muslim women. It is anticipated that this will stimulate midwives to further engage in discussions with Muslim women and their families around infant feeding to facilitate respectful and individualised care.
Supporting women in the second stage of labour
Authors: Holvey Nicola
Published: May 2014

This article endeavours to evaluate and critique the evidence and the associated limitations with many studies that look at time limits during the second stage of labour. It also seeks to examine the consequences of using delayed spontaneous pushing versus the Valsalva manoeuvre, in conjunction with time restraints in relation to maternal morbidities and neonatal complications. It discusses how midwives can best support and empower women in the second stage of labour and how information giving can lead to empowerment, informed decision making and woman's autonomy.
Weight-gain in pregnancy linked to infant mortality risk
Authors: Bainbridge Jane
Published: May 2014

Research carried out in the US has found that the risk of infant mortality increases the less weight a woman gains in pregnancy
Proactive Risk Management: Documentation of Patient Care
Authors: Wilson Jo
Published: May 2014

Proactive clinical risk management addresses the following issues: The identification of existing risks The assessment of potential systems failures The analysis of priorities for action The elimination or reduction of potential or actual hazards.
Attitudes to personal professional profiles: are they friends or foe?
Authors: Mallaber Colin , Turner Paul
Published: May 2014

This article investigates the attitudes of a group of teaching staff to the value and use of personal professional profiles (PPPs) in relation to the UKCC's requirements for periodic re-registration (UKCC, 1994). The data for the study were gathered using a postal questionnaire (65 of which were returned from a distribution of 200). Analysis of the questionnaires provided insight into how PPPs were regarded by the target group and raised some interesting questions about the future of ‘Standards for Education and Practice Following Registration’ (UKCC, 1994). A further study is planned to build upon the findings made in this preliminary investigation.
Synthetic casting tapes: benefits and uses of Delta-Cast Conformable
Authors: Capper Carole
Published: May 2014

Casting is a traditional practice that has changed relatively little over thousands of years. Today, however, with the emphasis on evidence-based medicine, health professionals are examining the practice and investigating ways of improving it for the benefit of both patients and those who perform it. Most fractures and many soft tissue injuries are usually managed in a rigid cast, which brings with it complications and disadvantages. The ideal form of fracture fixation would stabilize the fracture while allowing some movement of the fracture site and soft tissue compression. This article explores the use of Delta-Cast Conformable (Johnson and Johnson), a synthetic casting tape, in both primary and secondary casting. The role of Delta-Cast Conformable with regard to focused rigidity casting, a new philosophy in fracture management, is discussed.
The Aquacath hydrophilic coated single-use urinary catheter
Authors: Doherty Willie
Published: May 2014

Single-use hydrophilic catheters are now being used widely throughout this country, Europe and America, for intermittent self-catheterization or carer-assisted intermittent catheterization, with considerable success. They are also reported to provide greater comfort for users. The latest catheter to become available on prescription is the Aquacath coated urinary catheter, produced by Seton Continence Care. This hydrophilic catheter performed very well in a trial comparing coating stability after wetting of various coated catheters (Jones, 1997). The teaching of intermittent self-catheterization must conform to local protocols and trust agreements. Nurses should find out about these and follow them. When teaching any procedure or technique to untrained carers, the nurse must always remember that he/she has overall responsibility for supervision and ensuring safe practice.
Patient-focused care: primary responsibilities of research nurses
Authors: Campbell Tanya
Published: May 2014

This article provides a critical analysis of the concept of patient-focused care, and discusses its significance to the provision of nursing care in the UK today. Empowerment, as a component of patient-focused care, is addressed within the article in relation to government-led initiatives designed to afford certain rights to health consumers. It focuses specifically on the roles, responsibilities and concerns of the clinical research nurse in relation to patient-focused care and concludes that true patient-focused care will not happen until physicians, nurses and patients are educated and their attitudes changed.
Angry women mentally disordered offenders: a need to do more?
Authors: Cordall John
Published: May 2014

Anger is generally viewed as unfeminine and women who display anger are more likely to be unnecessarily labelled as ‘psychotic’ or ‘dangerous’. There appears to be a link between those with a history of abuse and the psychiatric population, particularly among female mentally disordered offenders (MDOs) in high security care. A need exists for this problem to be rendered visible, which is ultimately the responsibility of those healthcare professionals charged with providing care and treatment for this population. This article proposes methodology which is aimed at stimulating and refocusing healthcare professionals' thinking in terms of female MDOs, and the need to provide tangible evidence of high quality forensic care.
Inflammatory bowel disease 1: aetiology and pathogenesis
Authors: Rowlinson Annette
Published: May 2014

Inflammatory bowel disease, a chronic lifelong condition, affects between 15 and 30 people per 10 000 of the UK population. Despite the large number affected, there seems to be a paucity of information on this subject in the British nursing press. Hence, nurses have little or no understanding of the impact of this illness, and there is a danger that the distress and debilitation that inflammatory bowel disease can have on people's lives is underestimated. However, a healthcare professional, armed with the appropriate knowledge and attitude, can make a real difference to the quality of care that these patients receive. This article is the first in a series of three that shall review the aetiology, treatment and concept of patient participation in inflammatory bowel disease. The series aims to enhance nurses' understanding and stimulate further investigation into this chronic illness.
Inflammatory bowel disease 2: medical and surgical treatment
Authors: Rowlinson Annette
Published: May 2014

The first article in this three-part series reviewed the aetiology, treatment and concept of participation in inflammatory bowel disease. This article provides a brief overview of current trends in the medical and surgical treatment of inflammatory bowel disease. The discussion of medical management will include the most common drugs utilized for symptom control, their modes of action, routes of administration and side-effects. In addition, the role of nutritional support, both as an adjunctive and a primary therapy, will be considered. The options for, and consequences of, definitive surgical intervention in the event of failed medical management of both ulcerative colitis and Crohn's disease will be examined.
Confidentiality 6: HIV/AIDS patients and the duty of confidentiality
Authors: Dimond Bridgit
Published: May 2014

Staff Nurse Grey discovered that one of the junior doctors in the medical team was human immunodeficiency virus (HIV) positive. She felt that she was under a duty to disclose this information in order that the patients could be protected from cross-infections. Since her senior manager appeared to take little notice of the information, she informed the press. What is the law?
Central venous catheters: preventing infection and occlusion
Authors: Cook Neal
Published: May 2014

As central venous catheters (CVCs) become more widely used in today's healthcare environment, nurses require expert knowledge in relation to CVC maintenance to prevent complications and maximize efforts to optimize the individual's health status. This is especially so since CVCs have begun to be used outside intensive care units, e.g. in general wards, and can be associated with high incidences of infection, occlusion and subsequent compromise in patient health. Nurses are responsible for the maintenance and use of central access devices, such as CVCs, resulting in a need for literature specific to the nursing aspects of CVC management. This article addresses many nursing issues pertaining to care of the central line, focusing on evidence- and research-based literature, and also reviews the literature to make recommendations for practice.
The experience of therapeutic touch from a nursing perspective
Authors: Hayes Julie , Cox Carol
Published: May 2014

This article describes the phenomenon of therapeutic touch (TT). Similarities and differences in the experience of the phenomenon from the perspective of a novice practitioner and healthy volunteers are highlighted. A qualitative analysis of findings indicates that the experiences of giving and receiving TT can be classified within two categories: the cognitive (knowing in the widest sense); and conative (instinct and feeling). The key constructs which emerged in this study are associated with feelings such as tingling, warmth, coolness, comfort, peace, calm and security. Formulation of the two main categories, cognitive and conative, emphasize the relationship associated with what is known by the mind and instinctively felt by the body. The holistic aspects associated with the phenomenon of TT are confirmed in the therapeutic relationship which can be formed between the practitioner and recipient during the administration of TT. It is suggested that TT, when provided by the nurse in the clinical setting, can promote feelings of comfort, peace, calm and security among patients.
Nurses must not become substitute doctors
Authors: Scott Helen
Published: May 2014

Recently, the Government announced that it wants to remove the demarcation lines between nurses and doctors and allow nurses to take on more duties currently performed by doctors. This announcement raises serious concerns for the nursing profession.
Pressure sore formation in the operating theatre: 1
Authors: Pope Ron
Published: May 2014

While theatre nurses strive to master increasingly sophisticated equipment and techniques they must also endeavour to ensure that the quality of fundamental nursing care has positive outcomes for the patient. According to Land (1995), pressure area care is such a fundamental nursing activity that many health professionals do not recognize the importance of keeping abreast of new developments. A review of the literature concerning pressure sore formation suggests that, far from being a ward-based problem, all surgical patients experience a critical period during which they are most susceptible to pressure injury — the time spent on the operating table. This article, the first of two parts, outlines the pathophysiology of pressure sores and the contributory factors present within the operating theatre. The second part suggests nursing interventions to reduce the incidence of pressure sore formation during the perioperative phase.
Integrated care pathways: an audit tool in paediatric oncology
Authors: Selwood Karen
Published: May 2014

The families of children undergoing treatment for cancer encounter many professionals with varying levels of training, experience and competency. This can lead to variance in the care and advice they receive. The aim of the audit described in this article was to improve care for children with fever and neutropenia by introducing an integrated care pathway. Guidelines for neutropenia were examined and a retrospective analysis of notes undertaken to study what was happening before a pathway was introduced. From this, standards were set and a pathway developed which was introduced to all members of the oncology unit and implemented as part of the children’s care. This article will also focus on the audit and evaluation of the pathway. Following this, the pathway has been changed to reflect care and can now be used to introduce new evidence or research in this field.
Catherterisation and urinary tract infections: microbiology
Authors: Godfrey Helen , Evans Ann
Published: May 2014

Patients with urinary catheters are a substantial proportion of the total patient population and catheter care is an important area of nursing practice. Urinary tract infection associated with catheterization is known to be the most common nosocomial (hospital-acquired) infection. Urinary tract infections can be caused by exogenous microorganisms or endogenous faecal or urethral microorganisms. The different microorganisms which are responsible for causing urinary tract infections have particular characteristics. Many microorganisms form a biofilm, a living layer of cells which stick to the surfaces of the catheter and the catheter bag. Biofilms not only lead to urinary tract infections, but also they are associated with encrustation and catheter blockage. The article considers the microorganisms implicated in catheter-associated urinary tract infections and aims to develop an increased awareness of the characteristics of different pathogens which could lead to enhanced nursing practice and improved patient care.
Critical incident: reflection on the process of terminal weaning
Authors: Keen Adam
Published: May 2014

The article uses critical incident analysis to reflect on the process of terminal weaning. Terminal weaning is defined in the context of withdrawing ventilatory support when the expected outcome is the patient's death. Basic ethical concepts are identified, and the role of the nurse in ethical decision making is discussed in relation to the associated professional and legal issues. Conflict exists between professional and legal accountability in relation to advocacy. Caution is advised with regard to nurses becoming involved in the decision to terminally wean, and its practice.
Screening for hazardous drinking in a population of well women
Authors: Scott Helen K
Published: May 2014

Previous research suggests that only about 15% of people who experience alcohol problems come to the notice of healthcare providers. Research has also shown that there is often a failure among healthcare providers to identify alcohol problems in patients whose primary presentation is not overtly alcohol related. It has been implied that this failure is contributed to by a lack of training and support on the part of the organization. This article reports on a project in which a group of health visitors were trained in a brief method of screening for and intervention with alcohol problems and then supported in identifying and intervening with women among their caseload who were drinking at unsafe levels. The sample comprised 430 ‘well women’ between the ages of 18 and 45 years, with no known previous or current alcohol-related problem. All the women were on the caseloads of health visitors in one health board area and all women had children under the age of 16 years. It was found at screening that 13% of the sample consumed more than 14 units of alcohol per week. Consumption was measured 6 months after one session of minimal intervention, and it was found that 92% of the intervention group reduced their alcohol consumption. Mean consumption had decreased by 55%, from 21.11 units to 9.24 units per week. Among those women whose drinking had been at levels which were potentially problematic (capable of sustaining physical, psychological or social problems due to alcohol consumption), the mean weekly amount consumed decreased by 59% from 30.7 units weekly to 12.43 units.
What makes a leader effective in nursing?
Authors: Castledine George
Published: May 2014

Traditionally, ‘Pudding Sunday’ was a time when people came together to stir their Christmas puddings. It symbolized the importance of stirring the ‘will’ and thus motivating people through difficult situations. ‘Will’ is related to power, freedom, direction or choice and is an ideal term to use when referring to nursing's desire to dictate its future.
Interface pressure measurements in leg ulcer management
Authors: Finnie Allson
Published: May 2014

Interface pressure measurements are undertaken in health care as a useful tool to assist in understanding the pressures that exist between the skin surface and another surface. Pressure monitors are utilized to measure pressures under compression bandages and pressure garments and in determining pressures between patients and support surfaces such as pressure-reducing mattresses and cushions. This literature review identified that many studies using these measurements are inadequately described, and that there are many variables such as the effect of time, posture and temperature associated with such measurements that may lead to misinterpretation of results. Studies utilizing interface pressure measurements should be interpreted with caution and measurement techniques could be improved.
PROFESSIONAL ISSUES
Authors: Child Damian
Published: May 2014

The final report from the Crown review team was published in March 1999. It proposed that new groups of healthcare professionals should be permitted to prescribe medicines. Most of the recent progress has centred on the extension of community nurse prescribing. However, changes have also been proposed to prescribing practices within the hospital setting to include nurses, pharmacists, and other healthcare professionals. This study is an initial piece of work examining hospital nurses' perceptions of pharmacist prescribing to identify if there are issues that warrant further investigation. Postal questionnaires, seeking responses to statements describing pharmacists writing prescriptions for drug treatment, were sent to 200 nurses at five NHS teaching hospitals in Birmingham. Completed questionnaires were received from 115 nurses (a response rate of 57.5%). Fifty-four respondents added comments to the questionnaire, giving some insight into their responses to the statements on pharmacist prescription-writing and prescribing. These comments indicated five key issues that may warrant further investigation: (1) pharmacists’ knowledge of the patient (2) doctors losing the opportunity to review drug treatment (3) potential communication problems (4) pharmacists’ workload, and (5) legal and professional accountability.
The NSF for mental health from a transcultural perspective
Authors: Chady Satish
Published: May 2014

Since 1997, the new Labour Government has taken steps to revitalize the NHS in an attempt to ensure a safe, sound and supportive service for all of its customers. The drive towards an efficient and productive system of health care has been echoed through policy directives with operational strategies, as evident in various Department of Health (DoH) publications, including the NHS Plan (DoH, 2000). The National Service Framework (NSF) for Mental Health (DoH, 1999a) sets out a broad vision for the future, a vision where principles of care, quality and standard of services for the mentally ill are optimized. However, this vision is short of ideas which implicitly address issues directly related to the mental health needs of minority ethnic groups. As an area which is already exposed to severe criticism, this article seeks to adopt a ‘transcultural’ perspective on the NSF, exploring issues deemed necessary for the success of the NSF in meeting the needs of ethnic minorities. An initial examination of current problems sets the scene for future direction where principles of partnership in care, antioppressive practice, transcultural nursing, and education and training are seen as imperatives which need exploration. The author argues that it is imperative that these principles are fully examined and implemented into practice, to ensure a service based on quality standards and equity principles. For nurses it means the development and learning of new working principles and skills.
Training nurses to support carers of relatives with schizophrenia
Authors: Gall Sheena H , Elliott Lawrence , Atkinson Jacqueline M , Johansen Ron
Published: May 2014

Carers have an enormous amount of responsibility for the welfare and management of people with a mental illness in Britain, and many require help if they are to continue caring. Mental health nurses may be in a key position to offer support, but they are often unclear of what is required and how it should be delivered. Existing UK nurse-led psychosocial interventions for families often focus on the needs of the patient rather than the carer. This article describes a needs-led support service that has been designed for carers whose relatives are diagnosed with schizophrenia. It recognizes the importance of a collaborative partnership between carers and nurses. In 2000, 10 mental health nurses were trained to deliver this support to carers. An evaluation is currently underway. This article outlines the principles of the training programme and how it might enable nurses to meet the carers' needs.
Are we listening to children's views about their treatment?
Authors: Terry Louise , Campbell Anne
Published: May 2014

This article examines how the recommendations of a recent report ‘Listening to Children's Views: The Findings and Recommendations of Recent Research’ (O'Quigley, 2000) can be used within the healthcare environment in order to obtain successfully children's views about their medical treatment. Sometimes, the treatment proposed is objected to by the child and, occasionally, the approval of the courts is sought in order to allow treatment to proceed. At times like this, the child's voice seems muted. These are exceptional cases, but every day children's nurses have to look after children of all ages and act as advocate, adviser, counsellor and nurse. Autonomy, confidentiality and cultural sensitivity are dominant themes in the O'Quigley report. Using these themes, this article examines how, and why, children's nurses should adopt these recommendations to help ensure that the voices of adolescent children, in particular, are both heard and listened to by decision makers.
Relatives' perceptions of side rail use on the older person in hospital
Authors: Gallinagh Róisín , Nevin Rosemary , Campbell Linda , Mitchell Fionnuala , Ludwick Ruth
Published: May 2014

With an increasing emphasis on improving standards in the care of older people, the use of physical restraints has received growing attention in the nursing literature. Physical restraint use has been likened to abuse as it impedes the movement of a person, encourages dependence on staff and denies autonomy. Side rails (cot sides, bed rails) can be considered as a physical restraint device. The therapeutic use of restraint has not previously been adequately explained. Furthermore, there is a dearth of literature examining the personal experience of physical restraint use. The Family Interview Guide (Strumpf and Evans, 1988) was used to explore perceptions of nine relatives whose family had side rails used during their care in an older person ward. The findings of the study suggest that while families place value on the perceived safety function of side rails, they nonetheless have worries about their use. These pertain to the risk of patient entrapment and possible injury. Patients' relatives associate side rails with ritualized practice in gerontology and make suggestions for the re-design of side rails. The study also highlights the potential for increased family participation in the decision to use side rails.
Health issues associated with rural communities
Authors: Castledine George
Published: May 2014

The romantic view of the British countryside and the healthcare needs of people living in rural areas are probably based on fictional television programmes such as ‘Emmerdale’ and ‘Peak Practice’. However, for years, many rural areas have experienced problems in obtaining adequate health care and access to essential services. The sight of a district nurse going about her business against a scenic backdrop can often hide a multitude of complex and different problems. During the present foot and mouth crisis there is a particular danger that some health and nursing issues may increase dramatically and go undetected and therefore untreated.
The use of intermittent pneumatic compression in venous ulceration
Authors: Vowden Kathryn
Published: May 2014

Even with the application of four-layer compression bandaging, the recommended treatment for venous leg ulceration, patients with reduced mobility have delayed ulcer healing. Intermittent pneumatic compression (IPC) has an established role in deep vein thrombosis prophylaxis and has been shown to influence fibrinolysis, tissue oxygenation, oedema and venous return. It has also been suggested, but not yet proven, that IPC may improve the healing of venous leg ulcers. An extensive review of the literature has demonstrated that the use of this treatment on patients with reduced mobility has not been previously studied; yet, analysis of difficult-to-heal ulcer patients would indicate that this method of treatment may be appropriate and requires further study.
Evaluating pressure-reducing foam mattresses and electric bed frames
Authors: Gray David , Cooper Pam J , Stringfellowe Sandra
Published: May 2014

It could be argued that pressure ulcer prevention is simply a matter of matching those patients at risk of developing tissue damage with suitable pressure-reducing equipment. However, as many authors have identified, this can be complicated because of the lack of reliable evidence to support many products. This article seeks to evaluate the combination of a pressure-reducing mattress with an electric profiling bed frame. The study was conducted in a high-dependency cardiac surgery unit. Forty-four subjects were recruited during a 6-month period and their progress observed. Two outcome measures were used: pressure ulcer incidence and perceptions of comfort. No pressure ulcers developed during the trial and the perceptions of comfort were generally positive. The small sample size restricts the conclusions that can be drawn from the study, but when taken in conjunction with other small studies in this area there appear to be benefits from using such a combination of equipment.
Survey of continuing professional education within nursing homes
Authors: Aoki Yumie , Davies Sue
Published: May 2014

This article reports a survey of qualified nurses employed in nursing homes in a large city in the north of England. The aim of the study was to describe nurses' experiences and perceptions of continuing professional education (CPE), and their views on the development of their knowledge and skills through formal and informal education. Findings revealed that nurses in nursing homes perceived the value of educational programmes but had limited opportunities to attend formal education programmes. They faced a number of barriers and challenges in accessing formal education. Various informal ways of learning were used, including reading professional journals, watching videotapes and television programmes and accessing the internet. However, respondents appeared not to use fully opportunities for sharing knowledge with colleagues. Although this study is based on a small sample, the findings support those of other studies in this field. Collectively, these studies suggest an urgent need to develop a range of approaches to CPE within care homes, both formal and informal, if the standards outlined within recent policy initiatives are to be achieved.
Challenges faced by employees in the home care of elderly people
Authors: Soini Helena , Vlimki Maritta
Published: May 2014

In Finland the care of frail, elderly people is increasingly moving out of institutions and into clients’ homes. To cope with the challenges, nursing staff have to recognize the specific nursing problems involved in home care, as well as the most appropriate nursing interventions. The purpose of this study was to discover how homecare employees (n = 109) perceived the problems involved in the home care of elderly people, what they thought were the most relevant nursing interventions, and what type of assistance they expected and received in dealing with homecare problems. The focus was on homecare problems, because they form the basis for planning, implementing and evaluating interventions. The data were analysed using statistical methods and descriptive statistics. The results showed that elderly patients’ memory and their cognitive and physical capacity were the main sources of problems for homecare employees, defined as registered nurses, nursing assistants and home-help personnel. These problems were usually tackled by means of nursing interventions, such as memory tests, evaluations of the clients’ abilities to wash and dress themselves, encouragement of the clients to use their existing capacities, and allowing clients sufficient time in care situations. The most effective source of assistance to employees was managerial supervision and collaboration with co-workers. It is concluded that, in training, more attention needs to be paid to support employees’ abilities to identify nursing problems and to use specific interventions. Inservice training and clinical supervision should be tailored to address specific problems.
Developing continuing care: towards a teaching nursing home
Authors: Davies Sue , Powell Ann , Aveyard Barry
Published: May 2014

This article describes a partnership between staff, residents and relatives of a nursing home for older people with mental health problems, and lecturers within an academic department of nursing. The aim of the partnership is to develop practice and to improve the setting of the care home as an environment for living, working and learning. In our attempts to create a teaching nursing home, we recognize the need to ensure that all participants — residents, relatives and staff — feel that they are valued members of the team. We describe our progress to date, together with some of the challenges and benefits of working together.
Working with older people: what do the next 10 years hold?
Authors: Nolan Mike , Davies Sue
Published: May 2014

This article briefly considers the challenges facing gerontological nursing over the next 10 years. It suggests that future quality of care will depend largely on the ability to recruit and retain staff who actively choose to work with older people. This will mean raising the status and profile of gerontological nursing and identifying a philosophy that provides direction and purpose for future care practices.
Clinical and scientific data of a hydropolymer range of dressings
Authors: Ballard Kate
Published: May 2014

The Tielle™ family (Johnson & Johnson Medical) is a range of hydropolymer foam dressings that come in a variety of shapes and sizes, and are designed to fit the different types and locations of wounds that occur in practice. There are three types: Tielle, Tielle Lite and Tielle Plus. Each can be used as either a primary or a secondary dressing. The choice should be based on the characteristics of the primary dressing, if any, and on the degree of exudate that the wound is producing. This article aims to give an overview of the range and a summary of research-based clinical and scientific evidence to support clinical practice.
Nurses' knowledge of prevention and management of constipation
Authors: Richmond Janice P , Devlin Rita
Published: May 2014

Constipation is often a preventable problem in health care; therefore, health professionals must have the appropriate knowledge to help patients prevent this common complaint occurring. The purpose of this study was to assess nurses' knowledge of constipation in a teaching hospital in Northern Ireland. A knowledge questionnaire on constipation was obtained and adapted for use in this study using a non-experimental survey design to assess a convenience sample of nurses (n=131) within various hospital specialties. The results demonstrated gaps in nurses' knowledge of constipation and also indicated that knowledge varied between specialties and between nursing grades. Educational initiatives must not allow bowel care, often labelled ‘basic nursing care’, to be neglected in postregistration education and training.
Descriptive evaluation of Alione hydrocapillary dressing
Authors: Morris Louise
Published: May 2014

It is widely recognized that a moist wound environment enhances epithelial migration and resurfacing, as well as promoting autolytic debridement of necrotic tissue, reducing pain, infection and scarring (Russell, 2002). However, an imbalance in the level of moisture can lead to delayed healing, or even wound extension (Kindlen and Morison, 1999). The type of wound, itself, can be influential in relation to the level of exudate produced. With such a diverse array of wound management products now available, the healthcare professional faces a constant dilemma in deciding what dressing is suitable for maintaining an optimal level of humidity in the wound environment. Alione, a new hydrocapillary dressing, manufactured by Coloplast, appears to overcome this impasse by being sufficiently versatile to manage varying levels of exudate in all types of wounds.
Nursing management of nutrition in cancer and palliative care
Authors: Holder Helen
Published: May 2014

Malnutrition is prevalent in patients with cancer. This can have deleterious effects including reduced response to treatment, diminished quality of life, increased length of hospital stay and decreased survival. It is, therefore, imperative that thorough nutritional screening is carried out by nurses on patients' admission and during their hospital stay to detect those who are malnourished or at risk of malnutrition in order to plan their nutritional care effectively. Cancer cachexia is the progressive weight loss and emaciation seen in cancer patients, particularly in advanced disease, which can have a devastating effect on the physical, psychological, social and spiritual aspects of the patient's life. Therefore, the aims of nutritional care are identified depending on the stage of the patient's illness and recommendations made for nursing, pharmacological and nutritional interventions. These include nursing comfort strategies, the use of recommended pharmacological agents and dietary interventions such as experimenting with different foods, textures, portion sizes and nutritional supplements. The use of fish oil-enhanced nutritional supplements and artificial nutritional support is also discussed. Consideration is also given to the legal and ethical aspects of providing nutrition and nutritional support.
The current approach to human error and blame in the NHS
Authors: Ottewill Melanie
Published: May 2014

There is a large body of research to suggest that serious errors are widespread throughout medicine. The traditional response to these adverse events has been to adopt a ‘person approach’ — blaming the individual seen as ‘responsible’. The culture of medicine is highly complicit in this response. Such an approach results in enormous personal costs to the individuals concerned, and does little to address the root causes of errors and thus prevent their recurrence. Other industries, such as aviation, where safety is a paramount concern and which have similar structures to the medical profession, have, over the past decade or so, adopted a ‘systems’ approach to error, recognizing that human error is ubiquitous and inevitable and that systems need to be developed with this in mind. This approach has been highly successful, but has necessitated, first and foremost, a cultural shift. It is in the best interests of patients, and medical professionals alike, that such a shift is embraced in the NHS.
Clinical governance: trusts failing to meet the challenge
Authors: Tingle John
Published: May 2014

Clinical governance is the centrepiece of the Government's healthcare quality improvement strategy and therefore affects all nurses directly. A key report just published by the National Audit Office (NAO, 2003) shows that some trusts are failing to implement clinical governance properly and are falling down in important areas such as clinical audit and clinical risk management. Many nurses are involved in these areas and are in the position to influence change.
Network For Psychiatric Nursing Research Journal Club
Authors: Cutcliffe John JR , Jones Julia , Jackson Ann
Published: May 2014

In this article, the author surveys established psychiatric nurses' opinions of the content of advanced practitioner nursing roles by sending a questionnaire to a random sample of 100 members of the Network for Psychiatric Nursing Research (NPNR) network, receiving a response rate of 78%. The results identified elements of the ‘normal’ nursing roles (e.g. basic psychotherapeutic practices), and elements of the ‘advanced’ nursing role (e.g. enhanced autonomy in admission and discharge). The study concluded that an advanced psychiatric nursing role was supported by psychiatric nurses and recommended that pilot sites, to test the acceptability and effectiveness of the role, should be established.
Consent and the mentally disordered detained patient
Authors: Dimond Bridgit
Published: May 2014

Mavis has been detained under section 2 of the Mental Health Act 1983 for assessment. Her responsible medical officer prescribes for her an antidepressant. She refuses to take it. What is the law?.
Managing a necrotic heel pressure ulcer in the community
Authors: Clarkson Anne
Published: May 2014

This care study considers the management of an elderly confused woman with a heel pressure ulcer. The care was complicated by clinical infection in the wound resulting in a high exudate level. Management of the infection led to side-effects from systemic antibiotics and therefore topical antimicrobials were used. This highlighted the need to manage patients with wounds as individuals.
A case study of holistic wound management in intensive care
Authors: Cardozo Margaret
Published: May 2014

Complex wounds that have become contaminated after abdominal surgery can cause a great deal of distress to patients, and the management of such wounds requires an holistic and humanistic approach (Torrance, 1985). This case study aims to address the issues of wound management, involving some of the underlying and surrounding problems — exudate, malodour, nutrition and wound pain — that may be associated with chronic wounds after surgery. Further discussed will be the treatment and use of vacuum-assisted closure (VAC) therapy which was administered to the patient in this study. The clinical environment is an intensive care unit (ICU) within a district general hospital. The critical care nurse is primarily involved in caring for resuscitation of the critically ill patient and wound care is often a long way down the list of priorities; however, wound management is important and must be addressed as part of holistic nursing care.
The management of hard-to-heal necrobiosis with PROMOGRAN™
Authors: Onugha Nwando , Jones Annie M
Published: May 2014

Nearly one-third of patients with diabetes mellitus have some sort of dermatologic complication. Necrobiosis lipoidica diabeticorum (NLD) is a degenerative disease of the collagen in the dermis occurring in 0.3–0.7% of the diabetic population. There is no standard therapy for patients with NLD. The lesions associated with the condition appear as well circumscribed, erythematous plaques, with a depressed, waxy telangiectatic centre. One-third of these lesions may progress to ulcers if exposed to any trauma. Management of these compromised wounds is often difficult, as NLD often goes through stages of activity and inactivity. This case study clearly illustrates some of the problems associated with wound management in a 34-year-old woman with an unhealed ulcer of 3 years' duration. Treatment with a new protease modulating matrix resulted in complete healing of the ulcer after 8 weeks, where other dressing regimens had failed to affect healing over a period of 2.5 years.
The challenge of transitional care for young people with life-limiting illness
Authors: Maunder Eryl Zac
Published: May 2014

Transitional care for young people with life-limiting illness is a particularly complex issue. The process of moving from paediatric to adult services is often fraught and poorly planned. As a result, this can add to the distress experienced by the young people and their families. The ideal would be to have a dedicated service for young adults that bridges the gap in care. The continued slow growth of community children's nursing services, however, highlights the constraints in developing services for a relatively small percentage of the population. Healthcare professionals must recognize the specialist needs of this patient group, and develop strategies to ensure that young people receive the care to which they are entitled.
Confidentiality of patient information when preparing for death
Authors: Dimond Bridgit
Published: May 2014

Maggie O'Farrell, the writer, recounts that when she was a child she was severely ill in hospital and heard a nurse say to another child outside the room ‘Be quiet. There’s a little girl dying in there'. At first she had not understood, but as she stared and stared at the nurse who now would not look her in the eye, slowly she realized that this person had been talking about her. What are the legal implications?
Stress caused to nurses following the death of patients: employer's duty
Authors: Dimond Bridgit
Published: May 2014

Margaret worked in an adolescent unit for sufferers from cystic fibrosis. The unit was under considerable pressure since it served the whole region, and often teenagers were brought in at a very serious stage of their illness and died in the unit. One Christmas they had had a particularly stressful time, with several youngsters suffering long and uncomfortable deaths and Margaret, who had grown close to many of them over the years, found the work was becoming more stressful. Sometimes she was given the time to attend the funerals, but at other times the unit was too busy for staff to be released and they had to carry on working in the unit. Margaret found it difficult to cope with the pressure. She told her colleagues that she was not sleeping well and was advised to get some medication from the doctor. She did not like to miss work, since her loyalty to her colleagues meant that she was aware of the additional pressure that they would be under if she failed to get to work. One day she broke down in uncontrollable tears at work, and found it difficult to continue. She was advised to go home early, but found that her condition deteriorated, until she found herself shaking and too unsure of herself to do the simplest task. Her doctor advised her that she was suffering a form of mental breakdown and wanted to refer her to a specialist. She was advised that she would be unlikely to be able to return to work in the near future. She is concerned about her loss of income and inability to work. What is the law?.
Nosocomial bloodstream infections in a neonatal intensive care unit
Authors: Apostolopoulou Eleni , Lambridou Maria , Lambadaridis Ioannis
Published: May 2014

A study was performed to assess the incidence density of, and to identify the risk factors associated with, nosocomial bloodstream infection (BSI) in a neonatal intensive care unit (NICU) in Athens. Twenty-four of 105 patients developed nosocomial BSI (22.9%). The incidence density of BSI was 10.9 per 1000 patient-days. A multivariate model showed that only two factors were significantly and independently responsible for nosocomial BSI: central venous catheter use and umbilical catheter use. Results showed that the incidence density rate was high and the factors that had most influence on the development of nosocomial BSI were associated with the treatment received by neonates during their stay in the NICU. Therefore, surveillance of nosocomial BSI and strategies such as infection control, nursery design and staffing should be implemented to reduce the incidence of these infections. This effort should be multidisciplinary, involving staff who insert and maintain intravascular catheters, and healthcare managers who allocate resources.