bluuebunny/crossref_metadata_2025 huggingface dataset:
Depression and stroke: a common but often unrecognized combination
Authors: Gray Richard , Lindsay Bruce
Published: May 2014

Stroke is an extremely common rapid onset medical emergency that can cause permanent neurological damage. Depression is very common in both stroke survivors and their carers, but it is frequently overlooked in both groups. Nurses can make a substantial improvement to patient care by not only being aware of this issue, but also by making an active contribution to the detection of depression in stroke survivors and their carers. The mental health of carers is intertwined with the mental health and disease presentation of the patient. A family centred approach with a dual focus on the stroke survivor and the carer is therefore needed to maximize success in post-stroke care. Nurses can teach families to recognize depression and assist them to accept treatment. They can use the Patient Health Questionnaire 9–item depression scale (PHQ-9) as probably the most suitable screening and diagnostic tool for both groups. Nurses can play a role in destigmatizing the diagnosis and the link between symptoms of depression and treatment. Finally, nurses can play an important part in initiating, monitoring and adjusting treatment.
Case study: negative pressure wound therapy in an abdominal wound
Authors: Bryan Sandra , Dukes Suzie
Published: May 2014

This article explores the history and management of large abdominal wounds and the importance of a multi-disciplinary team approach to wound healing. It identifies the difficulties of using negative pressure wound therapy (NPWT) in a patient with a large abdominal wound, which is further complicated by an ileostomy. NPWT is increasingly used for large wounds with positive outcomes, however, the case study demonstrates the many difficulties involved and how they were overcome. Cavity wounds can take weeks, or even months to heal and many patients become frustrated. This can have a significant impact on their quality of life. Prolonged hospitalization is not only devastating to the patient and family both physically, psychologically and financially, but is also costly in terms of nursing time and resources.
New single-layer compression bandage system for chronic venous leg ulcers
Authors: Lee Gillian A , Rajendran Subbiyan , Anand Subhash
Published: May 2014

A new single-layer bandage system for the treatment of venous leg ulcers has been designed and developed at the University of Bolton. This three-dimensional (3D) knitted spacer fabric structure has been designed by making use of mathematical modelling and Laplace’s law. The sustained graduated compression of the developed 3D knitted spacer bandages were tested and characterized, and compared with that of commercially available compression bandages. It was observed that the developed 3D single-layer bandage meets the ideal criteria stipulated for compression therapy. The laboratory results were verified by carrying out a pilot user study incorporating volunteers from different age groups. This article examines the insight into the design and development of the new 3D knitted spacer bandage, along with briefly discussing the issues of compression therapy systems intended for the treatment of venous leg ulcers.
The use of Flivasorb®> in highly exuding wounds
Authors: Tadej Martin
Published: May 2014

Exudate can be an excellent indicator of what is happening within a wound and, therefore, provides valuable information during patient assessment. The volume, consistency, and particularly odour and colour, of any exudate will inform the practitioner about bacterial contamination, infection and stage of healing (Hampton and Collins, 2003). However, in the chronic wound, exudate must be effectively managed if the optimal moist environment necessary for wound healing is to be created, the negative effects of chronic exudate on fibroblasts are to be avoided (Phillips et al, 1998), and the surrounding skin protected from the risks of maceration (White, 2006). It is, therefore, important to understand chronic exudate and its effects so that appropriate treatment for the wound and peri-wound area is provided. Flivasorb®> (Activa Healthcare) dressings, which include superabsorber particles, can absorb the exudate and retain it firmly within the dressing, ensuring that the potentially damaging chronic wound exudate does not reflect back onto the wound, causing maceration. This article will describe the role of exudates in wound healing, the problems associated with chronic wound exudates and how Flivasorb dressings with superabsorbent particles can provide an optimum healing environment in highly exuding wounds.
Student nurses’ perceptions of non-traditional clinical placements
Authors: Gillespie Mark , McLaren David
Published: May 2014

The inclusion of non-traditional clinical placements within a pre-registration nurse training course led to some concerns regarding the relevance and appropriateness of such experience within a nursing programme. These concerns gave rise to a literature review to explore student nurses’ attitudes to clinical placements within non-traditional areas. Non-traditional placement areas enable contact with vulnerable populations, including older adults, people experiencing mental illness and those with intellectual or physical disabilities. Positive practice placement experience is associated with the successful development of clinical skills, strongly influences future career choice and is suggested to have a significant impact on the attitudes the student has towards the client group and specialism. There may need to be a shift in emphasis within nurse education, away from the traditional medical model, towards a more holistic understanding of care
Emergency nurses’ provision of spiritual care: a literature review
Authors: McBrien Barry
Published: May 2014

The emergency setting has undergone significant changes in recent years. Notably, the throughput and acuity of patients has increased, with a concomitant improvement in the clinical and technical management of these patients (Dolan, 1998; Coughlan and Corry, 2007). However, there is evidence to suggest that the increase in workload and proliferation of technology, at such a fast pace, has potentially threatened the caring component of nursing, including spiritual care (Wilkin and Selvin, 2004). During hospitalization, the majority of patients tend to become anxious because of the fear of the unknown, an uncertain future, and possible resultant complications of their respective illnesses. In this regard, patients being treated in emergency departments are at vulnerable periods of their lives. Consequently, while the emergency department can be physically demanding, nurses spend considerable time in intense interactions with patients. In spite of this, changes have brought associated pressures on both nurses and patients (Bailie, 2005). Therefore, although advances in technology can enable nurses to objectively measure responses to care; conversely, it can supersede the premise of holistic health care. Nonetheless, it has been empirically shown that caring and the provision of spiritual care is not only possible within the technological world of emergency nursing, but it can be positively enhanced by the mastery of the technological environment (Locin, 1995; Little, 2000)
Effective evidence-based catheter management: an update
Authors: Nazarko Linda
Published: May 2014

Every year over one million urinary catheters are inserted in NHS hospitals. Each of these has the potential to harm. Urinary catheters can lead to trauma and increase the risks of infection and bladder dysfunction. Urinary catheterization can have catastrophic effects on the bladder and a person’s ability to regain continence in the future (Patel and Arya, 2001). Approximately 25% of urinary catheterizations are not clinically necessary. Certain groups of people, such as older people, are at a greater risk of unnecessary catheterization and its associated risks. This article explores the clinical indications for urinary catheterization, the importance of appropriate product selection, and acting to reduce the risk of infection
Respiratory practitioners’ experience of end-of-life discussions in COPD
Authors: Crawford Anne
Published: May 2014

The importance of palliative care and implementing end-of-life tools nationally is well recognized, yet inequalities in care between patients with malignant and non-malignant disease are well documented. There is little evidence that open discussions regarding end-of-life decision-making are taking place routinely with patients who have non-malignant disease, so it seemed appropriate to investigate health professionals’ perspectives. Aim:This study aimed to explore and provide insight into respiratory health professionals’ experiences of their discussions with patients with life-limiting chronic obstructive pulmonary disease (COPD). Method A qualitative phenomenology approach was used. In-depth, face-to-face interviews were conducted with a purposive sample of three respiratory nurses, two lung cancer nurse specialists, and two respiratory physicians.Findings: The seven in-depth interviews were thematically analysed so that the data could be categorized. The themes that emerged were: choosing the right time; the skill of picking up and receiving cues; deciding when, what and how to tell; boundaries to discussion; and working with emotions.Conclusions: The main findings highlighted the difference in approach in discussions between patients with cancer and those with non-malignant disease. The emotional phenomena that emerged could have significant implications for clinical practice. The findings suggest that the emotional dimension plays a crucial part in engaging with patients and involving them in end-of-life care planning.
Improving peripheral cannulation practice at an NHS Trust
Authors: Bolton Debbie
Published: May 2014

Unplanned recannulations are a common occurrence in a number of hospitals both in the UK and worldwide (Schwengel, 2004; Jackson, 2007). In May 2008 the Clinical Nurse Specialist in IV Therapy at Brighton and Sussex University Hospital (BSUH) NHS Trust initiated a clinical audit to assess IV practice and determine the impact of recannulations within the Trust. The audit, which was initially carried out on 1000 sequential cannula insertions, and is currently ongoing, showed that 69.2% of the cannulas failed well before the routine change of 72 hours, and that 36.3% were removed because they had infiltrated. With the aim of reducing these numbers of unscheduled recannulations, the Nurse Specialist initiated a real-time, prospective clinical evaluation of a new cannula stabilization device at BSUH. This assessed the impact of the device alongside the currently used securement strategy (IV dressing) on unscheduled IV restarts in 50 cannulas compared with the baseline data. During the clinical evaluation, all IVs were tracked every 4 hours and all complication/ reasons for removal were noted. On initiation of the use of the stabilization device, the infiltration rate was reduced from the baseline level by 100%. There was also an 81% reduction in the rate of unscheduled IV restarts. The data from the clinical evaluation demonstrated the considerable benefits of using a cannula stabilization device compared with the current hospital practice of using IV dressings only for securement with regard to infiltration levels and unplanned restarts. This device may have significant future benefits in terms of improving patient care and reducing healthcare expenditure.
Effects of education and experience on nurses’ value of ulcer prevention
Authors: Samuriwo Ray
Published: May 2014

Few studies have focused on the value that nurses place on pressure ulcer prevention, even though values are a key determinant of a person’s behaviour and actions. Previous studies have reported that the value that a nurse places on pressure ulcer prevention is linked to the skin care that they deliver. This article describes a study that was undertaken to determine the value that nurses place on pressure ulcer prevention, which also identified how this value is formed. The participants in this study (n=16), were recruited from non-acute adult medical wards of 14 hospitals in one NHS trust, and a university. Data was gathered via semi-structured interviews and interpreted through Straussian grounded theory. The findings of this study show how the participants underwent a transition from placing a low to a high value on pressure ulcer prevention and how this affected patient care. The key point in this transition appears to be an encounter with a patient with a high grade pressure ulcer, which caused the nurses to reappraise their values. Looking after patients with pressure ulcers seems to increase the value that a nurse places on pressure ulcer prevention. The education that nurses receive on pressure ulcer prevention only appears to alter their values when they have some experience of looking after patients with pressure ulcers.
Hydrogels and their potential uses in burn wound management
Authors: Edwards Jacky
Published: May 2014

Hydrogels are recognized as the standard treatment for necrotic or sloughy wounds. Autolytic debridement of devitalized tissue is essential to promote wound healing; thisdepends on the whole area being kept moist so that natural enzymatic reactions can take place. Hydrogels are considered to be gentle debriders, promoting rehydration of non-viable tissues. Hydrosorb ® and Hydrosorb®Comfort are hydrocellular gel dressings that are made from 60% water and are therefore suitable for keeping granulation tissue and young epithelium moist. Additionally, Hydrosorb provides a cushioning effect for wound protection, and has a soothing and cooling effect on superficial burns.For some patients with burns, such as the elderly, Hydrosorb can be applied to speed up the process of debridement where surgery is not an option; a case study is given to show the effective healing process.
Simulation training for hyperacute stroke unit nurses
Authors: Roots Angela , Thomas Libby , Jaye Peter , Birns Jonathan
Published: May 2014

National clinical guidelines have emphasized the need to identify acute stroke as a clinical priority for early assessment and treatment of patients on hyperacute stroke units. Nurses working on hyperacute stroke units require stroke specialist training and development of competencies in dealing with neurological emergencies and working in multidisciplinary teams. Educational theory suggests that experiential learning with colleagues in real-life settings may provide transferable results to the workplace with improved performance. Simulation training has been shown to deliver situational training without compromising patient safety and has been shown to improve both technical and non-technical skills ( McGaghie et al, 2010 ). This article describes the role that simulation training may play for nurses working on hyperacute stroke units explaining the modalities available and the educational potential. The article also outlines the development of a pilot course involving directly relevant clinical scenarios for hyperacute stroke unit patient care and assesses the benefits of simulation training for hyperacute stroke unit nurses, in terms of clinical performance and non-clinical abilities including leadership and communication.
Effects and experiences of warm versus cold skin disinfection
Authors: Wistrand Camilla , Nilsson Ulrica
Published: May 2014

The intention of preoperative skin antisepsis is to reduce the risk of postoperative surgical wound infections through the prevention of contamination of the wound site from the patient's skin flora, and to provide a sterile work area.

This pilot study aimed to compare warm versuscold skin disinfection with a chlorhexidine solution on bacterial growth, skin temperatures and the experiences of the disinfection. Ten healthy volunteers without any association to Sweden's healthcare services were included in an experimental study with crossover design. The results showed that warm (38°C) disinfection seems to be comparable with cold (20°C) disinfection in reducing bacterial growth. Experiences differ, but warm disinfection is generally considered more pleasant than cold as a result of heat-loss to the skin. However, further research with larger sample sizes and on patients undergoing surgery is needed.
Why are nurse mentors failing to student nurses who do not meet clinical performance standards?
Authors: Jervis Anne , Tilki Mary
Published: May 2014

This article reports findings from a qualitative study exploring mentors' reluctance to refer students who did not perform adequately in clinical settings. A focus group and individual semi-structured interviews were undertaken with experienced stage two mentors in an NHS trust. Mentors spoke of having to balance objectivity and intuition when dealing with upset or angry students, those who were popular or those who tried hard but did not perform adequately. They describe a number of factors that led them to pass a student who was less than satisfactory. In particular the findings highlight difficulties with measuring and recording attitudes. The data demonstrate the willingness and motivation of mentors to keep up to date and learn from their students. However, findings also suggest the need for mentors to have greater confidence in their own clinical abilities. Recommendations are made for training strategies to address these barriers in order to ensure that only competent, caring nurses are allowed to register.
Ehlers-Danlos syndrome and wound healing: injury in a collagen disorder
Authors: Trudgian Julie , Trotman Sara
Published: May 2014

Ehlers-Danlos syndrome (EDS) is a rare familial disorder affecting the production, quality and strength of collagen. It presents in many forms, and many individuals experience hypermobile joints and soft, elastic skin. When injury occurs, EDS can result in severe bruising, the development of wide open wounds and delayed healing ( Babak et al, 2003 ). In the case discussed, Lilly, a 10-year-old girl, presented with a wide trauma injury to her lower leg. Healing was influenced by the poor collagen production associated with EDS, and the presence of a high bacterial burden that resulted in infection. Manuka honey was used to reduce the level of invading bacilli and stimulate production of collagen. Following this intervention, complete healing was achieved in two weeks. The action of manuka honey appears to be beneficial in the management of complex wounds, and further research is needed to determine its value in EDS. Involvement of Lilly and her family in clinical decision-making and in the production of this article resulted in a growth in understanding for all parties and the development of a relationship that optimized the nurse/patient experience.
Evaluation of patient outcomes: pressure ulcer prevention mattresses
Authors: Rafter Linda
Published: May 2014

This article reports the findings of a small evaluation audit which compares the Dyna-Form Mercury Advance Mattress to that of the Softform Premier Active Mattress (a foam mattress with dynamic underlay). A small group of patients with similar co-morbidities who were an emergency admission were recruited to an evaluation audit. Their median age and Waterlow score indicated that these patients were at high risk of pressure ulcer development. All patients were given the same nursing care on the two mattresses and all were moved, handled and repositioned 2-4 hourly. Of the patients nursed on the Dyna-Form Mercury Advance mattress, three did not develop pressure ulcers. The two who already had pressure ulcers when they were recruited appeared to have healed within four days. Of the patients nursed on the Softform Premier Active mattress, three patients did not develop ulcers and two did. Although the sample size was small, the comprehensive assessment gave interesting results, particularly on the Dyna-Form Mercury Advance. A larger study may be of benefit to demonstrate efficacy of these products further.
Intravenous drug preparation: the infection risks
Authors: Curran Evonne
Published: May 2014

The preparation of intravenous drugs is a common yet inherently dangerous nursing procedure. Potential errors associated with this procedure include incorrect drugs, doses and routes of administration. As a consequence of these recognized risks, a variety of checks are used to optimize safety. This paper explores the literature around infusate contamination, which can cause infusate-related bloodstream infection (IR-BSI). In addition, this paper will discuss the mechanisms of infusate contamination, as well as details of the types of microorganisms that cause contamination and the types of drugs that enable proliferation of microorganisms. Deficits within current guidance are revealed. The paper concludes that IR-BSI is a significant but under-recognized risk to patients. As microbial contamination sufficient to cause IR-BSI is not detectable to the naked eye, those who prepare intravenous drugs must be more aware of contamination risks and how to reduce them.
Return on investment: workload, complexity and value of the CNS
Authors: Oliver Susan , Leary Alison
Published: May 2014

The rheumatology nurse specialist (RNS) has become an integral and vital part of the multidisciplinary team and is valued by patients. Yet, a number of challenges regularly face all clinical nurse specialists (CNS) in the UK. The perception that CNS are an expensive and poorly defined nursing resource results in regular threats to their sustainability, particularly that of the RNS. This study examined return on investment of the RNS.

Method:

An interrelational Structured Query Language (SQL) database collected data on the day-to-day activities of the RNS based on previous models of CNS and RNS work, and qualitative narrative data were then subjected to data mining.

Results

The RNS represented an excellent return on investment, in terms of income generation activity, patient safety and efficiency. These outcomes were achieved using key principles of proactive case management using vigilance, rescue work and brokering. The mean average per whole time equivalent (WTE) RNS per annum represents £175 168 in terms of income/savings to an employing NHS Trust. This figure is likely to be an underestimation, as calculations on reduction in bed days in hospital have not been included.
Parents’ experiences of their child’s first anaesthetic in day surgery
Authors: Andersson Lisbet , Johansson Ingrid , Österberg Sofia Almerud
Published: May 2014

Background: Parents play an important part in their child’s anaesthesia. When a child has to receive anaesthesia, it is of great importance that parents are there by his/her side as children depend on them for support. Many parents worry and experience fear before their child’s anaesthesia and studies show that there is a correlation between a worried parent and a worried child. Aim: The purpose of this study was to illustrate the meaning of being a parent at one’s child’s first anaesthesia in day surgery. Method: Six parents were interviewed and data were analysed using a descriptive qualitative approach inspired by phenomenology. Result: The phenomenon, ‘a child’s first anaesthesia in day surgery as experienced by parents’ is based on the following components: ambivalence between worry and relief, a feeling of losing control, needing to be prepared, being able to be present and a need of emotional support. Conclusion: Specific individually-adapted information with a compulsory preoperative visit, presence and participation from, if possible, both parents at their child’s anaesthesia but also designated staff from the anaesthetic team to focus solely on supporting the parents at their child’s anaesthesia induction can improve the conditions for security.
Making patients active participants in their own treatment decisions
Authors: Griffith Richard
Published: May 2014

#x2018;No decision about me without me’ describes the Department of Health’s latest vision for the health service where patients are active participants in their treatment decisions. This article argues that for ‘no decision about me without me’ to be a reality, nurses must be required to obtain a truly informed consent from their patients by ensuring that information about the benefits and risks of treatment are properly explained to all patients regardless of their ability to question the treatment decision.
Exploring compassion: implications for contemporary nursing. Part 1
Authors: Straughair Collette
Published: May 2014

The origin of compassion is firmly rooted in religious ideologies. In 19th century Great Britain, Christianity was the prominent religion and scripture advocated that followers should always be compassionate in their deeds and actions. Florence Nightingale was a Christian and translated her ideals into the characterization of the professional nurse. The image of the ministering angel, performing the work of God, was perpetuated for some time. However, as the profession of nursing advanced to develop evidence-based practice, some of the ethos of the compassionate nursing character was seemingly lost in favour of technical skills. This is supported by evidence suggesting that nurses have a decreased affinity with the ethos of altruism. Recent reports have highlighted negative patient experiences which reflect a clear lack of compassionate nursing care. This has led to a variety of documents re-endorsing the concept of compassion as a core and fundamental nursing value. This has raised several issues for nursing practice which require due consideration if the profession is to restore the image of the compassionate nurse, technically skilled and clinically effective, equipped with the appropriate skills, knowledge, values and attitudes to fulfil the pledges to respond to patients with humanity and kindness and to deliver high-quality compassionate care.
The Mental Health Act:exploring the role of nurses
Authors: Laing Judith M
Published: May 2014

This paper examines the role of approved mental health professional (AMHP) which was introduced by the Mental Health Act 2007. It outlines the scope and functions of the role and explores the likely impact on the nursing profession. While the expansion of the role does offer opportunities for career progression and enhancing professional autonomy and status, it must be accompanied by a corresponding increase in resources and training, to enable nurses to fully harness the AMHP role. This expansion will inevitably bring with it increased legal responsibility and accountability and the extent to which mental health/learning disability nurses will be willing to shoulder that remains to be seen.
Exploring compassion: implications for contemporary nursing. Part 2
Authors: Straughair Collette
Published: May 2014

A range of contemporary political and professional literature endorse the principle of compassion in nursing as a core and underpinning philosophy fundamental to the profession. However, despite pledges to ensure that compassion lies at the heart of nursing, the concept has not been clearly defined. It is evident that uncovering the true meaning is complex and challenging owing to its subjective nature. In light of this, several implications must be considered. Effective student nurse recruitment is essential to ensure that the most appropriate individuals are selected. Contemporary marketing campaigns must be implemented, and recruitment strategies developed, which consider specific values and attitudes. Service user involvement in recruitment and selection, curriculum planning and learning and teaching strategies, and post-qualification education, can enhance nurses' understanding of the patient perspective and make headway in embedding compassion as a core nursing value. Additionally, effective role modelling in practice which demonstrates high-quality compassionate nursing care is essential. Nurses must be adequately supported in the clinical environment to facilitate compassionate behaviours and clinical leadership at all levels must uphold political and professional pledges to achieve this. Consideration of these implications for practice is essential to ensure that nurses are able to respond to patients with humanity and kindness, and deliver high-quality, compassionate care to all.
Sweat and tears: treating the patient with primary hyperhidrosis
Authors: Wheeler Tracey
Published: May 2014

Hyperhidrosis is a distressing disorder characterised by excessive sweating. Whereas some cases are secondary to underlying conditions, primary hyperhidrosis is the more common form affecting around 3% of the population. Typically starting in childhood or adolescence, primary hyperhidrosis has a significant impact on an individual's quality of life and self-esteem, which is similar to that of more well recognised skin conditions, such as psoriasis, severe pruritus and acne. Treatment options for primary hyperhidrosis are varied, including topical treatments, Botulinum toxin A, systemic medication, iontophoresis and surgery; however, each method has drawbacks that are discussed in this article. Case examples within the article illustrate the potential of several of these treatments. Particular issues surrounding the treatment of children and adolescents with this condition are also discussed.
Nutrition for wound healing
Authors: Medlin Sophie
Published: May 2014

The importance of the role of nutrition in wound healing is an area that has been widely explored over the last decade. It is well recognised that both macronutrients (protein, fat and carbohydrate) and micronutrients (vitamins, minerals and trace elements) play important parts in the healing of both chronic wounds and acute injuries. The term ‘wound’ encompasses many different situations from leg ulcers to laparostomy wounds. This article provides an overview of the role of different nutrients in the healing of wounds and guidance to nurses on first-line assessments, which can be used to ensure the patient is receiving adequate nutrition for successful wound healing. It will focus on commonly seen wounds in primary and secondary care but will not cover specialist wound management, such as laparostomy sites and burns, as these must always be cared for by experienced and specialist multidisciplinary teams.
Focus group interviews in nursing research: part 1
Authors: Doody Owen , Slevin Eamonn , Taggart Laurence
Published: May 2014

Focus groups are used by researchers in the social and behavioural sciences to explore phenomena and are accepted as a legitimate qualitative methodology. The primary goal of focus groups is to use interaction data resulting from discussion among participants to increase the depth of the enquiry and reveal aspects of the phenomenon assumed to be otherwise less accessible. This article, the first of three articles on focus groups, examines the nature of focus groups, issues regarding planning focus groups, selecting participants and the size of the groups. This article is aimed at students who are undertaking research modules as part of their academic studies or writing a research proposal as well as at novice researchers who intend to use focus groups as a means of data collection.
Workplace wellness for HIV/AIDS-affected nurses in South Africa
Authors: Basson Helena Aletta , Roets Lizeth
Published: May 2014

Purpose:

The development of a framework for a workplace wellness programme for HIV/AIDS infected and/or affected nurses in South Africa, who comprise registered nurses and midwives, enrolled staff nurses and auxiliary nurses.

Research objectives:

To identify and describe components for a framework of a workplace wellness programme.

Background:

Registered nurses and midwives, enrolled staff nurses and auxiliary nurses (referred to as nurses) in the South African nursing workforce are confronted daily with HIV/AIDS in the workplace due to the high HIV/AIDS prevalence rate among sexually and economically active adult women between 15–49 years of age. The research explains how health and wellness could be promoted by instituting a workplace wellness programme.

Research design:

Quantitative descriptive research.

Findings:

The nurses emphasised the threat of HIV/AIDS and considered a workplace wellness programme a priority. Conclusion: A logic model underpinned the workplace wellness programme framework.
Making the link between critical appraisal, thinking and analysis
Authors: Whiffin Charlotte Jane , Hasselder Alison
Published: May 2014

Nursing has become an all-graduate profession; as such, student nurses must develop their skills of critical analysis. The need to develop critical analytical thinking has been identified as the single most important skill in undergraduate education and reaching the academic requirements of level six study. In degree-level healthcare programmes, students are frequently asked to complete a structured critical appraisal of research. This paper examines how critical appraisal activities can be an opportunity for students to develop transferable critical thinking skills. Critical appraisal teaches objectivity, reflection, logic and discipline, which encourage students to think critically in both theory and practice.
What are the roles of clinical nurses and midwife specialists?
Authors: Wickham Sheelagh
Published: May 2014

Research shows the increasing part the Clinical Nurse Specialist (CNS) plays in healthcare today. But what does a CNS actually do in their day-to day-work? This study, set in the Republic of Ireland, aimed to explore the CNS and clinical midwife specialist (CMS) roles in practice.

Quantitative methodology was used to explore the roles and activities of the CNS and CMS. Following ethics approval, a valid and reliable questionnaire was circulated to the total population of CNS/ CMS in Ireland. The data were analysed using SPSS.

This study articulates the individual role elements and activity level. The findings show the CNS/CMS to be active in the roles of researcher, educator, communicator, change agent, leader and clinical specialist, but the level of activity varies between different roles and individual role elements.

The CNS/CMS is seen as a valuable resource in health care today and has potential to have a positive effect on patient care. The majority of CNS/CMSs are active in varying roles but the analysis shows lesser activity in some areas, such as research. The findings merit further study on role activity and possible variables that influence role activity.
The effect of stress on health and its implications for nursing
Authors: O Donovan Regina , Doody Owen , Lyons Rosemary
Published: May 2014

Stress is an important issue within nursing and it is difficult to find agreement among those who are expert in the area regarding a concise definition of stress. Nevertheless stress is seen as a negative feeling affecting people's health either physically and/ or psychologically. However, stress is a normal part of life and considered necessary to increase functional capacity, whereas stress over a prolonged period or when extreme can cause distress which may have debilitating effects that reduce work output, increase absenteeism and reduce one's ability to cope with situations. The most important resource in any organisation is the employee; therefore maintaining and supporting their health is vital to ensure their ability to work, maintain standards and continuously improve standards of care. Leadership styles within organisations must facilitate staff to be involved in decision making; thereby staff feel more valued and work in an autonomous way. This article identifies and discusses the effect of stress on health and its relationship to nursing.
Holding children and young people: defining skills for good practice
Authors: Page Andrea , McDonnell Andrew
Published: May 2014

Physical holds are used to help children and young people receive clinical care in situations where their behaviour may limit the ability of nurses and allied professionals to deliver treatment effectively. This article provides an overview of a qualitative study of 11 nurses and allied professionals who were interviewed with semi-structured questions. The major findings suggest there is a lack of clear and agreed terminology and nurses and allied professionals are guessing at how to describe the practice. As a result, there was no discussion or documentation of the practices of holding (whether successful or unsuccessful) within the clinical area. For the last decade, professional opinion was that this is an ‘uncontested practice’. It can therefore be questioned whether this practice has moved from being ‘uncontested’ to ‘indifferent’. Nurses and allied professionals need to revive a common definition of ‘good’ around the actions of holding, which can hopefully lead to holding skills being more clearly defined and evidence-based.
Science and intuition: do both have a place in clinical decision making?
Authors: Pearson Helen
Published: May 2014

Intuition is widely used in clinical decision making yet its use is underestimated compared to scientific decision-making methods. Information processing is used within scientific decision making and is methodical and analytical, whereas intuition relies more on a practitioner's perception. Intuition is an unconscious process and may be referred to as a ‘sixth sense’, ‘hunch’ or ‘gut feeling’. It is not underpinned by valid and reliable measures. Expert health professionals use a rapid, automatic process to recognise familiar problems instantly. Intuition could therefore involve pattern recognition, where experts draw on experiences, so could be perceived as a cognitive skill rather than a perception or knowing without knowing how. The NHS places great importance on evidence-based practice but intuition is seemingly becoming an acceptable way of thinking and knowing in clinical decision making. Recognising nursing as an art allows intuition to be used and the environment or situation to be interpreted to help inform decision making. Intuition can be used in conjunction with evidence-based practice and to achieve good outcomes and deserves to be acknowledged within clinical practice.
How patient beliefs affect adherence to prescribed medication regimens
Authors: Chummun Harry , Boland David
Published: May 2014

This article analyses the evidence relating to patients' beliefs and adherence to prescribed medication regimens. Between 30% and 50% of patients question the appropriateness and effectiveness of their prescribed medication and often do not comply with their regimens, which means significant amounts of NHS cash is wasted on unused medications. A critical analysis of published literature from several electronic databases and professional journals was undertaken. This showed a strong qualitative relationship between patients' beliefs about their medication and adherence to regimens. Better communication with and involvement of patients in the decision-making process of medication prescribing is significant in reducing misconceptions, improve beliefs and promote adherence to prescribed regimens.
Gastro-oesophageal reflux. Part 3: medical and surgical treatment
Authors: Talalwah Narmeen Al , Woodward Susan
Published: May 2014

Introduction and background: Gastro-oesophageal reflux disease (GORD) is a recurrent, long-term gastrointestinal condition characterised by the abnormal reflux of stomach contents into the oesophagus. Heartburn is the most dominant symptom, which can be life long and can considerably reduce quality of life. The main goals of treatment are to alleviate symptoms and prevent relapses, oesophageal stricture and adenocarcinoma. This paper presents a review comparing the effectiveness of omeprazole with Nissen fundoplication surgery for the treatment of GORD. Methods: A search for English-language studies on adults was conducted using three databases—MEDLINE, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL). Thirteen studies were included in the review. Findings: Nissen fundoplication is more effective in controlling heartburn symptoms, healing oesophagitis and preventing relapses than omeprazole. Quality of life, in terms of productivity and ability to work, is difficult to assess in the omeprazole group and, as a result, a comparison of this aspect is limited. Although fundoplication is expensive in the short term, it is more cost-effective than omeprazole after 8 years. Conclusions: Nurses need to be aware of the effectiveness of omeprazole and fundoplication to provide patients with accurate information, which assists patients in decision making regarding treatment options.
Evaluation of an electrocardiograph-based PICC tip verification system
Authors: Oliver Gemma , Jones Matt
Published: May 2014

Performing a chest x-ray after insertion of a peripherally inserted central catheter (PICC) is recognised as the gold standard for checking that the tip of the catheter is correctly positioned in the lower third of the superior vena cava at the right atrial junction; however, numerous problems are associated with this practice. A recent technological advancement has been developed that utilises changes in a patient's electrocardiograph (ECG) recorded from the tip of the PICC as a more reliable method. This evaluation discusses how a vascular access team in a large acute NHS Trust safely and successfully incorporated the use of ECG guidance technology for verification of PICC tip placement into their practice.
Hidradenitis suppurativa: a case study
Authors: Topley Barbara , Brain Sandra
Published: May 2014

This article identifies the care and treatment of a male patient during an acute flare up of hidradenitis suppurativa (HS). This article looks at HS, which can be a progressive chronic condition that impacts heavily on all aspects of a patient's quality of life. The choice of a silver alginate dressing proved effective in managing multiple surgical wounds in a comfortable and effective manner, improving the patient's quality of life.
Nursing documentation of inpatient care in eastern Ghana
Authors: Asamani James Avoka , Amenorpe Frank Delasi , Babanawo Felicia , Ofei Adelaide Maria Ansah
Published: May 2014

Background:

Despite the usefulness of a well-documented nursing care record, documentation still has its setbacks and receives varying levels of priority among nurses and other health professionals. However, since the quality and standard of patient care is often measured from retrospective records, it is imperative to examine the practice of nursing care documentation.

Aim:

The study described in this article examined current practices of nursing care documentation in Ghana.

Method:

By means of multiple sampling strategies, a retrospective approach was used to evaluate 100 patient care records in two hospitals between 1 November and 31 December 2012.

Findings:

Major findings are that 46% of care given to patients was not recorded in the nursing care records; that nurses’ progress notes were not written for 63% of patients after the first day of admission; and that 57% of documentation was not signed by nurses.

Conclusion and recommendation:

The standard of nursing care documentation is not on a par with that in developed countries, partly owing to a lack of guidelines, as well as a persistent shortage of nurses and the limited use of nursing care records. It is recommended that nursing stakeholders use a multidisciplinary approach to develop policies/guidelines on nursing care documentation and provide training opportunities for nurses on effective documentation.
Choosing the ‘right’ people for nursing: can we recruit to care?
Authors: Wood Cate
Published: May 2014

Can we recruit to care? A brief view of the recruitment of student nurses at a UK university is highlighted as an example of selecting the ‘right’ people for nursing careers. The Francis report advises that student nurses need to be both intelligent and caring, with an intrinsic desire to help others. They are required to be passionate about the values that underpin nursing and motivated to put the welfare of others above their own. When recruiting nurses from a society with values far removed from those desired by the nursing profession, finding the right people to become the workforce of the future is a difficult task. Academic and practice personnel interviewed potential student nurses with an emphasis on looking for caring attributes alongside the necessary educational requirements. The students were being recruited for a new humanised nursing curriculum with caring values at the heart of the educational experience.
Understanding mitochondrial disease and goals for its treatment
Authors: Codier Estelle , Codier David
Published: May 2014

Mitochondrial disease is a progressive, debilitating, incurable illness that results from mutation of genes that regulate mitochondrial function. The disease can manifest in utero or at birth, during childhood, or have a delayed onset in adulthood. Mitochondrial disease can be transmitted as a genetically carried mutation or develop as a spontaneous genetic mutation later in life. As a multisystem disease with a highly variable clinical presentation, mitochondrial disease can present as ‘any disease with any symptoms at any age’. Consequently, all patients with progressive, unexplained multisystem illness should be evaluated for mitochondrial disease. Treatment goals include slowing of disease progression and maximising quality of life. There is no cure for this illness. Effective interdisciplinary care includes energy management, nutritional support, physical therapy and emotional support for the patient and their family.
Why don't nurses consistently take patient respiratory rates?
Authors: Ansell Helen , Meyer Alannah , Thompson Shona
Published: May 2014

This is an investigation into nurses' practice of when they would not take and record a patient's respiratory rate. It reports results of qualitative, descriptive research involving interviews with ten ward nurses from three hospitals in New Zealand. Results affirm that, despite it being the most sensitive vital sign for managing patients, nurses acknowledged circumstances in which respiratory rate taking was missed. Reasons were complex and, contrary to expectations, not always associated with the introduction of technology to record other vital signs. Time pressures, work interruptions and rationalised judgements made by experienced nurses all contributed to incidences of missed respiratory rate taking. It is concluded that patient respiratory rate measures do not seem to be highly valued, calling into questions nurses' level of understanding of respiratory physiology, as well as the extent to which intuitive nursing practice is supported by critical analysis.
Using a soft-silicone dressing to treat moist desquamation
Authors: Trueman Ellen , Taylor Lesley
Published: May 2014

Skin reactions are a common side effect of radiotherapy. Radiotherapy damages basal cells and skin reactions occur when the basal layer is unable to produce enough new cells to compensate for the loss of damaged cells at the skin's surface. Skin reactions progress from erythema, through dry desquamation to moist desquamation. As yet, there are no nationally recognised guidelines for the management of radiotherapy-induced skin reactions. As a result, there is widespread variation in practice throughout the UK. Hydrocolloid and hydrogel dressings have been used to treat moist desquamation. However, this article describes the successful clinical experience with an alternative dressing, Mepilex Lite®. The clinical evidence presented also raises the question of whether Mepilex Lite can be used prophylactically as an alternative to aqueous cream on grade 1 (erythema) reactions. Further evidence on this indication for Mepilex Lite will be published in a BJN supplement in November 2014.
Sexual health: is it different for young ethnic minority people?
Authors: Croghan Emma
Published: May 2014

Rising teenage conception rates and rates of adolescent sexual infection continue to be a public health priority. This study aimed to create a picture of the experiences and knowledge of young people, with particular focus on the Black and ethnic minority youth groups.