bluuebunny/crossref_metadata_2025 huggingface dataset:
Empowerment in nursing: paternalism or maternalism?
Authors: Christensen Martin , Hewitt-Taylor Jaqui
Published: May 2014

The aim of this article is to explore whether patient empowerment flourishes in the wake of current health reforms or if there is a power struggle between nursing and medicine as to what is in the patients’ best interest. Shifting the balance of power from healthcare professionals to patients has become a key element of healthcare policy in England. The RCN's definition of nursing places patient empowerment as a central remit of nurses. However, achieving genuine patient empowerment is not easy and requires individuals and organizations to alter their beliefs, values and behaviours. To empower patients nurses must be in a position to share power and this may require a realignment of the traditional power base within health care. Although empowerment is often viewed on a one-to-one level between professionals and patients, for true patient empowerment to occur, issues of power and control must also be addressed at a national and political level.
Drug calculations: are they safer with or without a calculator?
Authors: Pentin Jayne , Smith Joanna
Published: May 2014

The safe administration of medicines is a key nursing activity. The most common type of medication error is administering the wrong dose (Armitage, 2006). To administer medicines correctly, nurses must apply appropriate knowledge specific to the patients receiving medication, and execute the skills required to administer medicines to a high degree of accuracy. This may include mathematical calculations. The potential for errors in child health settings is compounded by the complex calculations often required to ensure children receive the appropriate dose. Nurse educators face dilemmas in both pre- and post-registration settings relating to students’ lack of ability to undertake drug calculations without a calculator. This means that students may not be able to follow the Nursing and Midwifery Council (NMC) Guidelines for the Administration of Medicines (NMC, 2004b). Medication dosage calculations continue to be problematic for qualified nurses. It is too early to assess whether changes in state education will improve pre-registration students’ abilities to apply skills in basic mathematical principles to drug calculations. In the meantime, it is important that nurses who appear to have a weakness in applying mathematical principles to drug calculations seek, and are offered, the opportunity to develop these skills.
Study of peristomal skin disorders in patients with permanent stomas
Authors: Herlufsen Per , Olsen Anne Grete , Carlsen Bente , Nybaek Hanne , Jemec Gregor BE , Karlsmark Tonny , Laursen Troels Norgaard
Published: May 2014

The aim of this article was to investigate the frequency, severity and diversity of peristomal skin disorders among individuals with a permanent stoma in a community population. All individuals with a permanent stoma (n=630) in a Danish community population were invited to participate in a cross-sectional study. A total of 202 individuals (101men; 101women) agreed to participate. Data were collected through questionnaires and clinical examinations. It was found that peristomal skin disorders were higher for participants with an ileostomy (57%) and urostomy (48%) than in those with a colostomy (35%). Of the diagnoses of skin disorders, 77% could be related to contact with stoma effluent. Only 38% of diagnosed participants agreed that they had a skin disorder and more than 80% did not seek professional health care. The study revealed a high frequency of peristomal skin disorders. Participants frequently failed to perceive that they had a skin irritation and did not seek help. This suggests that more education and perhaps regular, annual follow-up visits at local stoma care clinics are needed.

Declaration of interest: This research was funded by Coloplast A/S, Humlebæk, Denmark.
Safety in urine sampling: maintaining an infection-free environment
Authors: Roodhouse Alison , Wellsted Anne
Published: May 2014

The insertion of an indwelling urinary catheter is thought to be implicated in 80% of all urinary tract infections (UTI). In patients with an indwelling catheter, one of the most effective ways to determine whether or not there is evidence of a UTI is to aspirate a sample of urine for analysis, typically using a syringe and needle. Inevitably this puts the healthcare worker at risk of a percutaneous needlestick injury and accidental exposure to serious and potentially life-threatening viruses. Infection control is now taken increasingly seriously in UK hospitals, and the elimination of infection risk is regarded as a priority. In addition to training, and safer working practices the government recognizes the need for new technological innovation to help further reduce risks. In the urine sampling environment, there is a new needle-free port (EZ-Lok from Bard Ltd), designed specifically to reduce the occupational health risk of needlestick injuries.
Developing a plan of care using the Roper, Logan and Tierney model
Authors: Mooney Mary , O'Brien Frances
Published: May 2014

This care study, using the Roper, Logan and Tierney Model of Nursing, examines the presentation of a patient with a history of drug misuse and a current diagnosis of infective endocarditis and hepatitisC. While this particular model of nursing incorporates 12 activities of daily living, this care study will deal with three specific activities: maintaining a safe environment, communication and breathing. One of the main concerns arising from this care study was the inadequate management of pain for the patient. It is suggested in the literature that healthcare professionals do not always adequately address pain management, primarily because of fear of causing addiction. The authors suggest that the patient's history of drug misuse in this study may have further mitigated against him receiving adequate pain control.
Comparing no-touch and tympanic thermometer temperature recordings
Authors: Woodrow Philip , Higgs Debbie , Lewis Tracy , Whitney Sarah , Buras-Rees Stefa , O'Donnell Aidrian , Harris Paul , McHenry Michelle , Boorman Pat , May Vicki , Hendrick Jasmine
Published: May 2014

Temperature is a vital sign which can be measured using various types of clinical thermometers. Pulmonary artery temperature is considered the ‘gold standard’, but this measurement is not usually clinically practical. There is currently no consensus for optimal alternative site or equipment. This research compares 178simultaneous measurements from 5 clinical areas, using two types of thermometers: tympanic and no-touch temporal. No-touch thermometers were all set to oral equivalent. Tympanic thermometers were adjusted to either oral (n=105) or core (n=73) equivalent. Maximum acceptable difference was identified as 1oC. Two data sets (oral/core; oral/oral) were analysed using Bland-Altman method on Excel programmes, comparing all thermometers and separating oral and core-equivalent tympanics. The two thermometers were found not to be equivalent. As a simple comparison between two thermometers, this research cannot identify which thermometer is more accurate.
Selecting a urinary catheter and drainage system
Authors: Robinson John
Published: May 2014

Selecting the most appropriate urinary catheter and drainage system is an important factor towards patient comfort. Inappropriate selection may introduce an array of unnecessary catheter-associated problems and discomfort for the patient. The author has found that nurses may be able to name or recognize catheters they use, but not other makes and models of similar products produced by other companies. Therefore, selecting a catheter and drainage system can be confusing due to the vast array of catheters, materials used and drainage systems available from various companies. Consideration should also be given as to when catheter care begins: before or following catheter insertion. This article is written to help in the selection of a urinary catheter and drainage system which is best suited for the patient.
Outcomes of a nurse-led osteoporosis and falls assessment
Authors: El Miedany Yasser , Gardiner Anne , Toth Mathias , El Gaafary Maha
Published: May 2014

Osteoporosis is a major public health concern. Recent evidence from clinical and epidemiological trials on osteoporosis has stressed the urgency for early and accurate diagnosis of vertebral fractures. Despite the fact that vertebral fractures are very common and associated with decreased quality of life, they are frequently missed in daily clinical practice. The authors developed a protocol to be applied through a specialized nurse-led osteoporosis vertebral fracture service that allows for accurate diagnosis, identifies patients at risk and shortens the time of assessment and management. A total of 114 patients have been reviewed over 12 months. Completing the referral form and the clinic proforma helped the nurse cover all causes of vertebral fractures and shortened the lag time for assessment and management. Osteoporosis therapy was commenced once diagnosis was confirmed.
Nurse negligence in oral/nasal suctioning caused patients distress and put them at risk
Authors: Castledine George
Published: May 2014

This case centres on the procedure of oral/nasal suctioning. It is a method which is carried out by a registered nurse who has received further training. The purpose of the procedure is to help patients who are able to cough, but are too weak to expectorate. Secretions often accumulate in the back of the throat (the pharynx) and upper airway passages and cause the patient to develop an obstructed airway. The procedure is sometimes referred to as oronasopharyngeal suctioning because a suction catheter can be inserted through the mouth or nostril. The nurse should assess the patient carefully before she carries out the procedure as it can cause distress. It is important, therefore, to explain the procedure to the patient and determine their level of understanding as to what is going to happen. Telling the patient that suctioning may stimulate transient coughing or gagging is important, emphasizing the importance of coughing and its role in helping to clear secretions.
Reducing the risk of acquiring antimicrobial-resistant bacteria
Authors: Bissett Linda
Published: May 2014

Antimicrobial-resistant organisms have become a major issue for all healthcare staff. The Government, media and public are now calling for action to be taken to minimize the risk of acquiring such an infection when admitted to any healthcare setting. Although it is impossible to completely remove the risk of acquiring infection, there are methods already available to healthcare staff and the public that would help to reduce the number of antimicrobial-resistant infections that occur. The National Audit Office (2000) has estimated that if the guidelines already in place were adhered to, the rate of hospital-acquired infections could be reduced by between 15% and 30%. Their use would also help reduce the amount of antimicrobial drugs prescribed and may lower the risk of further development of antimicrobial-resistant microbes. This article examines microbial resistance, sources of infection and discusses the measures that can be taken to reduce the incidence of antimicrobial-resistant infection that occur within the healthcare setting.
Why tackling MRSA needs a comprehensive approach
Authors: Fairclough Sarah J
Published: May 2014

Methicillin-resistant Staphylococcus aureus (MRSA) causes a fifth of hospital-acquired infections and many other bacteria now show increased resistance to antibacterials. In some parts of the world, community-associated MRSA infections cause a growing number of infections (Fridkin et al, 2005). Attempts to control the spread of MRSA rely on several factors: detecting and isolating infected or colonized patients (cordon sanitaire), rational antibiotic prescribing, hand hygiene and cleanliness. Nurses are key to implementing all of these measures. This article examines the epidemiology of MRSA, as exemplifying an antibiotic-resistant bacterium, and reviews the evidence for the various interventions. A single measure alone is unlikely to eradicate MRSA from either hospitals or the community; indeed, eradicating MRSA is probably impossible. However, a comprehensive approach, including, in particular, good hand hygiene, could reduce the morbidity and mortality arising from MRSA and other hospital-acquired infections.
Online support for medicine dosage calculations
Authors: Little John
Published: May 2014

This article reports findings from a small project run within the Robert Gordon University that aims to provide nursing students with online support for medicine dosage calculations through formative assessment. The project motivation is discussed together with an evaluation of a subset of data from 177 student participants. This evaluation focuses on the 20 or so students who have engaged most with the project, and assesses the extent to which these students have been able to transfer benefits derived from formative assessment of their skills to summative assessment. Evidence is presented that shows: students who do well formatively do not seek individual tuition, those who truly engage with the formative online assessment subsequently pass their summative assessment, students agree or strongly agree that the formative assessment helped them pass their summative assessment and students making multiple attempts do not simply copy the correct answers given in feedback, but retry the assessment.
Part 1: Nurses' guide to alcohol and promoting healthy lifestyle changes
Authors: Harrington-Dobinson Anne , Blows William
Published: May 2014

In the first of three articles we consider the mechanisms by which alcohol affects the human body and mind. In subsequent articles we will examine the impact of alcohol on health and social wellbeing and the support and health promotion measures that the nurse might use to assist patients. Alcohol has distinctive effects on physiology that are mediated by gender and the level of exposure to the drug over time. In this article we consider the ways in which alcohol acts as a mental stimulant and then as a depressant, and we examine how exposure reinforces further alcohol consumption. Consideration is given to how alcohol is metabolized and how it may then interact with other drugs within the body.
Developing a complementary therapy policy
Authors: Fearon Julia
Published: May 2014

Increasingly, healthcare professionals from a variety of settings are looking to integrate complementary therapies into mainstream healthcare. Robust policy development is a prerequisite for effective integration and the building of sustainable services. Unfortunately many of those wanting to drive forward the complementary therapy agenda have little knowledge of policy development. For those individuals planning to integrate complementary therapies into care, this article will address some of the issues around developing a complementary therapy policy: the need for a robust policy, how to begin developing a policy and suggested inclusions for such a policy.
Clinical Corner: Management of pyrexia during blood transfusion
Authors: Helyar Sinead
Published: May 2014

A 41-year-old female patient presented with weight loss, dehydration, ulcerative pharyngitis and a pyrexia. She was lethargic and had recently experienced a number of falls. She was allergic to several medications, including paracetamol and ibuprofen. A routine blood sample indicated a haemoglobin level of 5.3g/dl. Three units of leucodepleated red blood cells were prescribed for transfusion.
Acute urinary retention: developing an A&E management pathway
Authors: Anderson Beverley , Khadra Abbas
Published: May 2014

Acute urinary retention (AUR) is a painful and distressing condition which is associated with significant morbidity requiring hospitalisation, catheterisation and often surgery (Kirby, 1998). AUR often develops from benign prostatic hyperplasia (BPH) and its incidence increases with age. The management of AUR is highly dependent on the cause, mainly BPH and clot/haematuria. Medical management will often necessitate the insertion of a urinary catheter, a procedure which is associated with an increased risk of urinary tract infections (Mulhall et al, 1998). The use of alpha-adrenegic antagonists (alpha-blockers), 5-alpha-reductase inhibitors, a trial without catheter and the catheter valve are recommended to delay or prevent the need for surgery and future complications. Proper assessment and documentation, particularly in relation to the catheterisation process is of vital importance. The authors demonstrate how audit was used in the development of a management pathway to provide guidance to accident and emergency (A&E) practitioners in their delivery of care to patients who presented to the A&E with AUR.
The importance of keeping patient records secure and confidential
Authors: Castledine George
Published: May 2014

The NMC state that, ‘good record keeping is an integral part of nursing and specialist community public health nursing practice. It is a tool of professional practice and one that should help the care process. It is not separate from this process and it is not an optional extra to be fitted in if circumstances allow.’ (NMC, 2005)
Making foot care a priority
Authors: Bookless Bev
Published: May 2014

One of the main drivers in the development of the National Service Framework (NSF) for Diabetes (Department of Health (DH), 2001a) was the need to reduce inequalities of service provision. The problem was that there were, and still are, unacceptable variations in treatment, as well as in the outcomes of that treatment across England. According to an analysis of the latest Quality and Outcomes Framework (QOF) data from primary care, this variation in diagnosis and treatment is still continuing. For example, the percentage of patients with diabetes with a record of the presence or absence of peripheral pulses in the previous 15months varies from 50.7% to 99.2% between PCTs (National Diabetes Support Team (NDST), 2006). More information on the QOF data relevant to diabetes care can be seen at www.diabetes.nhs.uk/downloads/Factsheet_QOF.pdf .
Using a Delphi approach to develop a strategy for A&E in defence nursing
Authors: Kenward Gary , Berry Andy , Despres Lieutenant Julian , McLeod Flight Sergeant Judith
Published: May 2014

The Armed Forces has seen an increase in the number of operational deployments overseas and a greater demand for Accident and Emergency (A&E) trained nurses. This article describes a modified Delphi study used to contribute to the development of a strategy for emergency nursing in the Defence Nursing Services. Twenty-eight A&E specialists took part and the key issues raised were recruitment and retention, staff development, new roles, research priorities, increased internal recruitment of A&E nurses to meet operational demands, and the need for a structured career pathway to help retention. The most pressing areas requiring research were evaluation of the nurse practitioner role, clinical competencies and managing heat injuries in the operational setting. The modified Delphi study provided a valuable and detailed insight into the challenges and aspirations of the military A&E nursing cadre and has assisted in developing a strategy for emergency nursing
Nurses’ rationale for blood glucose monitoring in critical care
Authors: Croser Angela , McDowell Joan RS
Published: May 2014

Morbidity and mortality in a critical care environment is improved when there is tight control of blood glucose. This study aimed to explore nurses’ rationale for blood glucose monitoring in a critical care setting. An exploratory qualitative design was utilized in one acute division of a large NHS Trust in Scotland. Volunteers were sought by letter and through posters in the clinical areas. Five staff nurses from two critical care areas volunteered to take part in one-to-one interviews that were tape recorded. All transcripts were analysed using content analysis. Nurses described differing perspectives on blood glucose monitoring. Nurses did not know the blood glucose level that defines hyperglycaemia, a knowledge gap which impacts on care interventions. Three sisters from the wards were interviewed to determine their perceptions of the reasons for the poor response rate. They identified several issues thought to impact on staff volunteering for research.
Galvanic skin responses from asking stressful questions
Authors: Page Martin , Robson Rev Canon Alan
Published: May 2014

This study considers the effects of stress on interviewers as they ask challenging questions to interviewees. A convenience sample of 40 subjects was drawn from health and social care professionals and divided in to a study group and a control group. Instrumentation was by unobtrusive galvanic skin response monitors. Data calibrations were checked against heart rate and finger temperature monitors for accuracy. The findings showed that when the interviewer asked a challenging question which they had designed themselves, it triggered a measurable stress response in 80% of interviewers. The respondents did not show stress responses to the same challenging question.
A written assessment is an invalid test of numeracy skills
Authors: Wright Kerri
Published: May 2014

Nurses need good clinical numeracy skills to aid them in their clinical practice. There is some concern, however, that the calculation skills learned during pre-registration nurse education have little practical application to nurses. This article discusses the Fitness for Practice initiatives from the Nursing and Midwifery Council which aim to ensure new registrants are numerate. The article argues that written numeracy assessment tools are not a valid test of the numeracy skills candidates will require for clinical practice and that nurse education needs to focus on researching and examining how best to support, assess and develop the numeracy skills of nursing students within their clinical practice placements to ensure that at the point of registration they are fit for practice.
Nurses’ ethical decision-making role in artificial nutritional support
Authors: Tsaloglidou Areti , Rammos Kyriakos , Kiriklidis Konstantinos , Zourladani Athanasia , Matziari Chrysoula
Published: May 2014

This study provides an insight into the process of ethical decision-making regarding the initiation or withdrawal of artificial nutritional support of seriously ill patients and explores the nursing involvement in it. Fifteen health carers were recruited from a clinical nutrition unit in the UK and qualitative research methods were used to gather data. The findings of the study indicate that nursing contribution to decision-making appeared to be in the ‘back room’ as the nurses feel that the decisions about difficult ethical dilemmas are ‘out of their hands’ because of lack of knowledge, experience and confidence. The medical staff and the clinical nurse specialist appear to be primarily responsible for making important decisions. It is clear from the study that to become more effective in the process, nurses need to enhance their knowledge in nutritional support and to develop their practical skills in ethical decision-making through experience and research.
Short-term regulation of acid-base homeostasis of body fluids
Authors: Clancy John , McVicar Andrew
Published: May 2014

The first in this two-part article explores the short-term homeostatic mechanisms involved in maintaining the ‘acid-base balance’ of body fluids. The second article identifies the intermediate and long-term homeostatic mechanisms involved in maintaining the ‘acid-base balance’. The acid-base balance of the body refers to the ideal pH of body fluids, which is determined by the hydrogen ion (H+) concentration of body fluids. Normal pH optimizes enzyme action and a healthy metabolism. Prolonged abnormal pH leads to disordered metabolism and illness, therefore, an understanding of pH is crucial for nurses who have access to patient’s medical records. Since observing a patient’s blood and urine pH aids assessment, diagnostics, planning care, implementing care and re-evaluating healthcare intervention. The aim of this article is to educate nurses in the understanding of the biochemical functioning of buffers as the short-term regulators of pH control.
Peristomal skin care: an overview of available products
Authors: Black Pat
Published: May 2014

Intact skin provides a protective barrier between the body and it’s environment. The frequent application and removal of stoma appliances can damage skin by stripping away the epidermal layer. Hydrocolloid flanges in either a one- or two-piece appliance hold moisture in the mass and are therefore more skin friendly than older appliances with acrylic adhesives, making hydrocolloid the choice for ostomy appliance manufacturers. Peristomal skin problems are a significant problem for the stoma patient. As many as one-third of colostomy patients and more than two-thirds of ileostomy and urostomy patients will be affected (Lyons and Smith, 2003). The correct and judicial use of barrier creams, gels, lotions, sprays and wipes in peristomal skin care can play an important role in giving the stoma patient a good quality of life.
Measuring patient dependency in child and adolescent mental health
Authors: Abeles Paul , Holmes Eleri , Danquah Adam , Wadge Malli , Hodgkinson Peter
Published: May 2014

Within the context of child and adolescent mental health inpatient services, a literature review was undertaken to understand the concept of inpatient dependency and how it can be measured. Articles and books relating to patient dependency and its measurement in various contexts were retrieved, and other published measures were identified. It was found that dependency has been defined in many different ways, and various techniques have aimed to quantify or categorize patients’ dependencies. This article focuses particularly on measures used in adult psychiatry and paediatric services. At present, there is no available established measure of patient dependency in child and adolescent inpatients. This article identifies the need to develop a measure of inpatient dependency that is specifically designed for these services, and outlines a tool that the author have recently designed.
Is the modern NHS fit for nursing students?
Authors: Chambers Derek
Published: May 2014

Regretfully 2006 will not be remembered for the excellent work and accomplishments of those working in the NHS but as the year that exposed an unprecedented crisis within it. In the space of a week, hospital Trusts announced that thousands of jobs were to be axed and wards closed in an effort to stem the financial crisis. This placed even greater pressure on the remaining clinical areas which were already buckling under the pressures of Government incentives, such as Payment by Results. Payment by Results aims to make the NHS more efficient and productive (Kings Fund, 2005) by encouraging healthcare providers to treat more patients and to discharge them as quickly as possible (Dixon, 2004). Unfortunately, such initiatives have placed extraordinary demands on clinical areas and consequently nursing workloads
Under diagnosis of alcohol misuse in the older adult population
Authors: Loukissa Dimitra
Published: May 2014

Alcohol abuse in older adults is common, yet it is often under detected and misdiagnosed, and as a result associated with considerable morbidity. There is growing concern that as the population ages, there will be a substantial increase in the number of older adults needing treatment for alcohol misuse and currently, little is done to identify and address this situation. Factors contributing to under diagnosis include, but are not limited to, depression, dementia, physical changes associated with age, life events, late onset of alcoholism and lack of screening. A case report is presented and existing research findings are discussed. The importance of assessment, the use of screening tools, treatment issues and identification of other comorbidities are presented. The focus on increased awareness among clinicians as well as their role in identifying and addressing alcohol abuse issues in the older adult population is explored.
Nursing attitudes towards recording of religious and spiritual data
Authors: Swift Chris , Calcutawalla Sara , Elliot Rosie
Published: May 2014

Poor recording of patients’ religious and spiritual information is known anecdotally and occasionally referred to in publications. Chaplains in particular encounter lack of data entries or errors in records on a routine basis. While novel forms of spiritual assessment have been discussed the only previously published United Kingdom research on nurses’ responses to patients’ spiritual needs uses the approach of critical incident analysis. This article reports on the findings of a nurse focus group used to generate issues likely to resonate with staff as to why poor assessment and recording occurs. Apart from clinical factors, nurses cited the intrusiveness of questions about spirituality and the feeling that assessment was ‘unnecessary’ as major reasons for non-recording. The most significant finding was the correlation between clinical area and the incidence of assessment. Nurses who admitted patients and always asked for religious and spiritual information were three times more likely to work in complex clinical areas. Further training is indicated as most likely to enhance accurate recording. More research is needed to establish whether these findings are matched in practice, and to identify whether the results found in one teaching hospital are equally true for other types of hospital in the UK.
A comprehensive audit of nursing record keeping practice
Authors: Griffiths Paul , Debbage Samantha , Smith Alison
Published: May 2014

Good quality record keeping is essential to safe and effective patient care. To ensure that high standards of record keeping are maintained, regular clinical audit should be undertaken. This article describes an audit and re-audit of nursing record keeping at Sheffield Teaching Hospital NHS Foundation Trust. The article demonstrates improving audit data in 2005 and 2006 and describes how audit and the resulting recommendations and action plans can result in real improvements in the quality of record keeping. The keys to success in this ongoing audit programme are identified as stakeholder involvement, support from the senior nurses in the organization and the use of the data for both local and trust-wide purposes.
Exploring inclusion and challenging policy in mainstream education
Authors: Bhagat Farhat
Published: May 2014

Education is both a human right in itself and an indispensable mean of a better future. Removing Barriers to Achievement,published by the Department for Education and Skills (DfES, 2004a), highlights its vision for giving children with special educational needs and disabilities the opportunity to achieve their full potential. Chapter two in particular focuses on removing barriers to learning and it is here where the Government focuses, emphasises and justifies the issue of inclusion of children with learning difficulties into mainstream education (DfES, 2004a). The aim of this article is to explore inclusion and simply challenge whether the policy is effective in its purpose by considering educational practice today. It is important that nurses from all fields have some level of understanding regarding the education of children in the community. This is vital to fulfil our role and provide the necessary support to users and families of the service.
Peripheral vascular access devices: risk prevention and management
Authors: Lavery Irene , Smith Emma
Published: May 2014

Intravenous therapy is a crucial and indispensable aspect of nursing practice in acute settings, and is expanding into community care. Peripheral venous cannulation is a common intervention and carries inherent risks to patients. This article explores preventative and risk-management aspects relating to peripherally-inserted cannulae, focusing on insertion, short- and longerterm risks. Assessment aspects should also encompass staff knowledge and competence, and regular maintenance of practice. Proactive measures are proposed to assess and manage the care of the patient and their device. Staff issues are also considered and measures discussed. Finally, ongoing review of the need for a cannula is essential to ensure appropriate and safe patient care.
Home therapy for lysosomal storage disorders
Authors: Hughes Derralynn A , Milligan Alan , Mehta Atul
Published: May 2014

Lysosomal storage disorders (LSDs) are a group of rare inherited metabolic disorders each resulting from the deficiency of a specific lysosomal enzyme and leading to the pathological accumulation of undegraded substrate. There are now several possible modalities of therapy for LSDs including intravenous enzyme replacement therapy (ERT). ERT is administered by intravenous infusion every week or 2 weeks. Therapy is lifelong and therefore a serious undertaking for patients and healthcare providers. Most patients will travel some distance to their specialist LSD centre and may therefore find frequent visits stressful, time-consuming and disruptive. The facility to administer enzyme replacement therapy in the home limits time spent at the hospital, restores independence and control of the disease to the patient, and reduces utilization of hospital resources and is associated with improved quality of life. A recent questionnaire survey indicates high levels of compliance with infusions in the home setting. Home therapy requires a well organized and regulated community infrastructure, individual assessments of patient suitability and protocols for management of possible infusion associated reactions.
A concept analysis of reflective practice: determining its value to nurses
Authors: Duffy Anita
Published: May 2014

Reflective practice has been welcomed into nursing education with open arms. However, practitioners are cautious of its perceived benefits and limitations considering the evidence-based literature has not been adequately tested. Concepts are well established as the building blocks of theory. It therefore follows that a primary step in building a theoretical base is undertaking a concept analysis. While there is an abundance of anecdotal literature available on reflective practice, it was deemed necessary to analyse the concept, define the attributes, antecedents and consequences, in order to identify a model case of reflective practice for clinical practice. This article uses Rodgers’ (1989) methodology to gain a better understanding of what reflective practice actually is, and whether the concept is in fact useful to the practising nurse.
The child’s right to participate in research: myth or misconception?
Authors: John Jill E
Published: May 2014

The growing acceptance of the need for children’s participation in any issues that affect them, including research, has been fuelled by the ‘children’s rights’ agenda, which has occurred in the UK since the ratification in 1991 of the UN ‘Convention on the Rights of the Child’ (UNCRC, 1989), which provides a framework for the development of national policies and laws to protect the rights of children (O’Hallorhan, 1999). There is a clear indication of this both within the UNCRC (1989) and the growing ‘sociology of childhood’, where the importance of children actively constructing their own lives by, for example, participating in and negotiating their own health care, education and social welfare by utilizing skills that go unrecognized (Mayall, 1998). With the current emphasis in the NHS on evidence-based care there is a need for those working with children and young people to include best evidence from research with children (as opposed to ‘on’ children) in both clinical and healthcare decisions. Recommendations for future research with children include the use of more innovative methodologies, such as action research and focus groups that will enable children to actively participate and to describe personal experiences through their own unique points of view.
Burnout in the caring nurse: learning resilient behaviours
Authors: Edward Karen-leigh , Hercelinskyj Gylo (Julie)
Published: May 2014

This paper reviews current literature to offer a discussion related to burnout, an issue that affects the entire healthcare sector, including nurses and patients. Literature suggests a correlation between moral distress and burnout in nurses. These issues are considered to be current and affect recruitment and retention of nurses. The authors propose supporting nurses by using knowledge of resilient behaviours as a means of transcending burnout and workplace stress. The authors believe that this process can be achieved through existing hospital professional development processes, for example supervision, reflective practice, in-service education and other forms of professional development.
The future of nursing: career choices in potential student nurses
Authors: Whitehead Elizabeth , Mason Tom , Ellis Jackie
Published: May 2014

Young people leaving schools and sixth-form colleges have the opportunity to choose a career path from an increasing number of courses in colleges of further and higher education. Nursing studies are now competing with a range of health-related disciplines such as health studies, psychology and complementary therapy. Compared with nursing studies, many of these courses appear more exciting and appealing to students who are in the process of choosing a career or programme of study. While the increased choice is a positive move for students, it may contribute to the shortage of students currently entering some areas of nursing. Indeed, some specialties in nursing, including mental health and learning disabilities, are so depleted in students that they are reaching a point of crisis. There is also concern that recruitment into nursing remains predominately female and White British. Given the diversity of the UK population and the reliance on school leavers as a potential source of supply, it is important to understand why male students and those from multiracial and multicultural environments choose, or do not choose, nursing studies. This research study involved a sample of 106 16-year-old students from three secondary schools in the north-west and south-east of England. The questionnaire results, collected in schools, revealed that students held traditional views or knew very little about the nursing profession.
Efficacy of commercial dressings in managing malodorous wounds
Authors: Lee Gillian , C Anand Subhash , Rajendran S , Walker Ian
Published: May 2014

This paper investigates a novel in vitro method of ascertaining quantitative comparative data on a selection of commercially available odour adsorbent wound dressings. The aim of this study is to determine and evaluate quantitative desirable data on the efficiency of odour adsorbency along with other comparable physical characteristics of commercial odour adsorbent dressings. This study is a part of an ongoing research programme into the design and development of novel odour adsorbent dressings for managing malodorous wounds. The study also includes the development of a controlled in vitro test method that simulates a more realistic situation. A selection of commercially available activated charcoal dressings were analysed and tested, and comparative evaluation was carried out and discussed.
Evaluating two dynamic mattresses in a nursing home setting
Authors: Buckland Richard
Published: May 2014

A formal, ethically approved, prospective product evaluation was undertaken in a nursing home setting. The aim of the study was to generate patient-focused clinical outcome data in a ‘real world’ setting to support use of the dynamic Sidhil Plus (mattress replacement) and Solo (mattress overlay) for patients who were at an elevated risk of pressure ulcers. The primary outcome was for patients to remain free from additional pressure damage while the products were in use. Secondary outcomes of interest included patient and carer views of the product. The results reported here indicate that for this client group these ‘low-tech’ products perform well. Of the 22 residents taking part, two developed pressure damage during the trial, however the position of the pressure damage indicated that the cause was most likely not the mattress.
Bioactive dressings: old ideas, new technology
Authors: BG Lansdown Alan
Published: May 2014

Wounds and wound care date back to the dawn of human civilization. Classical scholars, including Galen, Hippocrates, Celsus etc, showed an amazing awareness of the vulnerability of skin wounds and documented the basic principles of cleansing and protecting them from disease and further damage. Inscriptions, including the much quoted Ebers scrolls of about 1550bc, show that early physicians used dressings composed of natural materials, and a wide range of plant and animal fats, fibres and extracts as emollients, healing aids and protective substances in wound care. Plasters were a central feature of early wound care. Thus, the ancient Egyptians are recorded as using plasters of honey, grease and lint for the treatment of most types of skin wound. While many of these ancient practices were undoubtedly steeped in folklore and superstition, some have survived until the present day. Honey, in particular, is a popular therapy in modern day acute and chronic wound care clinics.
Reflective practice: a learning tool for student nurses
Authors: Wilding Peter Mark
Published: May 2014

Reflection is a vital skill in contemporary nursing with student nurses expected to engage in reflective learning from the very beginning of the nurse educational programme. This article demonstrates the meaningful learning that resulted as a consequence of using critical reflection on practice. Gibbs’ (1988) cycle aided the process highlighting the practical application of this cyclical framework to the author - a first-year student nurse. Matters concerning gender issues in nursing and professional conduct emerged from the analysis and were inherently explored. The article concludes by demonstrating the personal benefits of using Gibbs’ (1988) cycle to varying situations and thus promoting its excellence as a learning tool for student nurses worldwide as a consequence.
Increasing the time nurses spend on patient care
Authors: Castledine George
Published: May 2014

Time has been studied in various ways in the general work setting; for example, one of the first ways was in the late 1950s and 60s when there was a need to find out how long workers were spending on certain jobs and tasks. Such investigations were known as time and motion studies, and were primarily carried out to improve efficiency and productivity in industry. There was some attempt to introduce such studies into nursing situations, e.g. there were attempts to find out how long it took a nurse to do a medicine round, and how long it took a nurse to make a bed and complete a bed bath. Such experiments at breaking nursing down into specific tasks failed because it was felt that patients were human beings with individual needs and were not machines or objects of the production line.
Preventing venous thromboembolism through risk assessment approaches
Authors: Bonner Lynda , Coker Emma , Wood Lindsey
Published: May 2014

Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in hospitalized patients. Recent guidelines from the Department of Health and the National Institute for Health and Clinical Excellence recommend mandatory, universal VTE risk assessment for hospitalized patients and the provision of appropriate prevention measures (thromboprophylaxis). Careful selection of a suitable VTE risk assessment approach is required to improve the chance of its successful implementation in hospital. At-risk patients need to be identified, counselled and the most appropriate thromboprophylaxis selected, prescribed and delivered. Nurses are ideally placed to play a central role in the implementation of this change in clinical practice through leadership and education. Extended pharmacological thromboprophylaxis has been recommended in certain high-risk groups. New oral anticoagulants are being evaluated, which could change the way thromboprophylaxis is administered in future, benefiting both patients and nurses.
Professional regulation in nursing. Part 2: political change
Authors: Fullbrook Suzanne
Published: May 2014

The current Government came to power in 1997. In their manifesto, changes in ideology towards the provision of health and the place of those who provided health care were evident. As well as the issue of acceptable standards of healthcare provision, the issue of the regulation of nurses and other health workers was perused. This article reviews the political manifestos of 1997 and 2001, and reflects on the changes averred to in the context of the effects to the nursing profession in respect of professional regulation and central control by the Government of the profession as a whole. A conclusion is reached that political changes, not based on theoretical models of care, but rather on reports commissioned by Government, have resulted in far reaching consequences for nursing. This includes the replacement of the regulatory body (United Kingdom Central Council for Nursing, Midwifery and Health Visiting) with a new body (Nursing and Midwifery Council) and the inclusion of public persons into the management of nurses to the extent that for the first time, lay persons would have an influence in the outcomes of professional disciplinary hearings and sanctions.
Evaluating education in palliative care with link nurses in nursing homes
Authors: Waldron M , Hasson F , Kernohan WG , Whittaker E , McClaughlin D
Published: May 2014

Background: Palliative care is recognized as an important component of care for everyone with advanced illness. Historically, it has been provided in specialist settings, but it has been suggested that best practice in palliative care should be transferred to non-specialist settings, including care homes. Care homes require particular support for this and link nurses have been recruited to develop palliative care in these settings. Aim: To assess the palliative care education received and consequently cascaded by designated nursing home staff. Method: Questionnaire administered to private nursing home nurses who attended a palliative care training programme in one UK region. Findings: Thirty questionnaires were returned (response rate 77%). There was a high satisfaction with course content, facilitation and benefits accrued from participation. Many respondents (83%) had not commenced cascading training within their nursing homes due to lack of time and competing mandatory demands. Conclusion: Extending palliative care practice to non-specialist settings with the help of link nurses is possible and welcomed by nursing home staff. However, more substantive and on-going support is needed post-training from both nursing home management and training facilitator to enable and empower link nurses to undertake palliative care education with their peers.
Transition: do young people get a good deal?
Authors: Glasper Alan
Published: May 2014

Recent guidance from the Department of Health (DH, 2006), augmented by an erudite publication by the Royal College of Nursing (RCN, 2007), mandates that a named person or coordinator works with young people with ongoing health needs, their families and all agencies to plan for transition to adult services. Furthermore, transition clinics should operate in both paediatric and adult services to ensure the seamlessness of the process. But are young people getting a good deal from their health services across the UK? Young people in transition should transcend practice boundaries and yet it is this arena of clinical care, at the juxtaposition of child, adult, mental health and learning disabilities nursing which is proving contentious.