bluuebunny/crossref_metadata_2025 huggingface dataset:
Midwifery lecturers as supervisors: Bridging education and practice
Authors: Cook Dorothy , Payne Sheena
Published: May 2014

This article explores how the dual role of the midwife educationalist as a supervisor of midwives can enhance both education and supervision. Through educational supervisors, issues can be brought from trust supervisory meetings pertinent to the development of the midwifery curriculum. The educational needs of midwives can be considered, practice issues debated and the number of midwives on supervised practice discussed. At trust level educational supervisors can also contribute to the wider debate as they are not constrained by local issues. Educational supervisors can thread supervision through the midwifery curriculum ensuring students understand the purpose and value of supervision. Universities need to acknowledge the value of supervision, a good example being how the educational supervisor can be influential on fitness-to-practise panels.
Self-effcacy: Women's experiences of pain in labour
Authors: Talbot Rebecca
Published: May 2014

The purpose of this article is to explore how Women's perceptions of labour can be affected by the media and how one's belief in the body to cope with labour and to birth physiologically can change the birth experience itself. The terms ‘catastrophizing’ and ‘self-efficacy’ and their relationship with Women's experiences in labour will be explained. How midwives can increase a Women's self-belief, or self-efficacy, through better antenatal education in order to provide a more positive birth experience will also be discussed. The need for further research into changing perceptions of birth to create a stronger belief in the body's ability to birth normally without intervention will be highlighted.
Formula supplementation and the risk of cow's milk allergy
Authors: Smith Hazel A
Published: May 2014

The objective of this paper is to discuss the risk of supplementary feeding breastfed babies with cow's milk formula in the first few weeks of life for cow's milk allergy. The benefits of breastfeeding in reducing food allergies, the composition of human and cow milk and immunologic development of the infant are discussed. All known studies investigating the effect of supplementing breastfed infants with cow's milk formula are examined. A meta-analysis, of the studies discussed, found a risk ratio of 1.75 (95% 1.30–2.27), P=0.0001, for breastfed infants given cow's milk formula supplementation in the first few weeks of life against no supplementation given to breastfed infants.
Women have unrealistic expectations of assisted reproductive technologies
Authors: Bainbridge Jane
Published: May 2014

Researchers at Yale University found that more older women visting the fertility clinic expected to conceive easily despite their age.
Complementary and alternative medicine in the maternity setting
Authors: Jones Catriona
Published: May 2014

The increasing demand for complementary and alternative medicines (CAM) among childbearing women has been alluded to in midwifery literature for a number of years. There is a wealth of anecdotal evidence suggesting that pregnant women are driving the demand for CAM integration in midwifery practice. Midwives reportedly support the integration of CAM because it promotes normal birth, reduces medical intervention, and results in increased job satisfaction ( Mitchell and Williams, 2007 ). Furthermore, midwifery aided by CAM is considered to be a strategy adopted by midwives to facilitate the process of placing control away from the medical practitioner, and more into the hands of women ( Adams, 2006 ).

A literature review was undertaken to gain an understanding of the patterns of CAM demand in the UK. In particular, evidence of the extent of consumer demand for CAM was investigated. This paper presents the findings from a review initially undertaken to explore claims that CAM integration into midwifery is consumer driven. The concept of consumer demand and how this is captured and illustrated across empirical and non-empirical literature is examined. The findings highlight that appropriate research into consumer demand is required to sustain the integration of CAM in mainstream maternity care.
Women's perception of the term ‘obstetrician’
Authors: Kenyon Charlotte , Hills Alison , Winter Cathy , Draycott Timothy , Fox Robert , Siassakos Dimitrios
Published: May 2014

This study aimed to find how aware pregnant women were of the meaning of the term ‘obstetrician’, their feelings about it, and their understanding of the role. The perceptions of pregnant women attending the antenatal clinic of a tertiary maternity unit were surveyed using an anonymous questionnaire. One hundred questionnaires were issued and 83 completed. Of the 83, 72 (87%) had previously heard the term ‘obstetrician’, but 50 (69%) of these did not know its meaning. Most women described neutral connotations with the term and had no preference about the term used; however, approximately one-third of the participants preferred non-Latin terms such as maternity doctor. A more descriptive term may help bridge the apparent gap in understanding and promote a more balanced doctor–service user relationship.
H1N1 flu vaccine not associated with risk of birth defects
Authors: Bainbridge Jane
Published: May 2014

A new Danish study has revealed that the H1N1 vaccine does not pose a risk of birth defects or preterm birth in pregnant women.
The examination of the newborn: A literature review
Authors: Mcdonald Ginny
Published: May 2014

Historically, it was commonplace for paediatric senior house officers to perform the pre-discharge examination of the newborn. However, the current economic climate has lead to politically driven changes in policies that may or may not suit midwives. The European Working Time Directive has held consequences for midwives and their day to day role, which means it is now becoming commonplace for midwives to undertake further training in this area. This article explores the available literature surrounding the implications faced by midwives and women alike. An evaluation of the available literature, known as the EMREN study has been influential in this change in practice and is included in the discussion.
Occupational stress experienced by Japanese midwives
Authors: Sato Kaori , Adachi Kumiko
Published: May 2014

Studies have shown that half of Japanese midwives experience depression ( Akizuki and Fujimura, 2006 ), but the stress experienced by them is not well understood. This study examines job stress among midwives in hospitals and clinics in the Tokyo area. The Brief Job Stress Questionnaire (BJSQ) was distributed to 1397 midwives at 90 facilities. Responses were received from 606, and the valid responses of 556 respondents were analysed. The results showed that 442 midwives (79.5%) experienced a qualitative burden, 513 (92.3%) experienced a physical burden, and 25–35% reported high stress reactions. Progress is needed in the identification of tasks that contribute to qualitative job overload. A survey is needed to determine the specific workload that will lead to a reduction of midwives’ stress and an improvement of their workplace environment.
Improving clinical practice by better use of data: smoking in pregnancy
Authors: McCullough Bunny , Walker Sharon , Lee Jacey , Prady Stephanie , Small Neil
Published: May 2014

Midwives collect considerable amounts of data as part of their routine practice. They also have access to extensive information about patients and, more generally, about effective interventions. an investigation of data related to smoking in pregnancy was undertaken in one UK NHs Trust. The brief was to identify what data were collected, how these data were transmitted to appropriate staff and how these data were used to inform practice. in addition, evidence on smoking in pregnancy in the research literature was reviewed and examples of best practice in other Trusts sought. a wide range of issues inhibiting optimal use of data were identified and recommendations for changes made. as well as changes in approaches to data use and collection, this led to changes in clinical practice. specifically, this research supported moving from ascertaining maternal smoking behaviour via asking questions to undertaking carbon monoxide tests as routine antenatal practice.
Advice to promote healthy neonatal skin and treat common skin disorders
Authors: Jones Kathleen
Published: May 2014

The maintenance of good skin in newborns is important to enable the skin to protect the body from infection and other toxins. This article examines the evidence around the products and information which are available to parents and health professionals in order to provide optimum care for infants. The lack of research to guide policies and protocols for care of the skin hinders the provision of evidence-based care ( Steen, 2008 ). Parents need to be informed about how to cleanse their infant’s skin, and how to prevent and treat nappy rash and other common skin problems in newborns.
Caring for asylum-seeking women
Authors: Price Cheri
Published: May 2014

Cheri Price, newly qualified midwife, discusses how to support pregnant women new to the UK
Should a ‘scoop and run’ system be implemented for all low-risk women who have an unplanned home birth?
Authors: Grayson Janine
Published: May 2014

At a time when choice remains a fundamental concept to holistic maternity care, ambulance services propose to implement a ‘scoop and run’ policy for all unplanned home births. While the safety of women and their babies remains paramount and pivotal in any service developments, it is essential that midwives continue to act as advocates for women and ensure that service changes continue to provide women-centred care. As the Health and Social Care Act ( Department of Health, 2012 ) pledges to place service users at the focus of developments in health-care systems, this article considers whether or not all low risk women experiencing an unplanned home birth should be transferred into a consultant-led unit.
Home visits by student midwives in the early postnatal period – a qualitative study of students' reflections
Authors: Aune Ingvild , Lilleengen Anne Marie
Published: May 2014

Objective: The aim of this study was to gain insight into the reflections of student midwives in their encounters with women and their families during home visits a few days after birth. Design/setting: 13 student midwives from Sør-Trøndelag University College and 10 student midwives from Oslo and Akershus University College each visited a woman they had supported during childbirth. These were healthy women with normal pregnancies and births. Following the visit, the students wrote reflection notes about their experiences. These qualitative data were analysed with the help of systematic text condensation, which is a modified version of Giorgi's phenomenological analysis. Findings: The findings include two main themes: ‘experience of meaningfulness’ and ‘development of midwife identity’. The students described the visit during their practical studies as meaningful; they were personally involved and actively participating in the women's reflections on their birth experiences. The students experienced that building a relationship with women resulted in mutual confidence, trust and an experience of mastery, and the home visit provided them with the opportunity to make realistic observations of the new family. The students developed their midwife identity through a common experience and understanding, feedback from the women, and through an experience of personal growth and mastery. Conclusions: In an attempt to achieve high-quality midwifery skills, student midwives benefited from the home visit to the new family a few days after childbirth. A follow-up in the postnatal period gave the students meaningful practical training and valuable learning experiences. They experienced personal growth and were able to develop a midwife identity. The home visit gave the students an opportunity to end the relationship with a feeling of having completed the work. They experienced the importance of continuity of care by ensuring the families had a smooth transition to the follow-up appointments at a public health clinic.
The effect of lavender aromatherapy on pain perception and intrapartum outcome in primiparous women
Authors: Kaviani Maasumeh , Azima Sara , Alavi Narges , Tabaei Mohammad Hossein
Published: May 2014

Introduction:

Labour pain is a main preoccupation of pregnant women. In this study, the authors determined the effect of lavender aromatherapy on pain intensity perception and intrapartum outcome in primiparous women.

Methods:

In this randomised controlled trial, 160 participants were divided into two groups. The aroma group received 0.1 ml of lavender essential oil mixed with 1 ml of distilled water via tissues attached to their gowns close to their nostrils. Meanwhile, the control group received 2 ml of distilled water in a similar way. Pain intensity perception was measured by Visual Analogue Scale (VAS) before the intervention and at 30 and 60 minutes afterwards.

Results:

The mean of pain intensity perception in the aroma group was lower than that of the control group at 30 and 60 minutes after the intervention (p←0.001).

Conclusion:

This study revealed that aromatherapy decreased the labour pain, but did not affect the duration of labour phases and Apgar score.
An education in midwifery: The role of an elective placement in shaping a student's approach
Authors: Wilson Hannah
Published: May 2014

Despite the widespread recognition of the benefits of minimal interventions within birth, the number of women having a ‘normal birth’ is less than half and dissatisfaction is often reported ( Department of Health, 2005 ; Birth Choice UK, 2013 ). This paper presents how an elective placement in a freestanding birth centre shaped the author's attitude to midwifery. The placement specifically enabled the author to consider what makes birth go well (rather than focusing just on what makes it go ‘wrong’) and encouraged her to examine the role she might play in contemporary maternity services. This experience was powerful in identifying avenues for personal and professional development, and has enabled the author to clarify her objectives as a midwife and what is needed to achieve them.
Empty Arms: Supporting bereaved mothers during the immediate postnatal period
Authors: McGuinness Denise , Coughlan Barbara , Power Sheila
Published: May 2014

The death of a baby, whether before, during or after birth is extremely sad. Mothers who were expecting a new life find themselves dealing with death. Midwives are one of a few people to share the important memory of the birth and death of a baby; therefore, the quality of care offered during this period is crucial to support mothers and limit the distress experienced at this difficult time. Emotionally, mothers require compassionate and sensitive care from midwives and health professionals, while physically the bereaved mother will require support and advice with her postnatal needs, as her body recovers from childbirth. The importance of knowledge and understanding of grief theory and the grieving process will guide midwives as they support the bereaved postnatal mother.
Audit of postoperative pain following day case surgery
Authors: Mackintosh Carolyn , Bowles Sandra
Published: May 2014

Day case surgery is an expanding area within the NHS. However, pain following day case procedures remains a constant concern for healthcare professionals. An audit of postoperative pain following a range of day case procedures over a 2-year period at a general hospital in the north of England found that 17–20% of patients experienced unacceptable levels of pain. However, very few of these patients were worried about the pain they experienced and none contacted their GP. This implies that healthcare professionals overestimate the significance of postoperative pain for the patients concerned.
Cushions and specialist chairs for pressure sore management
Authors: Cooper Pam
Published: May 2014

Many patients spend more time sitting out of bed than being cared for in bed. Consequently, the demand for specialist support surfaces for chairs to reduce the risk of pressure damage while the patient is up sitting is rising. This product focus examines a number of seating support surfaces produced by Karomed.
Negligence is costing the NHS £2.3 billion
Authors: Tingle John H
Published: May 2014

The realization that clinical negligence claims involving doctors, nurses and other health carers is a serious problem in the NHS was reaffirmed recently with the publication of the NHS Summarised Accounts for England 1996–97 by the National Audit Office (NAO, 1998). The NAO certifies the accounts of all government departments and a wide range of other public sector bodies. The report includes findings that:
Nursing physical assessment skills: implications for UK practice
Authors: Rushforth Helen , Warner John , Burge David , Glasper Edward Alan
Published: May 2014

The physical assessment skills of inspection, palpation, percussion and auscultation currently have only minimal recognition in UK nursing practice. Authors attest to perceived benefits in terms of continuity of care, holistic care delivery, rapidity of emergency intervention and reduction in junior doctors’ hours and workload. However, the use of such skills by nurses has been subject to little in the way of formal outcomebased evaluation, and there is a clear need for such research to be carried out within the UK. Important guidelines exist within the literature to underpin educational programmes in physical assessment; these are reviewed and their implications for UK practice are considered. It is concluded that while generation of a UK evidence base is required, there is a persuasive argument to underpin continued development of physical assessment skills within UK nursing practice.
Ethical dilemmas in clinical supervision 2: need for guidelines
Authors: Cutcliffe John R , Epling Mike , Cassedy Paul , McGregor Jane , Plant Nigel , Butterworth Tony
Published: May 2014

In this, the second half of this two-part article, the authors focus on ethical dilemmas in clinical supervision. Referring to the case vignettes included in the first part of this article (Vol 7(15): 920–3), the authors highlight how ethical dilemmas can arise and then provide some discussion on how they might be handled. As a result of the discussion, the authors conclude that there is a clear need for a specific set of guidelines to be produced that would help safeguard best practice within clinical supervision and ensure it remains an opportunity to help and support nurses in reflecting on their dilemmas, difficulties and successes (Cutcliffe and Proctor, 1998a). This would prevent supervision from becoming another form of management monitoring which might inadvertently prevent the resolution of intra- and interpersonal issues affecting the care of clients.
Care of elderly people in hospital is inadequate
Authors: Scott Helen
Published: May 2014

It is a damning indictment of health care today that a recently completed report has shown that care of elderly people in 16 randomly selected acute wards in England was seriously lacking in a number of fundamental areas. The report Not Because They are Old (Health Advisory Service 2000, 1998) was commissioned by Frank Dobson, the Health Secretary, in response to public concern over deficiencies in current systems of care.
The Nurse's Holding power: patterns of use in mental health
Authors: Ashmore Russell
Published: May 2014

Implementation of the nurse's holding power (Section 5(4) of the Mental Health Act 1983) is an important, yet poorly researched aspect of mental health nursing practice. Data collected from the Mental Health Act records of all patients detained under Section 5(4) in one trust from 1983 to 1997 suggest that detainees generally came from the acute mental health services, were female, were detained by male registered mental nurses and were held for an average of 2 hours and 24 minutes before being placed on another section of the Mental Health Act. The use of Section 5(4) seems to be influenced by the time of day, but not the day of the week, or month of the year. Peaks of Section 5(4) usage corresponded to such factors as the changeover of shifts, the absence of medical staff, visiting time and medicine rounds. The importance of these findings for clinical practice is discussed.
Professional issues facing nurse practitioners and nursing
Authors: Harris Anne , Redshaw Maggie
Published: May 2014

Legislative changes relating to professional nursing practice and a reduction in junior doctors’ working hours have led to an increase in the number of nurse practitioners in the UK. While the educational preparation for these new roles is varied, the challenges faced by nurse practitioners are similar in nature and have implications for the nursing profession as a whole. The measures that can facilitate the development of individual nurse practitioners include: effective communication and negotiation regarding the introduction of their role; clearly defined and documented role descriptions; clarification regarding areas of risk and liability; and organizational and professional support. The stance of the nursing profession in relation to the development of the nurse practitioner role is also explored and questions are raised about crossboundary working, future role development, and the impact of nurse practitioners on the delivery of patient care.
Implementing evidence-based practice for urinary catheterization
Authors: Adams Freya , Cooke Mary
Published: May 2014

Nursing development units (NDUs) are ideal centres for the critical examination of clinical nursing practice. In addition, staff are enabled to clarify appropriate and effective methods of care and interventions based on evidence to date (Department of Health (DoH), 1993, 1998; English National Board (ENB), 1996, 1997; Centre for Policy in Nursing Research, 1997). In July 1996, the staff within the cardiology NDU at Addenbrooke's NHS Trust looked at the potential for various projects that were central to practice. One concerned the management of urinary catheters. A pilot study was initiated, one outcome of which was the design of a project checklist based on Sackett et al's definition of evidence-based practice (EBP) (Sackett et al, 1997). In this article, the aims and intentions of the project are evaluated in relation to the problems associated with implementing evidence. In addition, the framework of the White Paper (DoH, 1998) is examined against the need for an organizational infrastructure, which is required to enable achievement of the outcomes of EBP. The benefits of the project are outlined, both in the changes to practice and for the unit. Recommendations for other professionals are also offered, as there are few recorded experiences in the literature of implementation of EBP, the process framework required and the costs involved.
How can the clinical credibility of nurse lecturers be improved?
Authors: Murray Cyril , Thomas Mike
Published: May 2014

The last 10 years has seen a surge in the development of academic pre- and postregistration courses. With the movement of colleges of nursing and midwifery into higher education it has become difficult for lecturers of nursing to remain engaged in clinical practice. However, the professional bodies, the students themselves and their employers expect lecturers of nursing to be clinically able, clinically credible and knowledgeable about contemporary practice in order to produce practitioners who are ‘fit for purpose’. This article outlines one innovative approach employed by an educational organization to enable lecturers of postregistration specialist nursing programmes to achieve clinical credibility by undertaking a minimum of 300 contracted hours of clinical experience. This approach was found to be beneficial to the lecturers, the students and the ongoing relationships between the trusts and the department of nursing.
Rehabilitation: scope for improvement in current practice
Authors: Nolan Mike , Nolan Janet
Published: May 2014

This article concludes this part of the rehabilitation series by looking at the nursing contribution to rehabilitation. It brings together the common elements which have emerged in the previous seven articles, identifying areas in which there is considerable scope for improvement to current practice. Indicative areas of knowledge and skill required for nurses to play a more active role are considered and a number of potential models are briefly described.
Clinical supervision for the development of nursing practice
Authors: Lowry Mike
Published: May 2014

Nursing practice demands a range of problem-solving skills and abilities, and preregistration courses may only provide limited preparation. Clinicians need to draw on the skills and expertise of experienced colleagues in order most effectively to use their time and energies in a new role or clinical area. Experienced staff may enhance both their clinical expertise and their support of colleagues through the role of clinical supervisor. Clinical supervision has benefits for the supervisor in terms of professional development and for the supervisee as regards identifying and addressing clinical problems. According to the position statement on clinical supervision for nurses and health visitors published by the UKCC (UKCC, 1996) clinical supervision aims to identify solutions to problems, improve practice and increase understanding of professional issues. This article examines roles and responsibilities in clinical supervision and discusses the benefits for individuals and for health services.
Transcultural mental health nursing 2: race, ethnicity and culture
Authors: Narayanasamy Aru
Published: May 2014

In the first article in this series (Vol 8(10): 664–8), transcultural nursing was explained in terms of its assumptions, benefits and limitations. The emerging literature in this area of mental healthcare practice was highlighted. In this article, a brief overview of concepts of race, culture and ethnicity is given and examples of mental health problems are addressed in the context of culture. Finally, the ACCESS model (Assessment, Communication, Cultural negotiations and compromise, Establishing respect, Sensitivity and Safety) (Narayanasamy, 1998) is suggested as a possible option for transcultural care in mental health nursing.
Teaching communication with the dying across cultural boundaries
Authors: Becker Robert
Published: May 2014

This article is based upon the author's personal experience, gained as a teacher of palliative care, when he was invited to be part of a small humanitarian aid team of experienced British nurse educators which worked for 2 weeks in the newly opened First Moscow Hospice in October 1997. The team was to act as both teachers and clinicians assisting the Russian health professionals to both understand and use the palliative care approach in a workable context for their culture. A case study is used to illustrate the ethical and practice-based nursing issues that arose which were related to communication difficulties, challenging myths and cultural norms, and the use of ‘self’ to demonstrate good practice. This article highlights how it is possible to overcome some of these difficulties, and shows what an honest and sensitive approach to communicating with the dying can achieve.
Case study approach to peripherally inserted central catheters
Authors: Arrowsmith Helen
Published: May 2014

This article looks at the referral of a patient (Mr H) for parenteral nutrition and the subsequent insertion of a peripherally inserted central catheter (PICC) by the nutrition nurse (NN). It explores the issues directly related to the PICC insertion including the route of intravenous access, the ability of the NN to insert the PICC, preparation, communication and consent, and prevention of the mechanical and septic complications of insertion. This case study demonstrates a good technical mastery of PICC insertion in relation to the issues raised. Mr H was satisfied with his care, offering positive feedback at follow-up visits to clinic. Critical analysis of the case study also revealed implications for further development of the role of the NN in ordering the check X-ray and the development of evidence-based standards and guidelines related to this procedure.
Correspondence
Authors: Scott Helen
Published: May 2014

Following a news item in the last issue of British Journal of Nursing (Vol 8(1): 8) revealing that the UKCC's Education Commission had commissioned a piece of work to look at what the future of nursing may be in the year 2010 (Warner et ai, 1998) I can only ask why?
IV devices and related infections: causes and complications
Authors: Parker Lynn
Published: May 2014

The use of intravenous devices has long been established as a life-saving and important part of total patient management. However, such devices are not without risk and their use is frequently complicated by local or systemic infections and complications. Twenty-five million patients are estimated to enter the NHS annually and receive some form of intravenous therapy by the peripheral route (Campbell, 1998). It behoves all staff who are involved in the management of intravenous devices to base their practice on what is agreed by consensus in the literature as being effective in reducing the risk of hospital-acquired infections. This article draws together such literature and presents recommendations for good practice for the management of intravenous-related devices.
Self-concept and cancer: understanding the nursing role
Authors: Cook Neal F
Published: May 2014

An experience of cancer can be personally challenging and devastating. Nurses are the ideal health professionals to guide patients through this period in their life because they are in the unique position of being an immediate source of support in patient care. It is therefore essential for nurses to understand the challenge that cancer presents to patients' self-conception in order to facilitate coping and adaptation. This article explores challenges such as investigation and diagnosis of cancer through to treatment, and guides the nurse in aiding the patient in self-conceptual adaptation using Roy’s Adaptation Model as a blueprint for care. It also draws upon research evidence and personal views.
Zero-Stik® Safety Syringe: an automatic safety syringe
Authors: Jeanes Annette
Published: May 2014

Needlestick injury (NSI) is an important although rare cause of the transmission of blood-borne viruses to healthcare staff. Many NSIs are avoidable. The use of universal precautions and careful sharps disposal are key factors in the prevention of injury. The availability of safety devices is increasing as it is recognized that action is necessary to prevent NSI. Devices that are easy to use and require no extra effort on behalf of the healthcare worker are preferred. There is evidence that safety devices decrease the rate of NSI. Zero-Stik® Safety Syringe, manufactured by New Medical Technology, automatically retracts the needle once the injection is complete. It is simple to use and requires no formal training.
Developing an activity measuring system in district nursing
Authors: Bentley Jenny , Tite Chris
Published: May 2014

The current measurement of face-to-face contacts for calculating district nursing activity is inadequate for district nurses, their managers, and purchasers. With the growing emphasis on health outcomes, a measure is needed which demonstrates health gain and effectiveness, yet which does not place an additional burden for data collection on nurses' time. This article describes the preliminary findings of a project carried out in East Berkshire which suggest that such a measure is possible, and that effective care, including Illness prevention, can be demonstrated. It shows that existing computer software can meet the demands for the measurement of health gain. While these are positive findings, district nurses, service managers and commissioners will need to allocate time to understand and interpret the data before drawing conclusions about the use of activity measurement in workforce planning, service costing and the effectiveness of district nursing interventions.
Changing NHS structures: implications for nursing careers
Authors: Rushmer Rosemary , Dowling Martin
Published: May 2014

This article explores what implications the flatter NHS structures (after the restructuring of April 1999) might have for nursing careers. It examines issues of recognition, reward systems and career pathways and the problems these may pose for the retention of qualified staff within nursing. It is seen that flatter structures will offer little in the way of traditional vertical promotion opportunities and readers are invited to explore the possibility of lateral promotion, continuous development, career grids and the rise of the generic nurse. Speculation about the introduction of competency-based pay systems are introduced. The article attempts to progress the debate in the area of the links between structure and supporting human resource infrastructures within the public sector set against background context of severe cash constraints. It seeks to raise the issues and open debate among practitioners.
Malnutrition and pressure ulcers: nutritional assessment tools
Authors: Russell Linda
Published: May 2014

Good nutrition is essential throughout life and often patients have a poor understanding of what a balanced diet comprises. Nurses need to have a good comprehension of malnutrition. Where malnutrition is evident it can be resolved by working with the patient to encourage a healthy diet. One way to improve patient nutrition is by a nutrition audit of patient food. Numerous nutritional assessment tools exist which help to identify a patient's nutritional status. No nationally standardized nutritional assessment tool exists and there is a danger of assessment methods becoming as proliferate as pressure ulcer risk assessment tools. A solution to this problem may be to use a pressure ulcer risk assessment tool with a nutritional risk assessment tool such as the Burton Score. Pressure ulcers and malnutrition have been demonstrated to be strongly correlated with each other. Malnutrition is not just present in hospitals but also in nursing homes. A solution to this problem is to use nutritional tools to highlight nutritional deficiency in a patient's diet not only in hospitals but also in the community and in nursing homes.
Gerontological nursing 5: realizing the future potential
Authors: Nolan Mike , Tolson Debbie
Published: May 2014

In this, the final article in the series, the authors consider the prospect for the future of gerontological nursing with a special focus on philosophy of care, expert gerontological nurses and evidence-based practice. The article highlights the need for more research and education in gerontological nursing if quality of care is to improve and gerontological nursing is to consolidate its place in the future of nursing practice.
New nurse competencies: are they adequate?
Authors: Castledine George
Published: May 2014

Over the years there have been accusations that nursing education programmes do not produce competent clinical nurses. The recent UKCC Education Commission report (UKCC, 1999) highlighted this concern when it reviewed preregistration nursing programmes. Evidence showed that new nursing diplomats or graduates were not as clinically skilled as their predecessors.
Multiprofessional perceptions of a paediatric nursing development unit
Authors: Glasper Edward Alan , Brooking Julia , Raphael Helen
Published: May 2014

This article describes the final component of the quinquennial evaluation of a King's Fund accredited nursing development unit (NDU) within a paediatric outpatient department of a large district general hospital during the period 1993–1998. The study draws upon descriptive data obtained through a questionnaire distributed to 83 members of staff associated with the outpatient department. Overall, the results demonstrate that NDU status has enabled staff to embrace the change process more readily than might have been possible otherwise. The basic premise that NDUs should promote nursing innovation is explored and critically evaluated.
Using biography to enhance the nursing care of older people
Authors: Clarke Amanda
Published: May 2014

This article describes how the use of the biographical approach in nursing practice should enable a fuller understanding of older people as individuals, based on their lived experience. This, in turn, should affect the way in which nurses work with, and care for, older people, encouraging person-centred practice. First, drawing on a life story, the article describes the ways in which people’s accounts of their past lives may provide an insight into their present needs, priorities and aspirations; it also helps to reveal and challenge our assumptions about later life. Second, the article discusses why the biographical approach is particularly appropriate for the care of older people in continuing care settings and how this approach could be undertaken.
Living with a young person who wets the bed: the families' experience
Authors: Morison Moya J
Published: May 2014

After allergic disorders, bed-wetting is the most common chronic condition of childhood. It can seriously diminish the quality of life of young people and their families, having an impact on day-to-day activities, family holidays and the young person's willingness and ability to stay away from home with friends and wider family. In this ethnographic study, family members describe the practical and social consequences of bed-wetting, both for themselves and for the family, and the methods that they have employed to encourage the bed-wetting to stop. Most of these methods have little chance of success. Many families’ feelings of helplessness and isolation are reinforced by lack of help from healthcare professionals, although the professional's intention to be helpful is rarely questioned. The nature of the families’ experiences illustrates the urgent need for adopting a new professional approach to the support of these families, which is based on the principles of ‘family nursing’.
Assessing therapeutic intervention used by NHS Direct nurse advisers
Authors: Ashmore Russell , Hemingway Steve , Lees Janet , Barker Mark
Published: May 2014

The National Service Framework for Mental Health has identified NHS Direct as a ‘new point of access’ to appropriate mental health services. Mental health calls account for approximately 4% of all calls received by NHS Direct but raise the greatest level of anxiety among advisers and take twice as long to deal with as other calls. In order to provide adequate advice, it is essential to ensure nurse advisers can deal with this type of call. As a first step in meeting these needs this short research article reports on the types of interventions deployed by 18 nurse advisers during role plays with a mental health ‘client’ expressing self-harm.
The use of wound drainage bags for complex wounds
Authors: Benbow Maureen
Published: May 2014

The routine use of drainage devices for wound management is relatively uncommon because of the extensive range of dressings available. However, there is an almost equally large range of wound drainage devices with different designs and properties from which to choose. Large, complex wounds with a fistula draining small bowel content are difficult to manage. This article focuses on wound drainage bags and explores the case of a patient with a large abdominal wound with a fistula at the lower end whose effluent was contained by Wound Manager (manufactured by Craig Medical, obtained from ConvaTec).
Death of adolescents: parental grief and coping strategies
Authors: Davies Alyson Mary
Published: May 2014

The death of an adolescent is a particularly complex issue. The process of grieving and coping can be complicated by the tension that may have existed in the parent/child relationship because of the conflict in terms of personal ideology at this stage in the adolescent's development. As a result, parents of adolescent children who die have the potential to experience abnormal grief reactions. Parental coping strategies vary according to the mode of death and outlook adopted by the parents, although some studies suggest parents bereaved of adolescent children do not exhibit marked differences in grieving or coping in comparison to other groups of parents. Healthcare professionals must recognize the specific and special needs of this parent group, and provide appropriate support to minimize the risk of harmful sequelae that may occur as a result of inappropriate and insensitive care.
Ward sister/charge nurse: the key role in nursing
Authors: Castledine George
Published: May 2014

Twenty years ago, Pembrey (1980) measured the performance of ward sisters in relation to individualized nursing. The report not only emphasized how crucial the ward sister's role was, but also identified some key factors towards its success. One factor was the importance of preparation, education and experience. Many sisters identified role models (often other senior sisters) as the source of their learned behaviour, rather than formal management training. Although ward sisters had a lot of authority over their wards, they lacked formal managerial authority to exercise power over some services, e.g. supplies, catering and finance.
Nutrition and the life cycle 5: nutritional needs of older adults
Authors: Coutts Alison
Published: May 2014

The previous four articles in this series on nutrition and the life cycle reviewed the nutritional needs during pregnancy (Vol 9(17): 1133–8), infancy (Vol 9(21): 2205–16), childhood (Vol 10(1): 26–31) and adulthood (Vol 10(6): 362–9). This article, the last in the series, will review the special nutritional needs of the older person. Older adults form an increasing proportion of our society, and it is important that nurses appreciate their special needs. The article concentrates on the healthy older adult, and reviews what nutritional advice nurses should be providing in order to help them achieve maximal health.
A dedicated follower of fashion? Topical medications and wounds
Authors: Cutting Keith F
Published: May 2014

This article reviews the factors that impinge on the application of topical medications in wound care. The role of systemic and topical antibiotics in wound care is reviewed. Similarly, two antiseptics — iodine and silver, of great current interest in wound management — are scrutinized. The value of these topical agents in the management of wound bioburden should be ascertained from the perspective of understanding the advantages and disadvantages of their use and not established from what is currently the trend.
Compliance with science: benefits of developing community leg clubs
Authors: Lindsay Ellie
Published: May 2014

As a district nurse providing leg ulcer management in a rural community, the author was aware that the effectiveness of compression therapy was, in many cases, compromised by poor compliance to treatment. Once the author had researched the underlying causes of non-compliance, she addressed the issues by developing innovative leg ulcer clinics (‘Leg Clubs’) to provide holistic care in an environment of patient empowerment, destigmatization and peer support. Analysis of data acquired over an 11-month period illustrates that this new approach has yielded significant reductions in the incidence of non-compliance, allowing the benefits of compression therapy to be realized.
Research-based care on an acute inpatient psychiatric unit
Authors: Bartholomew David , Collier Elizabeth
Published: May 2014

Many studies of research-based practice in nursing highlight factors that impede the development of practice. With the aim of adding to this body of knowledge, a modified grounded theory approach was used in order to understand more about these barriers and how individual nurses utilize research in their practice. A selective sample of five staff nurses from one acute inpatient psychiatric unit took part in semistructured interviews. Three main themes were identified, each with two sub-themes. These were (a) activities to utilize research with (i) a ‘systematic’ model and (ii) a ‘latent’ model of research utilization (b) enhancing research utilization with (i) organizational culture and (ii) individual attitude and knowledge and (c) impeding research utilization with (i) resources (ii) resistance to change. It is suggested that for these nurses research utilization occurs through their individual knowledge, skill and motivation coupled with organizational commitment. Recommendation is made that further investigation of the ‘systematic’ and ‘latent’ models should be carried out. Additionally, it is suggested that these research findings might be used to inform future training, further research-based initiatives and to raise managerial awareness of the impeding factors of research utilization.
Solving the enigma: toilet training children with learning disabilities
Authors: Rogers June
Published: May 2014

Promoting continence with children with a learning difficulty has traditionally taken second place to managing their other needs. Previous studies have given the impression that children are not ready for toilet training unless they are able to experience awareness of self and respond to the stimulus of a full bladder. This has resulted in assumptions regarding the ability of some children with learning difficulties to become toilet trained and consequently they are ‘labelled’ as incontinent and automatically issued with nappies. This approach means that any underlying problems such as constipation are not addressed. By taking a different approach, and focusing on assessing bladder and bowel maturation the author has found that children who were once considered incapable of toilet training can become continent.
What do patients want to happen to their dentures before surgery?
Authors: Wood Marion
Published: May 2014

The removal of dentures before having an anaesthetic can be an undignified and distressing event. However, there has been a gradual change in practice and dentures are now often left in place during an anaesthetic. This enquiry into patients' preferences was carried out to find out what patients would like to happen to their dentures, and to see if there were any differences in opinions among age groups. A postal questionnaire was sent out to patients who wore dentures following discharge after surgery. One hundred replies were analysed. There was a spread of opinions across the age groups and by gender. Nurses need to allow patients the choice of what to do in relation to their dentures when going to theatre, although the anaesthetist must make the final decision of whether or not to remove them immediately before the anaesthetic if they feel patient safety could be compromised.
Children need to be cared for by children's nurses
Authors: Richardson Jim , Charles-Edwards Imelda , Glasper Alan , Powell Catherine , Whiting Mark
Published: May 2014

In recent months much has been said and written about preregistration nurse education. We have only just come to grips with the new ‘fitness for practice’ curriculum but are already moving on to debating the options outlined in the Nursing and Midwifery Council's Fitness for Practice and Purpose document (UKCC, 2001).
Pain in venous leg ulceration: aetiology and management
Authors: Mangwendeza Addah
Published: May 2014

Leg ulceration is a common chronic recurring condition which affects a significant percentage of the UK population. There has been much written about the management of leg ulcers; yet despite this, pain in venous aetiology remains poorly understood. This article will discuss some of the factors that contribute to pain in venous aetiology as well as offering clinical management strategies.