bluuebunny/crossref_metadata_2025 huggingface dataset:
Homeostasis, Part I. Homeostasis versus homeodynamism
Authors: Clancy John , McVicar Andrew
Published: May 2014

All nurses are familiar with the term ‘normal’, where it concerns the range of figures recorded during assessments and observations of body fluids and organ functioning. Many are familiar with the concept of homeostasis. However, few have heard of ‘homeodynamism’, which may be a more appropriate term. This article, the first in a series of six, defines this. It introduces the principles of homeostasis and looks at it at cellular, tissue, organ and system levels. After reading this article, the nurse should be able to: relate the principles of homeostatic theory to health and illness; know why and how systemic integration is fundamental to the maintenance of intracellular metabolic homeostasis; acknowledge that cells are the basic unit of health, illness and healthcare intervention; and appreciate that receptors, enzymes and adenosine triphosphate are the key chemicals of a healthy metabolism.
Interns' attitudes to IV cannulation: a KAP study
Authors: Carr Peter J , Glynn Ronan W , Dineen Brendan , Devitt Dara , Flaherty Gerard , Kropmans Thomas JB , Kerin Michael
Published: May 2014

One of the most common procedures for junior medical doctors is peripheral intravenous cannulation (PIVC). Considering this, an understanding of the peripheral intravenous cannulation procedure is paramount.

Aim:

The objective of this study was to identify the level of understanding of interns regarding intravenous cannulation.

Method:

An anonymized structured questionnaire using a knowledge attitude and practices (KAP) format was distributed to 60 interns affiliated to a university college hospital in Ireland.

Findings:

This study suggests that interns are poorly prepared for one of the most common clinical skills they will perform. They showed poor understanding of whether peripheral cannulation is a clean or aseptic technique, and lacked knowledge of the potential side effects of peripheral cannulation and IV therapy.

Recommendations:

A structured learning module on peripheral intravenous cannulation is required. A rigid, evidence-based, Objective Structured Clinical Examination (OSCE) on peripheral cannulation is recommended. The reduction of junior doctors’ weekly working hours to 48 under the European Working Time Directive offers the potential for nurses to take ownership of IV cannulation. This will allow junior doctors to focus on other clinical skills and assessments, which can only be to the advantage of the patient.
Care and cost-utility indicators for high-flow PICC catheters: a study
Authors: Hernández Paloma Ruiz , López Juan Luis González , Martín Juliana González , Eguía Beatriz Rivas
Published: May 2014

Intravenous therapy teams (IVTT) provide care, education and supervision of the patient with a central line, and his/her family. This article discusses the creation of an IVTT in the Hospital Clínico San Carlos of Madrid, Spain, demonstrating its effectiveness using cost-utility analysis and outcomes indicators. In 2009 the IVTT began using a high-flow peripherally inserted central catheter (PICC) with its target population of chronic patients dependent on central venous catheters or prolonged IV treatment. The team designed activity, welfare, educational and economic indicators. Of the 98 catheters placed, 80% of patients achieved a positive response; 42% of catheters were removed after death and 30% by the end of treatment. Four percent were removed due to infection. The average implantation duration was 45 days. The economic study showed an increasing cost saving compared to peripheral catheters after 90 days of implantation, and after 77 days compared to central venous catheters. This translated into an immediate saving of €161 (£133.70) and €303.83 (£252.31) per catheter over Hickman lines and ports, as well as reduced risks, length of hospital stays and costs. The study shows PICC to be cost-effective with reported benefits to patients, professionals and organizations. The creation of the IVTT has resulted in improvements to care and the management of resources.
When is a grade 4 pressure ulcer not grade 4?
Authors: Briggs Shiu-Ling
Published: May 2014

The adoption of the European Pressure Ulcer Advisory Panel (EPUAP) (2009) pressure ulcer classification system within healthcare trusts in the UK has provided health professionals with a common approach for the description of tissue damage for pressure ulcers. However, the omission of the ‘unstageable/unclassified’ and ‘suspected deep tissue injury under intact skin’ has caused difficulties when the visual appearance of pressure ulcers falls outside the four grades listed in the classification system. These difficulties lead health professionals to overestimate the degree of tissue damage, resulting in confusion in regards to determining the true extent of the tissue damage and often misdirection of scarce resources ( Moore, 2005 ). The Berkshire Tissue Viability Nurses Group attempted to bring clarity to the situation by highlighting the issues to raise awareness and stimulate discussion among health professionals. The author, with support of the Berkshire Tissue Viability Nurses Group, first presented the content of this article at a meeting of the No Needless Skin Breakdown Work Stream meeting of the South Central Strategic Health Authority Patient Safety Federation in January 2011.
The wound debrider: a new monofilament fibre technology
Authors: Haemmerle Gilbert , Duelli Heinz , Abel Martin , Strohal Robert
Published: May 2014

Debridement is a basic necessity to induce the functional process of tissue repair, especially in chronic wounds. In this pilot study the authors used a new debrider technology with specific monofilament fibres in a unique texture to evaluate its efficacy, safety and tolerability. In eleven patients, exhibiting all types of wound-associated debris (biofilms, slough, necrotic crusts and hyperkeratotic plaques), the debrider, wetted with physiological solution, was wiped without specific force over the wound for about 2–4 minutes. This led to removal of almost all debris leaving healthy granulation tissue intact, including small epithelialized islands of vital tissue. The procedure was without pain and adverse events. Scanning electron microscopic analyses identified the majority of the removed debris tightly packed within the monofilament texture. A surgeon who blindly assessed pictures taken before and after the debridement categorized all except one wound without the need for surgical debridement and ranked all the debridement results with the new debrider as ‘very good’ (best category). This formulates the basic concept that the new debrider-based technology is easy, fast, highly efficient, well tolerated and cost effective.
Case study in treatment of diabetic foot ulcer with alimentary gelatin
Authors: Pinto Nuno Manuel Teles
Published: May 2014

The patient with diabetic foot ulceration is undoubtedly one of the major challenges faced by nurses and physicians working in the field of wound treatment. About 15 % of diabetic patients experience foot ulceration in the course of their disease. This article reports the adoption of an unconventional treatment, based on gelatin, in a case of a stagnant diabetic foot ulcer, resulting in the successful healing of the wound and the limb being saved. Gelatin is fundamentally denatured collagen; its presence is paramount in the natural healing process, and this may be one of the reasons that the treatment obtained a good result. The fact that the gelatin used is of animal origin does not appear to compromise the outcome of treatment.
Reducing pressure ulcers in hip fracture patients
Authors: Thompson Mark
Published: May 2014

This article describes how a collaborative project within an NHS hospital reduced the incidence of pressure ulcers in hip fracture patients by 79.8%, thus improving outcomes of care and patient experience. The impetus for the project came from the negative effects on functional recovery that pressure ulcers can cause, a prevalence of 9.3% in the existing patient group, and the trust's commitment to reduce pressure ulcers for all patients by 50%, as per local quality indicators. Using a multiprofessional collaborative team approach, issues with current practice and how improvements could be made were identified. Following this, a best practice guideline and educational session based on national guidelines, but tailored to the local and holistic needs of hip fracture patients, was developed. The author proposes that the tailoring of an intervention to the specific needs of high risk patient groups is transferable to any area of practice where pressure ulcers are prevalent.
Patient Group Directions: a safe and effective practice?
Authors: Price Owen , Baker John , Paton Carol , Barnes Thomas
Published: May 2014

Patient Group Directions (PGDs) have been used in clinical practice for a decade. They enable non-medical practitioners to supply medicines to patients, in certain legally defined circumstances, without a doctor's prescription and in accordance with a pre defined protocol. The authors aimed to review the existing literature in order to identify and evaluate the evidence regarding the quality, safety and acceptability of PGDs within care systems and their impact on health outcomes. Searches of relevant databases were conducted, articles screened against eligibility criteria and relevant data extracted. A number of key issues emerged from the data including quality and safety of practice, acceptability to patients and practitioners, access to treatment and implications for professional roles and responsibilities. There were no data related to health outcomes. The review concludes that while PGDs may be an acceptable way to deliver care, their impact on patient outcomes and health status has been poorly studied.
Can nurses help to promote earlier diagnosis of bowel cancer?
Authors: Glasper Alan
Published: May 2014

Professor Alan Glasper outlines the rationale for the Department of Health's 2012 Be Clear on Cancer campaign, discussing its aims and encouraging all nurses to cascade the message of the initiative to those in healthcare environments
PROMs: a novel approach to arthritis self-management
Authors: Palmer Deborah , Miedany Yasser El
Published: May 2014

Despite our knowledge of many effective education techniques, there is little evidence that clinicians have incorporated them into their daily practices. One of the reasons for the underutilization of patient education may be that physicians are expecting the specialist nurses to provide this service, whereas the nurses lack any formal protocol for patient education in standard clinical practice. Self-management programmes are now acknowledged as a key element of quality care. A high priority for research is the development and diffusion of patient education strategies that are tailored to address patient needs and applicable for the standard day to day practice. This paper describes the rationale and design of the ‘Joint Fitness Program’ which is a new patient-based educational programme integrating patient-reported outcome measures (PROMs) and self-management for people with inflammatory arthritis. This education programme, which illustrates how theory can explicitly be translated into practice, addresses PROMs as an objective tool to assess the educational needs of patients with arthritis and uses the PROMs to design an education programme and not just evaluate the disease activity.
Final-year student nurses' perceptions of role transition
Authors: Doody Owen , Tuohy Dympna , Deasy Christine
Published: May 2014

Role transition can be both challenging and exciting. This study presents the findings of phase one of a two-part study conducted by Deasy et al ( 2011 ), which explored final-year student nurses' (n=116) perceptions and expectations of role transition. The students were registered on four-year BSc nursing programmes at an Irish university. Data was analyzed using SPSS (version 16). A response rate of 84% was achieved. Over half of respondents said they were adequately prepared for the post of registered nurse. Respondents generally perceived themselves to be competent across a range of domains: managing workloads; prioritizing care delivery; interpersonal skills; time management skills; ethical decision making; and providing health information and education. In contrast, not all were confident about their knowledge and many expected the transition to be problematic. Most expected to be supported and to receive constructive feedback. Recommendations include nurturing supportive work environments to reduce stress and increase confidence.
Tuberculosis care: Olympics 1948 vs 2012
Authors: Karim Kelvin
Published: May 2014

Tuberculosis (TB) is a multi-faceted illness associated with a long and fascinating history. Although much has changed in the diagnosis, treatment and prevention of TB over the past six decades, many of the challenges remain remarkably similar. In developing solutions to these challenges, key stakeholders and politicians would do well to learn from some of the more effective strategies from the pre-chemotherapy era. Despite working with insufficient resources, nurses have historically contributed significantly to the work of the multidisciplinary teams in delivering care to patients and families, as well as in implementing national TB control and prevention programmes. The current resurgence of TB in the UK makes it imperative to achieve consistently and appropriately-funded TB services across the country. Whether NHS commissioners and politicians will engage with nurses and others in the reconfigured NHS to achieve this, however, remains to be seen.
Nursing students' views of clinical competence assessment
Authors: Bradshaw Carmel , O'Connor Maureen , Butler Mary Pat , Fahy Anne , Tuohy Dympna , Cassidy Irene , Quillinan Bernie , Egan Geraldine , McNamara Mary C , Tierney Katie
Published: May 2014

This paper reports on some outcomes of a research study evaluating a new assessment framework of clinical competence used in undergraduate nursing programmes in the Mid West Region of Ireland. First, this paper presents both the strengths and weaknesses of the present model, as articulated by student nurses. Second, it generates a broader critical debate around the concept of competency assessment. The model of competence in question was developed by the Irish Nursing Board then elaborated on by the University of Limerick in partnership with local health service providers in 2002. Methodology involved a triangulated approach, comprising a series of focus group interviews with students (n=13) and preceptors (n=16) followed by a survey of students (n=232) and preceptors (n=837). Findings from the student focus groups are reported here. Themes identified using Burnard's (1991) framework for analysis are preparation for competency assessment, competency documentation, supporting assessment in practice, organisational and resource factors and the competency assessment structure and process. Results from this research have implications for refinement and revision of the present competency assessment framework, for student and staff preparation and for collaboration between stakeholders.
Exploring advanced nursing practice: past, present and future
Authors: Duke Natasha
Published: May 2014

This article examines the nature of advanced nursing practice. It identifies confusion around the terms of advanced nurse practitioner (ANPs), nurse practitioners and specialist nurses, and identifies what advanced practice is. The history of how ANPs evolved is discussed from its haphazard development to a more organised approach. Current advanced practice is identified, along with NHS plans for nurse development. Law, ethics and professional accountability are examined in relation to the additional responsibility ANPs have. Finally, the author's role as an ANP is considered within the context of primary care and NHS reforms.
Transformational leadership in nursing practice
Authors: Doody Owen , Doody Catriona M
Published: May 2014

Traditionally, nurses have been over-managed and led inadequately, yet today they face unprecedented challenges and opportunities. Organisations constantly face changes that require an increasingly adaptive and flexible leadership. This type of adaptive leadership is referred to as ‘transformational’; under it, environments of shared responsibilities that influence new ways of knowing are created. Transformational leadership motivates followers by appealing to higher ideas and moral values, where the leader has a deep set of internal values and ideas. This leads to followers acting to sustain the greater good, rather than their own interests, and supportive environments where responsibility is shared. This article focuses on transformational leadership and its application to nursing through the four components of transformational leadership. These are: idealised influence; inspirational motivation; intellectual stimulation; and individual consideration.
Mepitel® One: a wound contact layer with Safetac® technology
Authors: Barrett Simon
Published: May 2014

This article examines the use of Mepitel® One, a wound contact layer that promotes wound healing by using the clinical benefits of Safetac® technology. A wide range of clinical evidence shows that dressings with Safetac prevent trauma, minimise wound pain and associated psychological stress, while facilitating undisturbed wound healing. Mepitel One has been developed as a highly transparent wound contact layer with Safetac on the wound contact surface alone; this makes it easy to apply without sticking to gloves, and allows it to be used with a choice of secondary dressings. The dressing can stay in place for up to 14 days and allows examination of the wound without removal. The clinical evidence reviewed here shows that Mepitel One is a versatile option for use on a wide range of wound types to promote undisturbed healing and minimise pain at dressing changes.
Pin site infection in orthopaedic external fixation devices
Authors: Walker Jennie
Published: May 2014

External fixation is a well-established mode of treatment within orthopaedics; however, despite continued research, pin site infection is still a problem. Pin site infection may cause pain and discomfort to the patient, and result in osteomyelitis or sepsis if minor infection is not managed in a timely and appropriate manner. Fundamental issues such as the assessment and reporting of infection are important in dealing with pin site infection, as is the ongoing management of the pin site itself. Many types of care are evident, with varying evidence to support their use in clinical practice. This article will discuss the identification and classification of pin site infection and the methods of care.
The role of anxiolytic premedication in reducing preoperative anxiety
Authors: Carroll Jennifer K , Cullinan Eithne , Clarke Linda , Davis Niall F
Published: May 2014

Prevention of preoperative anxiety with anxiolytic premedication is associated with improved preoperative outcomes in surgical patients. The objective of the authors' study was to evaluate the percentage of surgical patients that are prescribed premedication for preoperative anxiety before their anticipated surgical procedure. A prospective study was carried out by theatre nursing staff in the theatre reception bay of a university teaching hospital. A questionnaire was designed to record the number of patients that described symptoms consistent with preoperative anxiety. The number of patients that had been offered anxiolytic premedication for preoperative anxiety was also recorded. Consent was obtained from 115 consecutive surgical patients (male, n=52; female, n=63). Of these, 66% (n=76) reported anxiety before their surgical procedure (male: n=27, female: n=49). Premedication with a low-dose benzodiazepine was prescribed by an anaesthetist in 4% of cases (n=5). Patients that received premedication preoperatively reported effective relief of their anxiety symptoms This study demonstrates that preoperative patient anxiety is highly prevalent. The authors' findings suggest that premedication with anxiolytic pharmacological therapy may be an underused therapeutic resource for managing preoperative patient anxiety.
GuardIVa: a novel antimicrobial haemostatic IV dressing: Part 2
Authors: Donnellan Peter , Real Keith , Pennington Jerry , Reid Ronald , Dreyer Jerrold , Rico Jean , Boston K , NíBeilliú Máire
Published: May 2014

This article is the second of a two-part series on GuardIVa®, a novel antimicrobial haemostatic IV dressing from HemCon Medical Technologies. In Part 1 ( Donnellan et al, 2011 ), the ability of GuardIVa Antimicrobial Haemostatic IV Dressing to significantly suppress skin flora re-growth was demonstrated in a clinical study conducted with healthy human volunteers. In addition, the antimicrobial and haemostatic efficacy of the dressing and its effects on wound healing were presented following a number of independently conducted in-vitro and in-vivo tests.

In Part 2, the dressing was assessed for use as part of dressing change kits for patients with temporary short-term catheters in the intensive care unit (ICU) of a major US hospital. The use of GuardIVa Antimicrobial Haemostatic IV Dressing by a wound care nurse on a high level functioning quadriplegic patient presenting with redness, fluid and bleeding at the access site of a percutaneous medical device was also assessed. The positive outcomes from these experiences demonstrate that the GuardIVa dressings may be used as an effective component of catheter site regimens implemented by health professionals in a range of medical applications in diverse facilities.
Implementing enhanced recovery in gynaecology oncology
Authors: Rooth Carolyn , Sidhu Amar
Published: May 2014

Enhanced recovery involves the adoption of a selected number of evidence-based interventions used together and implemented in a ‘fast track’ care pathway during preoperative management, surgery itself and throughout the immediate postoperative period. Aimed at promoting effective patient recovery after surgery, this has been shown to improve the patient experience and facilitate early patient discharge following major surgery in some clinical areas ( Department of Health, 2010 ). Applied to the clinical management and nursing care of women affected by gynaecological malignancies in one London tertiary referral centre hospital, enhanced recovery has been seen to improve patient experience and shorten the length of overall hospital stay. Implementation requires careful planning, appointment of key practitioners and commitment of the multidisciplinary team to realise successful outcomes. The authors' experience suggests that challenges are associated with changing practice and that while careful planning is essential, successes are to be gained, which significantly benefit patients, staff and the NHS Trust. In sharing this experience of implementing enhanced recovery, the authors hope to encourage others to consider application of this innovative strategy.
Prostate cancer overview. Part 1: non-metastatic disease
Authors: Drudge-Coates Lawrence , Turner Bruce
Published: May 2014

Prostate cancer is now recognised as one of the most important medical problems facing the male population, with additional factors such as age, race and familial history amplifying the risk of disease. Part 1 of this two-part article, discusses and provides an overview of the key risk factors, through to diagnosis and management of nonmetastatic disease. With the current changing dynamics in healthcare provision both in hospitals and the community setting, the articles aims to inform the wider nursing arena of the key issues that may be raised by men seeking advice and intervention both before and following treatment.
Professional boundaries in the nurse–patient relationship
Authors: Griffith Richard
Published: May 2014

Complaints about failures to maintain professional boundaries are increasing, with the Nursing and Midwifery Council reporting some 247 new cases in the year 2011–12. Professional boundaries are essential to effective nurse–patient relationships that must focus on care and treatment only. In this article the author outlines the scope of the nurse–patient relationship and reflects on activity considered as being outside the professional relationship.
An exploration of self-efficacy and self-management in COPD patients
Authors: Simpson Edwina , Jones Martyn C
Published: May 2014

Aim:

This study examined if self-efficacy in managing chronic obstructive pulmonary disease is associated with better mood, less breathlessness and fewer exacerbations; what helps or hinders patients in managing their chronic obstructive pulmonary disease (COPD); and patients’ suggestions to improve the self-management support they receive.

Background:

COPD is the fifth leading cause of death in the UK, and it has been suggested that supporting self-efficacy and self-management could improve patient outcomes and reduce demands for NHS resources.

Methods:

An exploratory, descriptive survey involving the collection of both quantitative and semistructured qualitative data was chosen. Participants were randomly selected from four GP practices across the north east of Scotland.

Results:

Higher levels of self-efficacy were associated with lower levels of breathlessness, lower levels of anxiety and lower levels of depression in COPD patients. There was no association between high self-efficacy and exacerbation rates.

Conclusion:

Increasing self-efficacy and reducing anxiety and depression in patients living with COPD are important focus points for self-management support.
Clinical trial: physical, psychological and social needs of patients
Authors: Hull Diana
Published: May 2014

Liver disease has become the fifth most common cause of death in the UK and is associated with significant morbidity. Obesity and type II diabetes have been shown to be on the increase as well, playing a major role in chronic liver disease. Treatment options remain limited for those patients with fatty liver disease. This article uses a reflective case study to demonstrate how the research nurse is able to identify some of the physical, psychological and social needs that impact on a patient's journey throughout his clinical trial participation. The patient's psychological wellbeing became compromised as a result of social stressors at home and coming to terms with his liver condition.
The assessment and management of falls in residential care settings
Authors: Duffy Anita
Published: May 2014

Care of the older person has become more specialised in Ireland particularly since the introduction of national and international healthcare standards. In this regard, older people are receiving more evidence-based quality care when living in long-term healthcare facilities in Ireland. Assessment and management of falls is currently high on the quality agenda in terms of measuring quality outcomes. Clinical practice is being standardised using evidence-based practice and research. Residential care nurses caring for older people in Ireland are required to demonstrate clinical competence when assessing and managing falls in the residential care setting. Healthcare legislation, policy and in-service education, occurring in both the public and private sector, require a multidisciplinary-team approach. This article addresses the nursing priorities regarding falls assessment and management strategies that residential nurses should consider when caring for the older person at risk of falling.
NICE consultation on developing social care standards
Authors: Glasper Alan
Published: May 2014

Professor Alan Glasper discusses the ongoing NICE consultation with key stakeholders and their plans to develop auditable guidance and standards for social care.
Patient warming in surgery and the enhanced recovery
Authors: Bernard Helena
Published: May 2014

Perioperative hypothermia is associated with poor outcomes for patients, yet it is preventable in most cases ( National Institute for Health and Clinical Excellence (NICE), 2011a ). NICE guideline 65 (2008) provides clear recommendations for avoiding perioperative hypothermia in surgical patients at each stage of their surgical journey, preoperatively, intraoperatively and postoperatively. This article describes the risks for patients at each of the three stages and disseminates the most recent NICE recommendations on how both patients and health professionals can work together to avoid perioperative hypothermia. The Enhanced Recovery after Surgery programme (ERAS) considers patient warming to maintain perioperative normothermia to be a key component in accelerating patient recovery. This article looks at how the NICE guidelines on inadvertent perioperative hypothermia and the ERAS programme complement each other to successfully and significantly improve patient recovery.
Parental presence and distraction during painful childhood procedures
Authors: Matziou Vasiliki , Chrysostomou Anthi , Vlahioti Efrosyni , Perdikaris Pantelis
Published: May 2014

Aim:

To investigate the effect of parental presence and the distraction of the attention by a toy in children undergoing a painful procedure.

Methods:

A randomised study with two experimental groups and one control group—130 children (64 girls and 66 boys), mean age 8.3 years (range 7–10 years) were randomly assigned to one of the three groups from September 2006 to March 2007: the parent presence group, the toy group, the control group. The verbal rating scale of pain, the assessment of vital signs before and after the procedure and the State–Trait Anxiety Inventory for Children were used.

Results:

Children who had their parent close to them showed a reduction in breaths (95% confidence interval (CI) for gradient of regression line): −4.20 to −2.80, p<0.001), mean blood pressure (95% CI: −4.88 to −2.99, p<0.001) and pulse (95% CI: −8.76 to −5.68, p<0.001) compared to the children whose parents were absent. They also felt less pain (95% CI: −4.40 to −2.71, p<0.001) and they were less distressed (95% confidence interval for A-State tool (CIA−State): −10.46 to −6.49, p<0.001 and 95% confidence interval for A-Trait tool (CIA-Trait): −5.71 to −2.13, p<0.001).

Conclusion:

Parental presence is considered to be important in decreasing children's pain, stress and their negative behaviour in general during invasive procedures.
Nurses’ perceptions of transfusion training: an evaluation
Authors: Stout Lynn
Published: May 2014

Within Scottish hospitals transfusion education is mandatory for all staff involved in the process of transfusion. Currently two modes of delivery exist, face-to-face and e-learning. The researcher, a transfusion practitioner, wished to evaluate the perceptions of registered nurses within her local children’s hospital to the transfusion education available. The aim of the evaluation was to ascertain whether there were perceived benefits, whether expectations were met and whether nurses perceived that there were any barriers to undertaking the education. Both quantitative and qualitative data were obtained by means of a questionnaire; all registered nurses in the hospital were invited to participate. The study indicates a high level of compliance with mandatory transfusion education and suggests both satisfaction and perceived benefits with transfusion education among those who responded. Some barriers were highlighted, but it was noted that these were not exclusive to transfusion education and in the current challenging environment with conflicting priorities on time, resolution may be complex.
A special case: treatment of a patient with necrotising fasciitis
Authors: Alblas Jolanda , J Klicks Rutger , Andriessen Anneke
Published: May 2014

The case study in this article describes the rapid and accurate diagnosis of a critically ill patient with necrotising fasciitis (NF). Full-thickness patchy skin necrosis of the right thigh, buttock and flank was detected on admission. Prompt radical debridement together with aggressive fluid resuscitation and broad-spectrum antibiotic administration was initiated. Case ascertainment was used to evaluate the effectiveness of a debridement and wound treatment regime, using a monofilament debridement product, negative wound pressure treatment and, after the critical period had ended, a bio-cellulose + polyhexamethylene biguanide (PHMB) dressing, followed by a collagen dressing. NF after open haemorrhoidectomy represents a life-threatening complication to otherwise healthy patients. Accurate diagnosis, prompt critical care and surgical treatment, together with debridement using the monofilament product and effective wound bed preparation, lead to a successful outcome.
Choosing the correct accessory for each stoma type: an update
Authors: Burch Jennie
Published: May 2014

There are many people with a stoma that report a good quality of life. However, for many, problems can be encountered that can directly affect them. The use of a stoma accessory, in addition to the stoma appliance, can often benefit people with a stoma in relation to treating sore skin or preventing appliances from leakage. This article focuses on some of the more common stoma accessories, including when and why they should be used.
Chronic wounds: management of healing and wellbeing
Authors: Grothier Lorraine , Pardoe Ann
Published: May 2014

This article discusses the impact of living with a chronic wound including the individual's wellbeing and the need for clinicians to consider the complex and often challenging factors that can help or hinder the patient experience. Patient engagement in the care planning process is an important consideration in promoting concordance ( Gray et al, 2011 ). When choosing a dressing regimen, clinical decision-making should be based on holistic assessment and include the patient's perspective, expectations and attitudes ( Dowsett, 2008 ).

Living with a chronic wound can have a significant impact on both the physical and psychological health of an individual and patients may suffer from multiple effects including reduced mobility, pain, poor nutrition and depression. Management plans that have been informed by patient feedback and are sensitive to their concerns can only serve to promote concordance and partnership and achieve a positive experience even when healing is not the endpoint.
The art of noticing: essential to nursing practice
Authors: Watson Fiona , Rebair Annessa
Published: May 2014

Noticing is integral to the everyday practice of nurses; it is the precursor for clinical reasoning, informing judgement and the basis of care. By noticing the nurse can pre-empt possible risks or support subtle changes towards recovery. Noticing can be the activity that stimulates action before words are exchanged, pre-empting need. In this article, the art of noticing is explored in relation to nursing practice and how the failure to notice can have serious consequences for those in care.
Patient experiences of enhanced recovery after surgery (ERAS)
Authors: Bernard Helena , Foss Mark
Published: May 2014

Enhanced recovery after surgery (ERAS) is a multimodal pathway whose strong evidence base is changing the methods used to care for patients before, during and after surgery. As a result, patients are being safely discharged at a much earlier stage than has previously been thought possible. Literature concentrates on the surgical and economical benefits of ERAS. There is a lack of research into the patients’ perspective of the programme. This study used semi-structured interviews to investigate issues of significance to ERAS patients. The issues were grouped into themes: information provision, inpatient experiences, home recovery experiences (i.e. home convalescence) and psychological and emotional experiences. Although participants reported many good aspects of their ERAS experience, the findings highlighted the need for improvement particularly with regard to post-discharge support from both community services and hospital follow-up.
Nurse screening for neuropathic pain in postoperative patients
Authors: Taverner Tarnia , Prince Jennifer
Published: May 2014

This study was designed to audit nurse assessment and documentation for neuropathic pain in postoperative patients. The audit focused on recorded signs of neuropathic pain in the immediate postoperative period. Nurses were educated on how to screen patients for neuropathic signs using the validated and reliable 7-item DN4. Data were obtained from 450 patient charts from the thoracic, orthopaedic and spinal units. Of the 450 patient charts reviewed, 423 included a record of nurse screening of neuropathic pain signs. Screening by nurses found 24% (n=102) of the patients reported between one and four signs of neuropathic pain within the first 3 days following their surgery. This study demonstrated that the incorporation of the 7-item DN4 neuropathic pain assessment tool within the generic pain chart enabled nurses to regularly screen postoperative patients for signs of neuropathic pain in the immediate postoperative period.
Re-examining the basis for ethical dementia care practice
Authors: Daly Louise , Fahey-McCarthy Elizabeth
Published: May 2014

Ethical nursing practice is an important component of quality dementia care. To be ethically competent, and to acquire the language, knowledge and skills required to explore and resolve ethical dilemmas in practice, the nurse needs an understanding of ethics and of the theory behind ethical decision-making. Traditional theories of ethics and ethical principles are commonly used to explore the dilemmas faced in dementia care practice. While these theories remain influential in healthcare practice, more contemporary ethical theories are equally relevant to the examination of the ordinary and extraordinary ethical dilemmas that present in conditions such as dementia. In this article, the ethical considerations central to effective dementia care nursing will be examined.
Nurse leadership in sustaining programmes of change
Authors: Clarke Ursula , Marks-Maran Diane
Published: May 2014

With a dearth of literature on sustaining new programmes in the NHS, a service evaluation was undertaken following the implementation of the Productive Ward (PW) programme in an acute hospital environment. It was hoped that areas would emerge that could help to sustain the programme following disbanding of the PW facilitation team. The service evaluation gathered data from 11 wards that were part of the PW programme. Data were collected on actual sustainability results, absenteeism over the 6 months prior to the sustainability score taken, changes to ward environments, changes to senior sister roles and attendance at the PW launch day or other PW activities. Themes from the literature and analysis of the data gathered were then developed into a discussion surrounding the factors that appeared to be conducive to sustaining this programme of change. Results indicate that change is difficult to sustain in an ever-changing environment. However, there appears to be a strong link between sustainability and the leadership skills and qualities of the ward sister.
Awareness and minimisation of systematic bias in research
Authors: Malone Helen , Nicholl Honor , Tracey Catherine
Published: May 2014

A major goal of nursing and midwifery is the delivery of evidence-based practice. Consequently, it is essential for the quality and safety of patient/client care that policy makers, educators and practitioners are aware of the presence of potential systematic bias in research practice and research publications so that only sound evidence translates into practice. The main aim of this paper is to highlight the need for ongoing awareness of the potential presence of systematic bias in research practice, to explore commonly reported types of systematic bias and to report some methods that can be applied to minimise systematic bias in research.
Academic reflective writing: a study to examine its usefulness
Authors: Bowman Marion , Addyman Berni
Published: May 2014

Reflection is widely regarded as important for learning from practice in Nursing. Academic reflective writing (ARW) is increasingly being used to assess reflective practice. However, there is currently scant literature on ARW, which is extremely complex, requiring students to link their own experiences to published literature. There are also concerns in the literature about the validity of ARW as a medium of assessment. In this paper, an exploratory discussion on ARW is illustrated with reference to the views of 8 self-selected students on a course for post-registered nurses. These students found ARW extremely challenging, and highlighted a range of difficulties associated with it. In conclusion, it is argued that the student experience of ARW warrants further investigation. In addition, it is suggested that either scaffolding should be put in place to facilitate the production of successful ARW, or alternatives should be explored.
What are the barriers to spiritual care in a hospital setting?
Authors: Rushton Lucy
Published: May 2014

Spiritual care is a vital component of care that is given to patients by health professionals in order to prevent poor health and treat illness. It is fundamental to patients' wellbeing and nurses' integrity that nurses carry out their care in a holistic manner and meet patients' spiritual needs. However, a number of studies show that health professionals are failing to meet patients' spiritual needs while in hospital.

Nurses are unable to fulfil patients' spiritual needs for a variety of reasons. The main barriers to spiritual care are the difficulty in defining spirituality; the lack of clear guidelines for the nurse's role in providing spiritual care; nurses' lack of time to provide spiritual care; and a lack of training and education on spirituality for pre- and post-registration nurses.
Oxygen therapy: professional compliance with national guidelines
Authors: Nippers Ingrid , Sutton Andrew
Published: May 2014

One of the major causes of critical illness in the UK is the deterioration of respiratory function ( British Thoracic Society (BTS), 2008 ). The administration of supplemental oxygen therapy, although often lifesaving, can also have serious consequences if performed inappropriately. A literature review was carried out to establish whether oxygen therapy was prescribed and administered in acute care in accordance with both national guidelines and local policy. Four common themes were identified from the literature: prescribing, monitoring, administration and equipment. The review suggests that an educational programme ranging from pre-registration curriculum content to the practical experiences of junior doctors with regard to oxygen management would be appropriate. The authors suggest that the current practice of healthcare practitioners should undergo a planned timetable of audit to improve the prescription, administration and monitoring of supplemental oxygen therapy for the benefit of patient outcomes.
New nursing apprenticeship schemes to be introduced
Authors: Glasper Alan
Published: May 2014

Professor Alan Glasper discusses the new Government initiative to introduce apprenticeship schemes leading to annotation on part 1 of the professional nursing register for those who have proven they can deliver health care.
Standardising fast-track surgical nursing care in Denmark
Authors: Jakobsen Dorthe Hjort , Rud Kirsten , Kehlet Henrik , Egerod Ingrid
Published: May 2014

Considerable variations in procedures, hospital stay and rates of recovery have been recorded within specific surgical procedures at Danish hospitals. The aim of this paper is to report on a national initiative in Denmark to improve the quality of surgical care by implementation of clinical guidelines based on the principles of fast-track surgery—i.e. patient information, surgical stress reduction, effective analgesia, early mobilisation and rapid return to normal eating. Fast-track surgery was introduced systematically in Denmark by the establishment of the Unit of Perioperative Nursing (UPN) in 2004. The unit was responsible for guideline construction and implementation using the ‘workshop practice method’: establishing a website, creating a knowledge centre, coordinating implementation agents, and arranging national workshops and conferences. The UPN has promoted implementation of fast-track regimes in all surgical departments in Denmark. We recommend the workshop-practice method for implementation of new procedures in other areas of patient care.
Reducing PICC migrations and improving patient outcomes
Authors: Hughes Meinir Elen
Published: May 2014

Inadvertent migration of central venous catheters can lead to several issues including delayed therapy and clinical morbidities such as thrombosis. Peripherally inserted central catheters (PICCs) are particularly at risk of movement. An innovative new device which allows anchorage of the catheter has proved very successful in the minimisation of catheter migration. The SecurAcath device incorporates a small blunt anchor which lies beneath the skin in order to secure the catheter in place and prevent inadvertent movement. An evaluation of 31 patients with a SecurAcath device in situ to secure a PICC found only one case of insignificant catheter migration. Some initial problems with infection and pain were encountered and interventions were put in place to minimise their incidence. SecurAcath removal proved to be the most significant challenge but this can be overcome with suitable guidance and training.
Haematuria: from identification to treatment
Authors: King Kathryn , Steggall Martin
Published: May 2014

Haematuria has a prevalence of 0.1% to 2.6%. Potential diagnoses may include infection, kidney stones, trauma, exercise or spurious causes, such as foods, drugs or menstruation, and a tumour. Approximately 20% of patients with haematuria have a urological tumour, with a further 20% found to have a significant underlying pathology. Haematuria is subsequently known as the ‘classic presentation’ of bladder cancer with 70-80% of patients experiencing painless, gross (visible) haematuria. However, in all cases of visible haematuria, a tumour should be suspected until proven otherwise.

A patient with visible haematuria requires urgent, stringent investigation, warranting specialist assessment and subsequent selective referral through a series of patient-centred investigations at a haematuria clinic. One-stop clinics have been shown to improve the patient experience in early diagnosis of potentially life-threatening conditions. Yet despite morbidity and mortality from bladder cancer increasing, the haematuria service has remained largely unchanged for several decades. This paper will discuss the tests and investigations that need to be undertaken in an individual with either visible or non-visible haematuria, and outline the care that is needed to support patients through the investigation process, with special focus on bladder tumour.
Continuing Professional Development: Chronic illness in adolescents and suicide risk
Authors: Greydanus Donald E , Pratt Helen D , Patel Dilip R
Published: May 2014

Overview

Overview This article discusses chronic illness in adolescents and suicide risk. The health professional's role in recognising the association will be explored. The article includes some self-assessment to test the reader's knowledge
A survey to identify the characteristics of London sex workers
Authors: Munro Gayle , Martin Caroline Hollins , Bonner Adrian , Rough Elizabeth , Martin Colin R
Published: May 2014

A demographic survey of London sex-workers established age, nationality, alcohol/drug use, physical/mental health concerns and whether trafficked or optionally migrated into the industry. There are overt differences between sex-workers—implications for police, health and social workers are that welfare services tailor care to meet individual needs within this population.
Sex, pregnancy and minors
Authors: White Sharon
Published: May 2014

In the first of a regular feature looking at the professional, legal and ethical dilemmas faced by nurses working with school-age children, Sharon White presents a case of teenage pregnancy, and traces the school nurse's decision-making process.