bluuebunny/crossref_metadata_2025 huggingface dataset:
Study raises concerns about school children's health
Authors: Castledine George
Published: May 2014

There has been much publicity recently over the health of school children, in particular the problems of obesity and the lack of physical exercise. Just how much the state of some children's health has declined was brought home to me following a research project involving an inner city secondary school in the West Midlands.
Clinical skills: an evidence-based approach to preoperative fasting
Authors: Oshodi Titilayo O
Published: May 2014

The procedure of fasting from midnight until induction of anaesthesia arose from concern that patients could regurgitate during induction of general anaesthesia when the pharyngeal and laryngeal refluxes are depressed. In this situation, the contents of the stomach do not come out of the patient's mouth, but go up into the oesophagus and trachea and are drawn back down into the lungs. This can damage the lungs, causing chemical inflammation, a condition referred to as aspiration pneumonitis or Mendelson's syndrome, a serious although rare complication of general anaesthesia. For many years, preoperative fasting has been a traditional practice for reducing this risk, but patients are being fasted for considerably longer than the evidence indicates is necessary. This article considers the current evidence for preoperative fasting times and examines why patients are still being subjected to prolonged preoperative fasting. Based on the evidence presented, recommendations are made regarding this aspect of care.
Humidification for oxygen therapy in non-ventilated patients
Authors: Pilkington Fiona
Published: May 2014

Oxygen therapy is a necessary treatment for some patients in hospital; however, as with any treatment there are side-effects. These include drying and cooling of the respiratory tract. This can lead to unpleasant side-effects, discouraging patients from continuing with their treatment. To overcome this there are a variety of humidification devices, both heated and cold, which can help people tolerate their treatment. This article will discuss the AQUAPAK® system which humidifies dry oxygen making it more comfortable for the patient to breathe and preventing dehydration of the respiratory system.
Psychiatric nurse who formed a sexual relationship with patient
Authors: Castledine George
Published: May 2014

The relationship between a registered nurse and his/her patient should at all times be a therapeutic, caring one, focusing solely upon meeting the health or care needs of the patient. In the following case, John was a qualified psychiatric nurse who specialized in drama therapy. He first met Rachel when she was referred to him for assessment.
Interpretation of arterial blood gases: a clinical guide for nurses
Authors: Simpson Heidi
Published: May 2014

Arterial blood gas analysis has become an essential skill for all healthcare practitioners. It provides important information with regard to adequacy of ventilation, oxygen delivery to the tissues and acid–base balance. Although each patient's clinical presentation will be judged individually, situations that warrant analysis of a blood gas sample include respiratory compromise, post-cardiorespiratory arrest, evaluation of interventions such as oxygen therapy, respiratory support and as a baseline before surgery. This article reviews the different parameters that are measured by various machines, with a focus on basic measurements of arterial blood gases. These include partial pressure of carbon dioxide in arterial blood (PaCO2), partial pressure of oxygen in arterial blood (PaO2), bicarbonate levels (HCO3-) in arterial blood and base excess/deficit. The physiology of acid–base balance is reviewed and the causes and presentation of the four acid–base disturbances is described. A systematic method to aid arterial blood interpretation is identified, together with discussion regarding the importance of interpreting PaO2 readings in relation to the amount of inspired oxygen a patient is receiving (FiO2), the practice of temperature correction and the relationship between standardized and actual bicarbonate readings.
Where will clinical nurse specialists be placed on Agenda for Change?
Authors: Maylor Miles
Published: May 2014

The imminent introduction of a new approach to pay and career development known as Agenda for Change will raise and dash many nurses' expectations. Among them clinical nurse specialists (CNS) could have a lot to gain if they are able to convince employers that they should be in the highest pay band. Already nurse consultants (NC) are in the top band, but the question needs to be asked as to whether this is simply to fulfil political directives, or whether it is because they match the job evaluation criteria? The political context for the introduction of Agenda for Change and for NCs is outlined, as is the professional debate about higher level practice. Job evaluation factors and the career progression framework are discussed, and suggestions are made regarding how to compare job profiles. If CNSs do not present themselves as expert practitioners, they will not be paid or recognized for what they might already do.
Acute hospital-based palliative care services for the older person
Authors: Jones Randall
Published: May 2014

With an increasing elderly population, estimated to rise to 26% of the UK's total population by 2020 (World Health Organization (WHO), 2004), this demographic represents a large area of potential referrals for hospital-based palliative care services. In planning service provision for this group, all nurses must examine current levels of access for older people to specialist palliative care services. This article explores barriers to the equity of access for older people to palliative care services, taking into account cultural, political, medical and ethical obstacles to the older person receiving evidence-based palliative care. The article analyses the benefits of palliative care involvement in a group who have multiple comorbidities and whose concerns, including adequate symptom control and assistance in making end-of-life decisions, reflect the philosophies inherent in the palliative care movement. Political- and clinical-based strategies in overcoming these barriers involving multidisciplinary working and education are necessary to ensure that the older person is being treated with dignity and fairness throughout his/her hospital journey.
Personal safety in the accident and emergency department
Authors: Ferns Terry , Cork Alison , Rew Maggie
Published: May 2014

Violence and aggression continues to be a significant problem for staff practising in accident and emergency (A&E) areas. In recent years the number of articles examining factors related to violence and aggression in the A&E department have steadily increased, allowing for a more in-depth examination of data. This article considers the characteristics of individuals who assault A&E staff, introducing the reader to the ‘recreational fighter’, an individual who enjoys and is attracted to violent confrontations. The article goes on to consider the role of gender, alcohol, age and social history in relation to the characteristics of individuals who assault nursing staff practising in A&E and offers a number of strategies for nursing staff to consider when attempting to minimize the risk of personal physical assault.
Micro-pigmentation: implications for patients and professionals
Authors: Collingridge Kim , Calcluth Julie
Published: May 2014

In the UK, reconstructive breast surgery is routinely offered to patients undergoing surgery for breast cancer. The results can be excellent, but without a nipple–areola complex the patient can feel incomplete. In response to patient need, an innovative nurse-led micro-pigmentation service has been developed in the authors' NHS trust, which provides women (and men) an opportunity to complete their reconstruction process. With the use of coloured pigments, micro-pigmentation creates a permanent image of a nipple–areola complex, which improves the aesthetic appearance of the surgically-created breast. As with the development of any new nurse-led innovation, the micro-pigmentation service has professional and client implications. Breast cancer can be devastating and may induce many psychological concerns, not least about body image and sexuality. This article addresses these issues, along with professional matters, such as autonomous practice, role expansion and the blurring of clinical boundaries. These factors are considered in relation to the nursing management of the micro-pigmentation service, where patient autonomy is encouraged to promote acceptance of self-image and closure on the breast cancer experience.
Medical care practitioners: introducing a new profession into the UK
Authors: Paniagua Hilary , Stewart Antony
Published: May 2014

The NHS is suffering from a serious shortage of qualified medical staff. One possible solution is to introduce medical care practitioners (MCPs) (USA-style physician assistants) into the healthcare team. This article examines the history and role of PAs, as well as some of the issues concerning the role, and how other health professionals might perceive it. The article also describes one MCP programme that has already started in Britain at Wolverhampton University. The use of MCPs in the UK appears to offer a potential solution to reduce the current skill shortage in this country.
Bed occupancy, turnover intervals and MRSA rates in English hospitals
Authors: Cunningham Joseph B , Kernohan W George , Rush Thomas
Published: May 2014

This article (a follow on from an article concentrating on Northern Ireland) examines the relationship between percentage bed occupancy (PO), turnover interval (TI) and methicillin-resistant Staphylococcus aureus (MRSA) rates in the acute beds of specialist English hospital trusts and describes the TI and levels of bed occupancy. The data were collected from publicly available data: MRSA rates of blood-borne infection per 1000bed days from the Department of Health; average length of stay from Hospital Episode Statistics; and percentage occupancy from the Department of Health Hospital Activity statistics were used. Pearson's Correlation coefficients were used as basis for inferential analysis. The mean TI for all trusts was as 0.94days, median 0.95days. Twenty percent of trusts had TIs, on average, of less than 0.58days (13.9hours) and 10%had a TI less than 0.32days (7.6hours). The mean PO was 84.98%and the median was 84.76%. Seventy percent of the trusts exceeded the recommended 82%bed occupancy. The inference from this study is that there is a relationship between TI and PO and rate of MRSA infection in specialist English hospitals and that PO rates are at a level which may interfere with good infection control procedures.
Nursing today: complacency or catastrophe?
Authors: Castledine George
Published: May 2014

It seems that we are now seeing more and more examples of bad nursing care and poor attitudes of hospital nurses, e.g. the letter by a senior staff nurse in our last issue of the BJN (Correspondence: 633). Trying to stay positive and make allowances for the problems in the health service is difficult especially when one keeps hearing of examples similar to that outlined in the letter and listens to similar stories from patients recently discharged back into the community.
Sexual health: case study of a patient who has undergone stoma formation
Authors: Williams Jenny
Published: May 2014

Studies have identified that following stoma forming surgery, 69% of patients have sexual health concerns (Van-de-Weil et al, 1991). However, studies suggest that this is an area of care that is frequently omitted by stoma care nurses (Borwell, 1997). By focusing this case study on the experiences of a patient cared for by the author, this article aims to identify patients’ needs with regards to sexual health care following stoma forming surgery. The author suggests that greater training on sexual health care should be provided for nurses. Nurses should discuss sexual health needs more openly with their colleagues to improve their skills, and with patients, so that patients are aware that sexual health is an area of value and that their concerns can be discussed and appropriately addressed.
Ward nurses' knowledge of computed tomography scanning
Authors: Majeed MA , Nayeemuddin M , Christie M
Published: May 2014

Patients benefit from and are reassured by advance information on procedures that they are to undergo. Ward nurses should have adequate knowledge of radiological investigations to ensure proper patient preparation and good interdepartmental communication to avoid delays and cancellations. This study was conducted to assess the ward nurses' knowledge of the process of computed tomography (CT) scanning. One hundred and twenty qualified nurses were asked to complete a questionnaire regarding CT scanning. The findings revealed a suboptimal level of awareness about the process. This is probably due to lack of formal teaching for nurses on the wards in regards the different radiological procedures and patient preparation. There is a strong case for better educational talks on rapidly changing radiological techniques for ward staff to ensure high-quality patient care.
Nursing care delivery in Japanese psychiatric units
Authors: Sawada Aki , Miyamoto Yuki , Kayama Mami , Setoya Nozomi , Porter Sarah E
Published: May 2014

Japan has the largest number of psychiatric beds per population in the world. At the same time, little research had been done to describe nursing care delivered in psychiatric units. To describe contents of nursing care, the framework for care classification and measuring methods must be examined. The purpose of this study was to develop a nursing intervention classification and examine the correlation between amount of care and patients' mental states. Data were collected from 39 patient care records from 4 randomly selected psychiatric hospitals. Patients' function and condition were evaluated by their doctors using the Global Assessment of Functioning (GAF) and the Brief Psychiatric Rating Scale (BPRS). Six care categories were extracted: basic activities of daily living, psychological support/interpersonal skills, medical support, monitoring, family support and miscellaneous. By examining three cases with this classification, there were significant correlations between the GAF and BPRS scores and amount of care for two acutely ill psychotic patients.
Care of head and neck cancer patients with swallowing difficulties
Authors: Gould Lisa , Lewis Sian
Published: May 2014

Cancers of the head and neck include oral cavity, oropharynx, hypopharynx, nasopharynx, larynx, nasal fossa, paranasal sinuses, thyroid, salivary glands and vermilion surfaces (Parker et al, 2004). Incidence of these cancers has risen in the past 30 years, particularly in people under the age of 65 years. Risk factors include cigarette smoking and excessive alcohol abuse. At time of diagnosis patients often present with swallowing difficulties due to tumour location and size. Further oncological treatments such as surgery and radiotherapy can exacerbate these difficulties and cause major nutritional problems. Dietary management in relation to texture modification and nutritional content of meals needs to be addressed as well as feeding strategies recommended by the speech and language therapist. Good communication between all members of the multidisciplinary team is paramount in ensuring that patients have the necessary support, education and quality of life they need.
Patients need specialist, sponsored nursing posts
Authors: Black Pat
Published: May 2014

In 1985, when Lee suggested that stoma care nurses (SCNs) should rise and meet the challenges of the changing provision of health care, little did she realize where some of the challenges would come from. In 1989 the ostomy industry started to sponsor SCN posts which was a new departure for the NHS, and since then, the role of sponsored nursing posts across the NHS has continued unabated. For many Trusts since 1989, sponsorship of nursing posts by ostomy companies has been viewed as the goose that has laid the golden egg. Even in 2006, in the climate of cash restraints and the possible loss of nursing posts, having a sponsored nurse must seem like an unexpected gift to Trust managers and finance directors. In 1990 it was reported that at least 30 SCNs owed their jobs to sponsorship from ostomy companies who sell and dispense appliances (Black, 1995). Today the figure is approximately 200 nurses, worth approximately £10 million (DH, 2005).
Extended nurse prescribing: improving care for older people
Authors: Astles Jane
Published: May 2014

This article examines the benefits to older patients in a hospital setting, including assessment, diagnosis and treatment by a nurse who is competent in the field and has in-depth personal and professional knowledge of that person. It explores how this approach promotes individual high quality care through a patient-centred focus and empowerment while supporting the Department of Health and Scottish Executive Health Department's agenda for service redesign. It also explores how expansion of the extended independent nurse prescriber's formulary will not compromise patient safety. It recommends that nurses practicing in non-acute care areas consider developing as extended independent nurse prescribers to raise standards of patient-centred care delivered to older people in hospital. The Nurse Prescribers' Extended Formulary (British Medical Association and Royal Pharmaceutical Society of Great Britain in association with Community Practitioners, Health Visitors' Association and Royal College of Nursing, 2003) is referred to throughout this paper as the nurses' formulary, nurse prescribers' formulary or nurse prescribers' extended formulary.
Bridging the gap: patient and practitioner
Authors: Morris Clare
Published: May 2014

‘While the concept of actively involving patients in their disease management and the process of care is an attractive proposition, it is a challenging strategy for practitioners and the healthcare system.’ (Vowden and Vowden, 2006)
What is the effect of preoperative information on patient satisfaction?
Authors: Walker Jennie April
Published: May 2014

The aim of this literature review is to examine the relationship between the provision of written information given to patients’ preoperatively and their postoperative recovery following elective surgery. It is not currently apparent which is the most effective method of delivering preoperative information, or at what stage of the preoperative phase is the optimum time to deliver such important information. The purpose of this review is to briefly outline the affiliation between anxiety experienced by surgical patients and the information received preoperatively and to examine the relationship between the provision of written information given to patients preoperatively and their postoperative recovery following elective surgery. Research findings are contradictory with respect to the effect of preoperative information on postoperative pain and patient satisfaction. However, research does indicate that the provision of good-quality preoperative information facilitates patients’ active involvement in their care, and therefore may contribute to an overall increase in satisfaction. There remains a need for rigorous research that identifies the optimum timing and method of delivering preoperative information to maximize their positive effects on patients undergoing elective surgery
The petals of recovery in a mental health context
Authors: Higgins Agnes , McBennett Pádraig
Published: May 2014

In the last 10 years the concept of recovery has entered the discussion on mental health. Since then it has been surrounded in debate – from advocates who suggest that there is a need to build mental health services on recovery principles, to people who suggest that there is insufficient ‘empirical’ evidence to support a reorientation of services. The focus of this article is on exploring the concept of recovery as both a process and an approach to care.
Discharge planning: communication, education and patient participation
Authors: Carroll Áine , Dowling Maura
Published: May 2014

For the most part, discharge from hospital is routine and uneventful. However, for a percentage of people, discharge from acute care requires careful planning to ensure continuity of care. This is particularly the case with older patients who have complex medical needs. This literature review reveals that the essential elements for discharge planning are: communication, coordination, education, patient participation and collaboration between medical personnel. Outcomes measures of successful discharge planning include patient satisfaction and quality of life. Smooth and efficient coordination of this process reduces stress and anxiety for the patient, family, nurse, doctor, hospital and community services.
A patient survey of nursing practice philosophy in 2001 and 2005
Authors: Noble Helen , Bradley Ruth
Published: May 2014

The nursing philosophy group at St Bartholomew School of Nursing and the London NHS Trust came together to review the existing nursing philosophy, which had been in place since 1996. A new philosophy was circulated in June 2000 and it was viewed as essential that this document be reviewed regularly in response to patient needs. A patient survey was produced to assess patients’ understanding of the philosophy and how it related to their inpatient stay. It was an important management tool, which enabled the development of patient-centred nursing based on real patient experience. The philosophy was updated in 2003 and the patient survey has since been repeated in 2005. Results have been delivered back to the Trust’s Nursing Policy Board and action plans have been agreed based on the results of the survey in 2005 within the Trust’s shared governance framework.
Evaluating student nurse learning in the clinical skills laboratory
Authors: Raphaela Godson Nina , Goodman Margaret , Wilson Ann
Published: May 2014

This small study was undertaken at Coventry University as part of a wider Nursing and Midwifery Council (NMC) project to determine whether learning that occurs in the clinical skills laboratories (CSLs) can be counted as practice hours or should remain as theory hours. At Coventry University, 3rd-year student nurses were educated on how to teach drug administration skills. They then delivered this teaching to 1st-year student nurses. Both adult and mental health students were involved in this process. All participants in the study were asked for their views of this learning experience. Mentors in practice were also asked how this learning impacted on the students’ performance in placement. The findings identify that students considered this to be a good way to learn because the safe environment of the CSL built up their confidence. Mentors also identified it as useful because students came better prepared to their placement, thereby reducing their workload.
Smoking ban causes less smoke in bars ‘shocker’
Authors: Bailey Asa
Published: May 2014

Shock revelation: Britain’s smoking ban has led to a massive drop in exposure to second-hand smoke for bar staff in England. Amazing eh? Who would have thought it... apparently it’s better for their health too!
Health facilitation in primary care seen from practice and education
Authors: Thomson Karen , Caan Woody , Gripton Jane , Lutchmiah John
Published: May 2014

Valuing People: A New Strategy for Learning Disability for the 21st Century (Department of Health, 2001a,b) aimed to introduce ‘health facilitation’ to improve the identification of health needs and access to appropriate care for people with learning disabilities. One London Borough took a leading role in implementing this new function, in the form of dedicated, full-time health facilitators. The authors examined the implementation and its impact, employing an innovative collaboration between professionals from practice, education and research. The clinical nurse involved was observed during her first year of health facilitation. The authors evaluated her impact on professionals, people with learning disabilities and the wider system of health. In some areas (for example, information technology) the health facilitator could make little progress in one year. However, she connected with a widening circle of local people and services, for example, in introducing health action plans for adults with a learning disability. Across the Borough some professionals became more aware of specific health issues in their local population.
Benefits of interprofessional education in health care
Authors: Illingworth Paul , Chelvanayagam Sonya
Published: May 2014

This article examines some of the literature regarding the benefits of interprofessional education (IPE) in the field of health care. These benefits in relation to service users (and carers), higher education institutions, service providers and students are all explored. Barriers to IPE are being broken down by many of the various stakeholders working towards a similar agenda. However, currently there remains some doubt as to whether IPE has a direct positive impact on the health gain of service users and carers. Research is needed to demonstrate if service users and carers benefit directly from IPE and if they do not, the reason for pursuing it needs to be questioned
Tracheostomy: facilitating successful discharge from hospital to home
Authors: Bowers Ben , Scase Claire
Published: May 2014

When a patient is identified as requiring a long-term or permanent tracheostomy, the complexity of the care needs and safety issues will dominate the focus of the discharge planning for the healthcare team. The effectiveness of this process will ultimately determine the success of the discharge and is essential in preventing critical incidents or readmission to hospital. An effective working partnership between hospital-based staff and the community team is a central component in achieving a successful and safe discharge. This article examines the discharge process from initial identification of a client requiring a long-term tracheostomy to the discharge itself and meeting the individual’s ongoing care needs at home. Discharge planning considerations and clinical priorities are explored from both the hospital-based and community perspectives.
Addressing a deficit: wound care and mental health nursing
Authors: Day Jacqui , Moriarty Abigail , Tremayne Penny
Published: May 2014

This article details the development and implementation of a teaching session introduced to address one of the key clinical skills that mental health nurses require in the practice setting – wound management. The session was introduced to equip a group of final year mental health nursing students with the knowledge, skills and attitudes they will need for practicing in a professional environment. The sessions were evaluated to determine their effectiveness in terms of the students’ satisfaction with the teaching process, the clinical value and relevance of the content, and to improve the quality of future clinical skills teaching.
The emotional impact of nursing student attrition rates
Authors: O’Donnell Hugh
Published: May 2014

Nursing student attrition continues to attract political, organizational and social interest for a number of reasons including: persistent nursing shortages, the age profile of the current nursing population and the economic costs of attrition. While attrition in nursing students is not a new phenomenon, it is surprising that this issue has attracted such little research attention. Completed attrition research in nursing has tended to focus on explanations for attrition obtained from students who persist, rather than the experiences of students who have withdrawn from preregistration nursing courses. The emotional impact on students who decide to voluntarily leave has attracted limited theoretical analysis, so a single case study design was selected to help explain the causes of voluntary attrition in nursing students within a School of Nursing and Midwifery. A semi-structured interview method was used to collect data from study participants. The study population was obtained through purposeful sampling and consisted of 15 students who had previously voluntarily withdrawn from pre-registration nursing programmes. This article describes the range of emotions which many students experienced and the process of gradual disengagement which may precede student decisions to formally withdraw.
The nurse’s role in supporting young people with complex health needs
Authors: Hewitt-Taylor Jaqui
Published: May 2014

An increasing number of young people have complex and continuing health needs. Their needs, the attitudes which individuals have towards them, and the way in which their needs are catered for by society can mean that it is more difficult for them to develop peer relationships, engage in leisure activities, take risks and develop sexual relationships than it is for other young people. Accessing further education and gaining employment may also be more problematic for them than it is for their peers. This may make it harder for them to develop independence and a positive self-esteem. Nurses who work with this group should be aware of the barriers which they may face, and plan support with them and their families so as to overcome these as far as possible, and to make them feel valued and respected.
Valuing local diversity in palliative care: translating the concept
Authors: Quinn Sharon , Hickey Deb
Published: May 2014

The contemporary challenges associated with addressing diversity, ethnicity, equality and accessibility in today’s healthcare economy, sometimes lead to a reactive response where service providers strive to apply these concepts in practice. This article describes establishing a group that could engage with the broadest spectrum of the local community in ways that would make a lasting and meaningful difference to the local population, including how individuals and groups engage with and access palliative care services. The Valuing Local Diversity in Palliative Care Group was formed in May 2006. The group, whose membership is composed of statutory and voluntary services and members of various community groups, has promoted some innovative and creative partnerships.
Taking the bitchiness out of nursing
Authors: Castledine George
Published: May 2014

The one factor above all which I think really spoils nurses’ camaraderie and professionalism is ‘bitchiness’. It seems amazing that in a profession which professes to care so deeply for patients and people, one of the biggest problems we face is caring for each other. You only have to work on a ward or in a nursing team of any kind to experience how bad bitchiness can get and how destructive it can be. Throughout my own career I have experienced this rather unpleasant and destructive side of nursing. To bitch means to be mean, nasty, spiteful, malicious, venomous and snide. It is a way of perhaps protecting ourselves against someone we do not like or feel threatened by their actions and presence. One of the most common examples is when cliques of nurses are formed which go into huddles and gossip about everyone else except themselves.
Skills for caring: valuing knowledge of applied science in nursing
Authors: Sturgeon David
Published: May 2014

The purpose of this article is to consider the implications of over-emphasizing the role of the nurse in terms of interpersonal relationships and emotional engagement. It seeks to explain why nurses are frequently more comfortable with the relational aspects of their work and less comfortable with their many tangible contributions. It examines why nurses often undervalue their considerable knowledge of applied science. It also evaluates why a change in attitude is necessary, and why nurses should enhance and give more prominence to their technical knowledge and skills. Finally, it includes a brief examination of current trends in nurse recruitment and retention, and their implications for the future of the profession in respect of the balance between interpersonal and technical skills.
Keeping fit for the game
Authors: Castledine George
Published: May 2014

Some football team managers, such as Rafael Benítez of Liverpool, believe in rotating their players to keep them fit for their games. It could also be argued that a similar system may help nurses keep themselves fresh for their nursing duties.
Reaching out to help in one of Africa’s friendliest countries
Authors: Castledine George
Published: May 2014

One of the advantages of working in nursing for as long as I have is that you get the opportunity of using your knowledge and experience in poor countries, which are often desperate for help. Of course you don’t have to be old to help, but it certainly is an advantage. I have just returned from Uganda following my second spell of helping people in remote country and island areas. The experience is not for everyone, but if you enjoy the opportunity of adapting to living in a challenging environment, are not upset by not having all the comforts of a modern home about you, are someone with a spirit for adventure and have a relatively tough personality, then this type of nursing may be for you.
Access to cervical screening for women with learning disabilities
Authors: Watts Sian
Published: May 2014

Evidence shows that the uptake of cervical screening is much lower in women with learning disabilities compared to other women. A literature review was conducted, including published and unpublished international empirical research, discussion articles and reports written in English from 1990 to October 2007, to identify what factors are preventing women with learning disabilities from accessing cervical screening, and what can be done to encourage uptake. From the literature reviewed, factors that prevent women with learning disabilities from accessing cervical screening fell into the following categories: administration errors; access to a GP; assumptions made by healthcare professionals about women with learning disabilities; perceived difficulties obtaining consent; attitudes of carers; the beliefs and experiences of women themselves; lack of accessible information; and physical difficulties. Findings on how cervical screening uptake can be improved in women with learning disabilities were categorized into: preparation with the women; working in partnership; and encouraging good practice. The literature review showed that there are many factors that may be preventing women with learning disabilities from accessing cervical screening, many of which can be overcome by healthcare professionals adhering to good practice guidelines, thus ensuring that women with learning disabilities have their right to access cervical screening services acknowledged.
A word in your ear
Authors: Morris Mervyn
Published: May 2014

As nurses we are used to dealing with risk, having to accept it as part of helping people, and always minimizing and avoiding it. However, sometimes the way we do things looks more risky than it is, and we should recognize that ‘it ain’t what you do it’s the way that you do it’ that creates problems.
Advance decisions and the Mental Capacity Act
Authors: Halliday Samantha
Published: May 2014

This article considers the requirements set out in the Mental Capacity Act 2005 for valid advance decisions. The Act recognizes that an adult with capacity may refuse treatment, including life-sustaining treatment, in advance of losing capacity. If that advance decision is valid and applicable, it will bind health-care professionals, taking effect as if the patient had contemporaneously refused the treatment. However, in cases where the advance decision does not relate to treatment for a progressive disease, it will be extremely difficult for the patient to meet the dual specificity requirement – specifying the treatment to be refused and the circumstances in which that refusal should operate. Moreover, while a patient may explicitly revoke an advance decision while she retains the capacity to do so, the continuing validity of an advance decision may be called into question by the patient implicitly revoking her advance refusal or by a change of circumstance. This article concludes that the key to enabling patients to exercise precedent autonomy will be full and frank discussion of the scope and intentions underlying advance decisions between patients and their health-care professionals.
Essence of Care – a key approach inimproving patient care
Authors: Ho Danny , Craig Eric
Published: May 2014

This project work is an illustration of how nurses can take a leading role in championing patient care. A small group of mental health nurses in a London Trust embarked on ‘getting the fundamentals right’ in their quest to improve care given to patients. A working group was formed to take this idea forward:The Essence of Care Steering Group. The group uses the Essence of Care benchmarking principles as a base, and an integral part of clinical governance as a guide. It takes a structured approach to sharing and comparing practice, enabling it to identify best practice and to develop action plans to remedy poor practice. Success is seen in the improvements in the quality and care experience of patients, carers and staff at local levels. Common standards in care across the service areas can be achieved and care can be measured in a more structured way across the service areas with easier, more constructive and meaningful sharing of information and skills. Staff morale is also enhanced
Shaping the future of nursing
Authors: Karstadt Lyn
Published: May 2014

Both the current Government and the Conservative Party are consulting on the future of the nursing and midwifery professions. Lyn Karstadt discusses the two consultations, the potential future impact each might have and the importance of nurses becoming involved in the rocess.
Resources to help solve drug calculation problems
Authors: Wright Kerri
Published: May 2014

This article is the third in a series of articles discussing drug calculations and discusses the resources, in terms of knowledge and skills, that are required to support the use of methods for solving calculation problems (Wright, 2009). The main resources discussed are clinical practice, numeracy knowledge (including number patterns), proportions and factors, and clinical tools such as syringes. These resources can be used as part of formal teaching sessions, or can be developed and practised by individual nurses to improve knowledge and confidence in solving drug calculations. The most important resource for developing drug calculation skills is regular exposure to drug calculations in clinical practice. Any drug calculation teaching and assessing, therefore must have clinical practice as the starting point, with numeracy knowledge not extracted and taught separately, but developed as a resource from within practice, for the purpose of supporting practice.
Successful treatment of nonhealing wounds with Xelma®
Authors: Bond Emma , Barrett Simon , Pragnell Jane , Victoria Royal
Published: May 2014

Chronic wounds come in all shapes and sizes and may be associated with co-morbidities that have a direct impact upon healing and the quality of life of patients, their families, carers, and even co-workers. Cosmetic appearance is important to both genders but especially so to female patients and unsightly wounds that are difficult to hide cause extreme problems that may have psychological implications. In addition to the effect that they have on patients, these wounds are associated with considerable resource requirements, which impact heavily on the already burdened NHS. This article presents three case studies of patients with chronic wounds that have shown a positive response, in terms of healing and impact upon the patient’s quality of life, to an advanced wound care product – Xelma®.
The legal system. Part 2: it’s not just for lawyers
Authors: Boylan-Kemp Jo
Published: May 2014

This is the second part of the two-part article intended to provide an introduction to the foundation elements of the English legal system. The ‘English legal system’ is a rather generic term that is often used to refer to the different sources of law and the court system in which the law is practised. Students of law will study the English legal system as a specific topic, but it is as equally important for those who work within a profession that is regulated by the law (as nursing is) to also develop an understanding of the legal boundaries within which such a profession works. This particular article follows on from our earlier consideration of the cornerstones of the legal system and looks at the different sources of law that can be found within the English legal system; focusing particularly on the concepts of common law, equity, and the impact of European sources on domestic law.
The mental health of nurses: a concern
Authors: Castledine George
Published: May 2014

Alistair Campbell, the former press chief to Tony Blair, has recently been publicising the plight of people who suffer from a mental health problem and don’t get a fair chance in employment. He cited Winston Churchill, Abraham Lincoln, Charles Darwin, Marie Curie and Florence Nightingale as examples of famous people who succeeded despite their mental health difficulties. Campbell, who suffered a nervous breakdown many years ago, believes that it is important to highlight just how badly people like him have suffered discrimination at the hands of ignorant employers. Mental health in the workplace is a huge issue, especially nowadays with the added strain of the current economic climate. Among nurses, not only are those known to have a mental health problem at risk, but other nurses, without any recognised difficulties, are just as vulnerable.
Right patient, right blood, right care: safe transfusion practice
Authors: Oldham Jane , Sinclair Linda , Hendry Catrina
Published: May 2014

Blood transfusion therapy can save and enhance patients’ lives but careful consideration must be given to the associated dangers. Nurses must have the skills and knowledge required to care for patients receiving blood components. It is important for nurses to understand the correct and safe way to approach transfusion practice as it is a constant and central component of modern health care. The number of people eligible to donate blood is reducing and each blood component comes from a donation given in good faith: it is given voluntarily with the expectation that it will be used effectively for the benefit of patients. Therefore at every stage of the transfusion process the nurse is responsible for the part they play in making sure that the correct patient receives the correct blood and also that blood components are used and handled with care. This article examines the key principles and practicalities to be considered in day-to-day practice. Areas covered include legal obligations, appropriate handling of blood components, the different elements of the transfusion process, recognition and management of transfusion reactions and education. A key theme running throughout is the management of clinical risk.
Managing adverse events in the use of bevacizumab and chemotherapy
Authors: Blowers Elaine , Hall Kate
Published: May 2014

The anti-angiogenic agent bevacizumab (Avastin®) has received regulatory approval for the treatment of metastatic breast cancer (MBC) in combination with the taxane chemotherapy agent paclitaxel. A range of side-effects associated with this agent have been identified across different tumour types; these are known to differ from those frequently reported with chemotherapy agents. This article is part one of a two-part literature review that was conducted to provide insight into the range, frequency and severity of adverse events that arise specifically in breast cancer when bevacizumab is combined with cytotoxic chemotherapy. PubMed and the websites of oncology conferences were searched to identify studies of bevacizumab plus chemotherapy in patients with MBC. Seventeen studies met the search criteria, including 3,836 bevacizumab-treated patients. Side-effects associated with bevacizumab included hypertension, proteinuria, thromboembolic events, bleeding and cardiac toxicity. Part two of the series will appear in the next issue of BJN.
Providing best practice in manual blood pressure measurement
Authors: Alexis Obrey
Published: May 2014

This article discusses the practical skills and underpinning knowledge needed when manually taking a patient’s blood pressure. The author defines blood pressure and the terms systolic and diastolic and explores the purpose of manual measurement. The article also goes on to examine what is meant by ‘normal’ blood pressure, hypertension and hypotension, as well as factors that may influence blood pressure measurement. There is a brief outline of the equipment used for manually measuring blood pressure, followed by some factors that may affect the accuracy of the final reading. The author also highlights the different positions used for taking blood pressure and the arguments surrounding their respective merits. Finally, the article includes a practical step-by-step guide to manual blood pressure measurement.
The use of a chronic pain diary in older people
Authors: Hager Kathy , Brockopp Dorothy
Published: May 2014

This article describes clinical data retrieved using a chronic pain diary in older people residing in a nursing home. Twenty-one diary entries provided the information necessary to formulate an effective plan of care. Residents reported duration of pain, pain at rest, pain with movement, number and location of pain sites, and pain descriptors. Although estimates of chronic pain among nursing home residents range from 44–80%, the nursing home participating in this project reported 0% persistent or chronic pain. Diary entries revealed that 17% of communicative residents reported chronic pain. Data showed that a majority of participants experienced pain with movement. They experienced pain an average of 11 hours a day and lower limbs and hips were the most prevalent sites, and residents averaged three pain sites. The dominant pain descriptors used were ‘achy’ and ‘exhausting’.
The new Start dressing range –Urgotul Start, UrgoCell Start
Authors: Powell Gail
Published: May 2014

Delayed wound healing has implications both for the clinician and the patient, as well as having a financial burden on the National Health Service. UrgoCell Start and Urgotul Start are the first dressings on the drug tariff to be impregnated with Nano-OligoSaccharide Factor (NOSF), a new compound that aims to promote wound closure through the inhibition of matrix metalloproteinase (MMP) activity. The dressings are designed to ‘kick-start’ wounds that are at risk of delayed healing. There is good clinical evidence, comprizing multicentre Randomized Controlled Trials, an observational study and case studies, to support the process of MMP inhibition and its clinical efficacy in kick-starting wound healing.
Care or harm: exploring essential components in skin care regimens
Authors: Voegeli David
Published: May 2014

Skin care is a fundamental aspect of basic nursing care, with the outcome of these interventions often used to gauge the quality of the care provided. However, possibly as a result of the ‘basic’ nature of this aspect of care, little attention has been paid to developing a firm evidence base to guide decision-making in this area. This is compounded by the wide variety of products now available, ranging from simple cleansers and moisturizers, to more complex agents that cleanse, moisturize and protect all in one, which can add to the confusion. This article explores the basic principles of skin care, and considers the evidence available to support the nursing interventions used, and the range of products available. Finally, it suggests the adoption of clear skin care protocols, and recommends actions that should form part of these
Widening participation in pre-registration nursing
Authors: Glasper Alan
Published: May 2014

Professor Alan Glasper discusses the career pathways open to nurses and healthcare assistants, following the Nursing and Midwifery Council’s decision that all nurses should be graduates