bluuebunny/crossref_metadata_2025 huggingface dataset:
Part 1: The cultural web – A model for change in maternity services
Authors: Freemantle Danielle
Published: May 2014

Organisational culture is a recognised problem in the NHS and can have significant impact, positively or negatively, on patient welfare and care. Although maternity services were not implicated, the recent Francis Report (2013) recognised the influence of a dysfunctional culture as a major factor in system-wide failings and their devastating consequences for patient care. The report's recommendations are set to impact all NHS institutions and influence policy for the foreseeable future. In a more recent and damning review of Furness Hospital's maternity service, cultural and professional failings have been brought to public attention. Morecambe Bay NHS Foundation Trust, along with the Care Quality Commission, has been indicted for a cover up of serious incidences within the maternity services, which included the deaths of 16 babies ( BBC, 2013 ). Sadly, these cases implicate midwives and also cast a shadow over the effectiveness of statutory supervision of midwives; the latter of which has been subject to Nursing and Midwifery Council (NMC) review (2011) . The profession cannot be complacent about the current provision and culture within UK maternity services. It is imperative for all providers, regulators and users of UK health services to explore how cultural change may be implemented to improve efficiency, effectiveness and the environment of care throughout the NHS. In this series of two articles, a model for cultural analysis, change and its challenges is identified. The first, focusing on woman-centred care, introduces Johnson's ‘cultural web’ model (1992) ; while in the second, the possibilities and potential of the model are demonstrated through a process of understanding and changing the culture of the labour ward.
Maternal and child health services in China
Authors: Zheng Xujuan , Morrell Jane , Watts Kim , Shen Qu , Zhang Huiyan
Published: May 2014

This article acts as an introduction to maternal and child health services in China, including descriptions of the maternal and child health service system, related legislation such as the one-child policy, antenatal, intrapartum and postnatal care—for example, ‘doing the month’ in China—and a comparison of maternal and child health statistics for the UK and China.
Nutritional issues of vulnerable groups around pregnancy
Authors: Wyness Laura
Published: May 2014

Maternal body weight and diet quality, even pre-pregnancy, can affect the uterine environment, birth weight and the baby's subsequent health into adulthood. This article briefly discusses dietary and nutritional advice for women around pregnancy. However, some groups of women may be particularly vulnerable to suboptimal nutrition and therefore may require more targeted diet and nutrition advice. Specific nutrient issues among several vulnerable groups are discussed in this article.
The impact of internet use on the client-professional relationship: A comparative analysis
Authors: Johnsen Helle
Published: May 2014

This study explores how internet use impacts the client–professional relationship among midwives compared to related professions. Thirty health professionals in Denmark and Norway took part in nine focus group interviews. A template approach was used to analyse data. Findings indicate that clients use the internet to prepare for the client-professional meeting and to seek second opinions. Professionals reported more limitations than benefits in relation to internet use. Limitations were linked to doubts of reliability of internet information and information overload. Midwifery clients were reported to use internet chatrooms as an information source. However, these were often perceived as interfering with midwifery work. Although midwifery clients were frequent users of internet information, they also turned to midwives for verification of the information they found. Seeking reassurance and the midwives distinctions between lay and professional knowledge suggests that the traditional client–professional relation is still intact.
Exploring maternal perinatal mental health using a blended learning package
Authors: Larkin Valerie , Flaherty Alison , Keys Claire , Yaseen Jonathan
Published: May 2014

This paper presents and discusses a collaborative midwifery curriculum development involving service users and academic staff, focusing on maternal perinatal mental health. An overview of contemporary drivers for service user involvement in midwifery care, practice and education and the significance of maternal perinatal mental health are highlighted to set the context for the educational development. The potential advantages and challenges of service user involvement in the pre-registration midwifery curriculum are outlined. The authors’ response to these challenges, through the process of initiating, implementing and evaluating a blended learning package is discussed. At the heart of this blended learning activity is the facilitated narratives of two service users, interspersed with student-focused reflective and analytical activity to develop an appreciation of a wide range of evidence, including practice experiences, theory and literature. This partnership approach to developing teaching materials for the pre-registration curriculum is advanced as a means to ensure the service user voice becomes central to the pre-registration midwifery curriculum.
Midwives' attitudes towards giving weight-related advice to obese pregnant women
Authors: Foster Christine E , Hirst Janet
Published: May 2014

It is estimated that 1 in 5 pregnant women are obese, this poses a significant risk to maternal, fetal and newborn mortality and morbidity and as such, maternal obesity is recognised as a challenge for contemporary and prospective maternity services. As key practitioners in maternity care, midwives are seen as frontline professionals delivering weight-related advice to obese pregnant women. This study aimed to explore midwives' attitudes towards offering obese pregnant women weight-related advice during pregnancy and the puerperium. Nine midwives were interviewed using an in-depth interview schedule. Data were analysed using Colaizzi's (1978) seven-stage thematic approach. Midwives' knowledge of risk associated with maternal obesity was good; advice giving was mainly confined to community practice; the amount and consistency of advice was determined by: women's responses, women's apparent motivation to change and midwives' self-perception as a role model. Four key themes emerged: challenges for practice; perceived proficiency; advice giving skills and midwives' perceived relationship with a woman. Midwives need to address personal issues around body image, as they appear to hinder advice giving, before they can develop effective communication techniques to be able to offer obese pregnant women weight-related advice. The recommendation is to investigate ways in which issues of body image influence midwives ability to offer weight-related advice.
Student midwives views on incorporating creative arts as a learning strategy
Authors: Noble Sarah , Pearce Ruth
Published: May 2014

This paper reports select findings from an initial study seeking to ascertain student midwives views on incorporating creative arts as a learning strategy into pre-registration midwifery curriculum. Concern regarding the quality of midwifery practice in relation to supporting mothers has been at the forefront of national news. There has been increasing friction between what student midwives learn about practice and what they witness in practice. The findings offer insight into whether creative arts is a viable pedagogy to enable students to engage with the emotionality of midwifery practice. The paper concludes that creative arts should be considered an integrated pedagogy in midwifery education as it goes some way to address the divergence of the art and science of midwifery to ensure graduating students are fit for purpose.
Towards the next research assessment exercise
Authors: Nolan Mike
Published: May 2014

The subject of the most recent ENB Annual Research and Development Conference held in December last year was ‘Developing the Capacity of Nursing and Midwifery Research: Preparing for the Year 2000 Research Assessment Exercise’ (RAE). Judging by both the numbers and seniority of delegates the topic is one of considerable interest to all areas of nursing, midwifery and health visiting.
Empowering children to effectively self-manage asthma
Authors: Wilkinson Richard Allan
Published: May 2014

The prevalence of childhood asthma continues to rise, despite the introduction and implementation of innovative treatment methods. Asthma is now one of the most common childhood diseases. It is widely believed that the causes of asthma are likely to be multifactorial. Education on asthma management remains primarily focused on the parents of asthmatic children. A heightened emphasis on education aimed primarily at the child is imperative if the negative trends in morbidity and mortality of childhood asthma are to be curtailed. This article examines the need to correlate educational content with the cognitive ability of the asthmatic child.
Assessment of significant harm: improving professional practice
Authors: Ayre Patrick
Published: May 2014

Judging whether a child is suffering or is likely to suffer ‘significant harm' has become a critical task for professionals working in the field of child health. Yet little guidance is available about what the phrase means in its entirety or how it should be applied in practice. This study set out to clarify the position by examining how the phrase was used in practice by a selected sample of experienced health and social work staff. The evidence collected suggests flaws in the general approach adopted by professionals to identification and assessment in child protection cases. The data indicate a heavy concentration of attention on the weaknesses of families being assessed rather than their strengths and on parents rather than children. Problems are identified in responding effectively to long-term, chronic abuse such as emotional abuse and neglect.
Stages of Stroke: a model for stroke rehabilitation
Authors: Watson Lynda D , Quinn David A
Published: May 2014

This article offers a model for stroke rehabilitation in both community and hospital settings which was developed as a result of observations made by staff working in both areas. It examines the effects of using more traditional models of stroke and neurological rehabilitation, where professional practice is more isolated, together with the effects of models for acquired brain injury that have identified positive outcomes. It was recognized by staff that a pragmatic model for stroke rehabilitation does not appear to be available. The Stages of Stroke model provides a ‘map’ with different routes to effective outcomes, helping those within stroke rehabiliation to recognize where they are and where they are going. It encourages a client-centred, not a service-centred programme.
The link between Down's syndrome and Alzheimer's disease: 2
Authors: Soliman Alison , Hawkins Debbie
Published: May 2014

In this article, the second of two parts, the needs of family and professional carers of people with Down's syndrome and Alzheimer's disease are examined. Substantial numbers of people with Down's syndrome survive to the age of 50 and beyond and so work still needs to be done on finding solutions to the problems faced by this client group and its carers. As well as the difficulties faced by any family carer of a person with dementia, those caring for someone with Down's syndrome and Alzheimer's disease may also have to deal with additional worries and problems. Consideration is given to service provision and the implications for nursing. A case study will illustrate some of the points made.
Constipation: cause and control in an acute hospital setting
Authors: Ross Helen
Published: May 2014

Constipation is not a glamorous subject, but its prevention and management can make a vast difference to patients' quality of life. This literature review identifies causative factors and describes the mode of action, side-effects and contraindications of many remedies currently available. Recommendations include a systematic approach to management in an acute ward setting, based on assessment of risk, maintenance of normal bowel routine and appropriate dietary advice and the use of appropriate pharmaceutical interventions where necessary. To be effective, this process should be underpinned by accurate documentation and the maintenance of a high level of knowledge and awareness among staff.
Discharge planning: establishing an effective coordination team
Authors: Summerton Heather
Published: May 2014

This article investigates the developing role of the discharge coordinator and explores how safe, effective and timely discharge from hospital can be achieved. In January 1996, a team of four discharge coordinators were jointly appointed by the King's Healthcare NHS Trust in partnership with the local social services department. The coordinators were appointed to work with the multidisciplinary teams to improve trustwide discharge planning practice. The team focused on six core objectives: central coordination, open interagency communication, continuing education, patient advocacy, information resource and audit of discharges. Despite the ward staff's early difficulties regarding the nature of the role, the team did begin to collaborate effectively when working alongside all members of the multidisciplinary team and with patients and families.
Transcultural therapy 2: mental health and learning disabilities
Authors: Jukes Mark , O'Shea Kate
Published: May 2014

The first article in this two-part series (Vol 7(15): 901–6) examined the issues surrounding healthcare provision in the context of the UK as a multicultural society in relation to mental health and learning disabilities. This second article considers the development of psychotherapy, theory and skills of working in terms of its impact and influence upon the education and practice of community mental health nurses and community nurses in learning disability within the UK. The major schools of influence in psychology will be examined in relation to their limitations for practice with clients from various cultures. In addition, three multicultural models of counselling which address cultural diversity will be appraised. Finally, the need for educational systems and service providers to foster and develop positive cultural attitudes among nurse practitioners will be emphasized. Both individual practitioners and employment organizations will need to be much more responsive and committed to developing multicultural services as we approach the millennium.
Evidence-based care: can we overcome the barriers?
Authors: Nolan Mike , Morgan Lynn , Curran Monica , Clayton Jane , Gerrish Kate , Parker Kath
Published: May 2014

Evidence-based care has become the new mantra within the NHS, despite the fact that the concept of applying research to practice has been promoted for several decades. However, literature on the subject suggests that formidable obstacles remain to the integration of research into care delivery. This article describes a study which used Funk et al's (1991a,b) Barriers Scale with a population of nurses in a large teaching hospital in the UK. This scale was specifically developed to identify barriers to the introduction of research into practice, and modified for a UK context. The results suggest that a complex array of barriers exist but that foremost among these is the nature of the organizations within which nurses work. Comparisons are made with data from the USA, and the need to create time for nurses to implement change, and to empower them to do so, is stressed.
Hydrocoll: a ‘new breed’ of hydrocolloid wound dressing
Authors: Williams Clare
Published: May 2014

Hydrocolloid dressings were first used in wound management in the 1960s. They provide the optimal environment for wound healing, i.e. a moist environment, constant wound temperature and infrequent dressing changes, and can be used on wounds in various stages of healing. As a result they are a popular treatment option for health professionals in both the community and hospital settings. This article describes the properties of Hydrocoll — a new and exciting range of hydrocolloid dressings from Paul Hartmann Ltd — which was launched in the UK in January 1998 and became available on the Drug Tariff in June 1998.
Assessment of patients requiring IV therapy via a central venous route
Authors: Hamilton Helen , Fermo Katherine
Published: May 2014

In the past, problems associated with the prolonged maintenance of a patient with a central venous catheter (CVC), inserted for the administration of antibiotics, chemotherapy, intravenous (IV) fluid replacement or IV alimentation, have limited the duration that such catheters can remain in situ. This article highlights the necessity for and increasing importance of accurate patient assessment before catheter insertion for the long-term care and maintenance of individual IV devices. CVCs that may once have had a limited lifespan as a result of thrombosis, infection and eventual lack of suitable venous access, are increasingly being maintained in a satisfactory functional condition for long periods, ranging from many months to years.
Autonomy or non-compliance in adolescent diabetes?
Authors: Timms Nicola , Lowes Lesley
Published: May 2014

Many physical, psychological, social and cognitive changes take place in adolescence. Emerging personal values and beliefs, an acute awareness of body image and a desire for peer conformity and increasing independence can make the transition to adulthood troublesome. For teenagers with diabetes, usual adolescent needs and concerns are complicated by the demands of a complex treatment regimen. This can result in non-adherence to the recommended programme of care and, consequently, poor glycaemic control, which increases the risks for diabetes-related complications in later life. This situation poses a major problem for healthcare professionals. Teenagers, however, are frequently preoccupied with the present, and are unable to perceive, or will ignore, their vulnerability to long-term health problems. This article discusses these difficult issues and, taking into account the increasing need for autonomy and independence in adolescence, makes recommendations for nursing practice.
Measuring the size of the leg ulcer problem in an acute trust
Authors: Dealey Carol
Published: May 2014

The majority of patients with leg ulceration are cared for in the community. There is insufficient evidence of the numbers of these patients who are being cared for in acute hospitals. This study sought to identify the size of the problem in one acute trust by means of a point prevalence survey. From a study population of 931 patients, 17 had leg ulcers, giving a prevalence of 1.8%. Out of 52 wards and units, staff on 44 (84.6%) said that patients with leg ulcers were admitted on occasion. In the case of 19 (36.5%) wards and units this was as infrequently as one or two patients a year. The results of this survey have considerable implications for ensuring that all patients receive optimum care.
Preventing rape and sexual assault of people with learning disabilities
Authors: Aylott Jill
Published: May 2014

This article will explore the increased prevalence of rape and sexual assault among people with a learning disability and identify factors that exist which increase this client group's vulnerability to becoming a victim of sexual abuse. There is significant under-reporting of such incidents and very few cases end up in prosecution. Within the nursing profession, there is much more that can be done to help decrease the level of vulnerability of people with a learning disability and to work with other agencies to advocate for legal justice and therapeutic redress for individuals.
Seasonal affective disorder: its recognition and treatment
Authors: Birtwistle Jon , Martin Nik
Published: May 2014

This article provides an introduction to seasonal affective disorder (SAD) and outlines various therapies, including phototherapy (light therapy), used in its treatment. SAD, colloquially termed ‘winter blues’, is a common condition that is thought to be caused by reduced levels of daylight in winter. During this period sufferers generally feel low and may experience clinical depression. The Department of Psychiatry at the University of Southampton has an established SAD service as part of its mood disorders clinic, which was developed from a research-based clinical investigation unit set up in the early 1990s. SAD is described as a mood disorder with a seasonal pattern and has a greater prevalence in countries with greater northern latitude. The aetiology of SAD is unclear, although the most promising theory suggests the role of the neurotransmitter serotonin. SAD is difficult to treat with conventional antidepressants although there is evidence that serotonin selective reuptake inhibitors may be useful for some patients. Phototherapy (light therapy) has been used successfully by many patients although it remains controversial and difficult to obtain on the NHS.
Drawtex: a unique dressing that can be tailor-made to fit wounds
Authors: Russell Linda , Evans Amanda
Published: May 2014

Drawtex is a new and innovative dressing using dispersion technology which works on capillary action. This promotes moist wound healing and provides the optimum environment at the wound interface. This dressing has the ability to absorb exudate 30 times it own weight. The unique capillary action draws the exudate away from the wound bed and into the core of the dressing from where it disperses into a second layer of Drawtex. The practitioner tailors the Drawtex to conform to the wound bed. Drawtex's non-adherence reduces the frequency of dressing change after the first week. This is not the only benefit as it is also very cost-effective at half the price of other modern dressing products.
Triage in accident and emergency 1: an overview of the literature
Authors: Allan Wilkinson Richard
Published: May 2014

This article, the first of two parts, reviews the concept of triage. The purpose is to make sense of the literature, and to provide an overview of the triage process. Although there are areas of consensus within the literature on triage, e.g. that accident and emergency (A&E) attendances and waiting lists are continually increasing and that triage can partially remedy these negative trends, contradiction and inconsistency between authors’ accounts of triage still dominates the literature. This article examines the concepts of waiting times and patient satisfaction. With regards to waiting times, it is suggested that a reassessment of government legislation affecting triage is required if the potential of the concept is to be ascertained. With reference to patient satisfaction, this article recommends that in order to establish whether triage enhances patient satisfaction, universal agreement on how to define it is essential. Within the reviewed literature this is presently elusive. Finally, this article contends that due to the varying infrastructures of A&E departments, implementing universal standards is extremely arduous.
Psychosis and medication: strategies for improving adherence
Authors: Coffey Michael
Published: May 2014

The development of traditional anti-psychotic medication has led to improvements in the care of mentally ill people. These medications have been the mainstay of drug treatment for schizophrenia for many years. In recent years, however, the advent of so-called ‘atypical' anti-psychotics has enabled patients to be treated without experiencing the range of severe side-effects associated with traditional medicines. Ensuring mentally ill patients take prescribed treatment is seen as an important element of the work of mental health nurses. Adopting approaches which are non-adversarial may provide better outcomes than straightforward advice giving. A combination of psycho-education and a technique known as brief motivational interviewing could provide a useful starting point for nurses. Whether such approaches will be supported given recent declarations on policy intentions remains to be seen.
Acute surgical wound care 3: fitting the dressing to the wound
Authors: Foster Lorraine , Moore Peter
Published: May 2014

The third article in this series on surgical wound care discusses the types of dressings currently available, and selection of the correct dressing for a particular wound type. There is an abundance of information on the types of dressings available. Wound management for the individual patient must be decided using best evidence and taking into account patients' increased involvement in their care, new technology and the push to mobilize early, leading to early discharge from hospital. The nurse needs to have a good knowledge of the types of dressings available, the properties of individual dressings and a sound understanding of wound healing, in order to make an informed decision on wound management. General factors such as safety, comfort, pain management and convenience must be borne in mind when deciding which dressing is the best for individual patients, given that dressings now have to be cost-effective as well as clinically effective.
Acute surgical wound care 4: the importance of documentation
Authors: Foster Lorraine , Moore Peter
Published: May 2014

This article, the last in a series of four, discusses the importance of documenting wound care. Studies have shown that nurses do not document wound care as often, or as accurately, as they should in order to comply with the UKCC's (1998) Guidelines for Records and Record Keeping. Although some wound assessment charts have been published and are in use, there is still concern about the validity or reliability of some of these charts. Studies show that further research is necessary in order to validate the charts that are currently in use. An increase in litigation has placed more emphasis on accurate record keeping which shows, in detail, the wound care that is given to each patient. Patients also want to be more informed about their treatment, and this can be done through the use of clinical pathways or multidisciplinary documents. This article also discusses the factors that have to be considered when putting a wound care chart together and gives some examples of existing charts.
Algosteril calcium alginate dressing for moderate/high exudate
Authors: Williams Clare
Published: May 2014

Algosteril is a new alginate dressing manufactured by Les Laboratoires BROTHIER and distributed by Beiersdorf Medical. It is a natural, pure, non-woven dressing made from calcium alginate fibres. It complements other products in the Beiersdorf wound care family such as Cutinova, Cutifilm and Cutisorb. Algosteril rapidly absorbs and retains wound fluid to form an integral gellified structure, thereby maintaining an ideal moist wound healing environment. It traps and immobilizes pathogenic bacteria in the network of gellified fibres, stimulates macrophage activity and activates platelets, resulting in haemostasis and accelerated wound healing.
Benefits of nurse teachers returning to clinical practice
Authors: Glossop Deanna , Hoyles Alyson , Lees Sheila , Pollard Carol
Published: May 2014

This article outlines an action research study developed to facilitate nurse teachers returning to clinical practice. The article explores how the teachers established partnerships with clinicians through which they were able to share the experience of returning to an area of nursing that they had previously only visited. It discusses four categories: expectations of self and others; entering someone else's world; more awareness of student needs; and teaching theory and practising nursing. These categories emerged following the analysis of journals, focus group interviews and individual interviews and led to a number of recommendations concerning the implications for other teachers wishing to return to clinical practice.
Family carers 1: difficulties and levels of support in Sweden
Authors: Lundh Ulla
Published: May 2014

Sweden has a well developed welfare system and until fairly recently the needs of family carers have received limited attention. However, there is now a growing acceptance of the need to provide better and more sensitive support services. Using questionnaires validated in the UK and translated into Swedish, this series of four articles considers the difficulties, satisfactions and coping mechanisms of a sample of Swedish carers, identifying the implications of the results for the design and delivery of healthcare interventions. This article focuses on carers' perceived difficulties and their satisfaction with existing levels of help.
Stoma care: empowering patients through teaching practical skills
Authors: Metcalf Chris
Published: May 2014

Teaching patients practical skills in stoma care is a complex process and although, arguably, at the very heart of stoma care nursing practice, has been largely ignored in the literature. Teaching principles are based upon social learning theory and educationalists provide guidelines on the most effective way to teach a practical skill. These guidelines have been utilized by nurses when teaching patients with newly formed stomas how to change a pouch. The process of adapting to a stoma and its daily management takes time. Psychologically, however, some patients will adapt more easily than others and researchers have attempted to identify factors which may account for this. Studies have demonstrated that patients who are satisfied with the amount of preoperative information they receive are less likely to develop psychological problems. Psychological adjustment may be affected if patients feel that they have developed insufficient pouch changing skills or have problems with leakage from their pouch or sore skin around their stoma. Studies have also demonstrated that cognitive factors, such as patients feeling in control of their illness and stoma, have been found to play a role in psychological adaptation. Clinical nurse specialists in stoma care are in an ideal position to target these cognitive factors using a variety of strategies including effective practical teaching to empower patients, thus facilitating psychological adaptation following stoma surgery.
Gerontological nursing 1: challenges nursing older people in acute care
Authors: Nolan Mike , Tolson Debbie
Published: May 2014

This article, the first in a series of five, will briefly trace the emergence of gerontological nursing and highlight some of the tensions that currently exist in the context of acute care environments. The next two articles will consider the prospects and challenges for nurses working with older people in community and nursing home environments, while the fourth article uses hearing impairment across a range of care contexts as a case study to summarize the ways in which the nursing contribution to the health needs of older people could be significantly improved. The series will conclude with an article drawing together the challenges that gerontological nursing faces in the new millennium.
Spirituality and being a ’friend of the patient’
Authors: Castledine George
Published: May 2014

One of the saddest things about life is that we do not discover our spirituality soon enough or in time to develop it. Recently, I have been involved in a professional capacity with two people who made me realize that if only we could understand our spiritual selves more fully, then the shocking experiences we have to deal with, such as the loss of a close one, may hold more meaning.
Conservative treatment of erectile dysfunction 3: literature review
Authors: Dorey Grace
Published: May 2014

This is the third of a three-part article addressing whether physiotherapy involving pelvic floor muscle exercises (PFMEs) is efficacious as a first-line treatment for erectile dysfunction (ED). The first part (Vol 9(11): 691–4) highlighted the prevalence of ED, associated risk factors, the anatomy of the penis and the physiology of erection. The second part (Vol 9(12): 755–62) concentrated on the published clinical trials investigating the treatment and prevention of ED. This part will critically analyse the literature. PFMEs using ischiocavernosus muscles (ICMs) and bulbocavernosus muscles (BCMs) seem to have merit as a treatment for ED due to mild or moderate venous leakage. Men suffering from ED due to other causes may also benefit. There is no strong evidence that electrical stimulation or electroacupuncture is effective or ineffective. No studies demonstrating preventive conservative treatments were found. There is evidence that the ICMs and BCMs increase penile rigidity in the tumescent penis, that pelvic floor muscle efficiency is higher in potent men than impotent men and that perineal muscle efficiency reduces with age in impotent men. There is limited evidence that pelvic floor exercises relieve ED due to venous leakage and are a realistic alternative to surgery. Randomized controlled trials are needed to explore the use of PFMEs as a first-line treatment for men with ED.
Electrical stimulation as a treatment for stress incontinence
Authors: Jeyaseelan Selvi M , Oldham Jacqueline Ann
Published: May 2014

Much research has been conducted into the use of electrical stimulation to restore function in weak/atrophied muscle and it is used widely in the field of muscle rehabilitation. As stress incontinence is a condition which is the result of pelvic floor muscle weakness, it is thought that the symptoms of this condition may be alleviated once the strength and endurance characteristics of this muscle group have been improved. Many studies have been conducted to evaluate the efficacy of various types of electrical stimulation, although definitive conclusions have yet to be drawn. Current forms of electrical stimulation for stress incontinence involve the use of uniform frequencies. In animal studies this type of stimulation has been shown to have drawbacks that are unacceptable when trying to rehabilitate muscle. Consequently, there is a need to develop more physiological patterns of stimulation that will enhance both strength and endurance characteristics without causing premature fatigue.
Selecting the correct intravenous device: nursing assessment
Authors: Hamilton Helen C
Published: May 2014

This article provides information for nursing and medical teams involved in the selection of intravenous (IV) devices for patients requiring venous access. For more than 25 years central venous access has been the mainstay for delivery of a variety of IV therapies. However, although the use of central venous access has facilitated innovative patient care, it has also precipitated many complications arising from inappropriate catheter selection. The information contained in this article is not intended to replace local policies but is offered as a reference for those involved in developing protocols for assessment of patients requiring therapies via the IV route. It aims to assist nurses in relation to matching an appropriate access device to individual patient requirements.
Enhancing clinical effectiveness among clinical nurse specialists
Authors: Cox Carol L , Ahluwalia Sonya
Published: May 2014

This article describes the findings of an exploratory study which aimed to discover how clinically effective nursing care is fostered among clinical nurse specialists (CNSs) and nurse practitioners (NPs) in an NHS trust in East London. The study was funded by the Central and East London Education Consortium and commenced in January 1999. Qualitative approaches included non-participant observation of practice, interviews during observation and focus group meetings. Findings from the research identify areas that both foster and hinder the ability of the CNSs and NPs to engage in and provide clinically effective nursing care.
The Flo-tech Adjuster chair from Medical Support Systems
Authors: Williams Clare
Published: May 2014

Pressure ulcer prevention in the seated patient is a neglected area. The early rehabilitation of bed-bound patients has reinforced the need for suitable seating to compliment pressure-reducing mattresses. Medical Support Systems has developed a hospital chair, the Flo-tech Adjuster, which addresses the problems of both pressure ulcer prevention and manual handling. The launch of the Flo-tech Adjuster has followed many years of research and constant refinement and improvement, and has filled a gap in the market for pressure-relieving devices.
Developing an oral assessment and intervention tool for older people: 3
Authors: Roberts Josephine
Published: May 2014

This is the last in a series of three articles which have examined oral care practices for older people. The first article (Vol 9(17): 1124–7) highlighted the importance of effective oral care. The second article (Vol 9(18): 2033–40) examined oral care interventions in detail to identify oral care that is evidence based. This article looks at the factors which have an impact on oral health, and which must be considered when assessing a patient's oral health status. The correlation between holistic assessment and careful documentation is examined, together with its associated relationship with maintaining effective oral care. The article also critiques a collection of published oral assessment tools to identify whether they would be appropriate for rehabilitation client groups. After identifying the lack of a suitable oral assessment tool within the literature, the need to develop an appropriate one is addressed. An oral assessment and intervention tool which has been developed in the author's clinical area is outlined.
Implementing 12-hour shifts on a cardiology nursing development unit
Authors: Wootten Nick
Published: May 2014

This article, the first of two parts, discusses the implementation of 12-hour shifts using a locally devised nursing development unit (NDU) framework. A literature review and force-field analysis were undertaken to plan, implement and evaluate the introduction of the 12-hour system. The literature review identified five broad categories: effect on care delivery; nurse education; cost-effectiveness; impact on staff; and implementation strategies. It also ascertained that the most successful methods of implementation were those that gained the cooperation of staff. The force-field analysis identified the restraining forces (e.g. tiredness, the European Working Time Directive and staff views) and therefore allowed the change agent to concentrate his limited time on combating these restraining forces. The second part of this series will examine the evaluation and audit of the 12-hour shift system.
A life story approach for people with profound learning disabilities
Authors: Hewitt Helen
Published: May 2014

This article presents an alternative approach to studying issues concerning people with profound learning disabilities. Previous approaches have relied too heavily on quantitative methods, e.g. questionnaires and rating scales, which demand a certain degree of verbal competence. When working with people with profound learning disabilities who can not talk, these techniques are clearly limited. The current research aims to redress this imbalance by presenting an in-depth qualitative analysis of issues concerning the identities of people moving from a long-stay hospital to community care. Life story books were introduced as a resource for presenting biographical information about clients previously undocumented. It is suggested that we should move away from measuring to observing. Life story books take the focus away from viewing the participants as patients or subjects to considering them as people with their own unique life.
NHS Direct: issues for education, management and research
Authors: Glasper Edward A , Thompson Fizz , Wray Denice
Published: May 2014

The NHS Plan (Department of Health (DoH), 2000) specifically highlights the role of NHS Direct in its vision of a health service designed around the patient. Despite this, the new nurse-led service has come under critical attack. NHS Direct is in the process of developing an evidence base to underpin its practice. It is recognized that telephone management skills are important clinical skills and while decision support computer software can help elicit an appropriate client history, the interpersonal skills necessary to establish a professional telephone relationship are commensurate with the suitability of the appropriate educational programme. This article will explore the ramifications of NHS Direct for curriculum development and evaluation. Factors such as skill mix, career pathways, recruitment and research and development will also be discussed. In a previous article the implications of NHS Direct for practice were examined (Glasper et al, 2000).
Diabetes specialist nursing: looking to the future, learning from the past
Authors: Da Costa Sara
Published: May 2014

Diabetes specialist nursing, like many other aspects of nursing, is facing a challenging time in terms of limited resources, staff stress and increasing client caseloads (Naughton and Nolan, 1998). This trend seems set to continue and therefore reflection on and analysis of the role of the diabetes specialist nurse (DSN) is essential so that DSNs can understand their role and meet such challenges proactively. This learning experience (Jarvis, 1992) will also enable DSNs to communicate effectively their role within their teams and to their peers and managers. The author contends that many of the problems currently faced by DSNs can be identified in the initial reactive creation and development of the DSN role which, in some cases, was 20 years ago. Therefore, this article discusses how the past could be influencing the present and future for diabetes specialist nursing. It cannot attempt to provide an exhaustive discussion, but will focus on the following major aspects: DSN titles and commencement; role entry and subroles; and role set and role definition. The article concludes with a vision for the future, informed by this analysis of the past.
Implementing evidence-based practice in infection control
Authors: Ward Deborah
Published: May 2014

Evidence-based practice is seen as a way of providing more effective health care and is considered to be vital in the current healthcare climate. However, in many areas of practice, and specifically in infection control, there is often little or no evidence to back or refute certain practices. This article looks at ritualistic practices, interventions with indirect evidence to support them and practices with overwhelming evidence in their favour which are not always followed. It is concluded that nurses need to integrate the best available evidence with clinical judgment and ensure that available evidence is disseminated appropriately.
Urinary sheaths and drainage bags available from Manfred Sauer
Authors: Doherty Willie
Published: May 2014

This article looks at the wide range of sheaths, adhesives and leg bags manufactured and supplied by Manfred Sauer. The company designs from the user's perspective and has a unique range of products from condom-type drainage systems to leg bags. The company also markets URIbags which are reusable, pocket-sized urinals for men and women.
Investigating the risk of pressure damage during childbirth
Authors: Newton Heather , Butcher Martyn
Published: May 2014

The incidence of pressure ulceration is well documented within general adult hospital and community healthcare populations (Department of Health (DoH), 1992). However, within maternity units this negative outcome is largely unreported. Indeed, many trusts exclude maternity units from their regular pressure incidence and prevalence monitoring. This article will seek to raise awareness of the potential causes and areas where clinical practices could be reviewed in the light of new evidence.
The cost-effectiveness of wound management protocols of care
Authors: Harding Keith , Cutting Keith , Price Patricia
Published: May 2014

A European cost-effectiveness study has been conducted using published clinical trial data from multinational studies on chronic venous leg ulcers and pressure sores. Data relevant to UK chronic wound management practice have been extracted and are presented here. A total of 15 pressure sore studies involving 519 wounds, and 12 leg ulcer studies involving 843 ulcers were used in a pooled analysis. The study objectives included the calculation of comparative costs in £ sterling for three different treatment protocols for each wound type. The protocols have been adapted for UK clinical practice in both hospital and community settings and are based on primary dressings and nurse time costs, wound cleansing and debridement, the use of fillers, and compression as appropriate. The focus of the study has been the cost-effectiveness comparison (as measured by cost per healed wound) of two modern dressings — Granuflex® hydrocolloid dressing and Apligraf® skin replacement — and traditional gauze dressings in the treatment of venous leg ulcers and, in the case of pressure sores, comparison of Granuflex® and Comfeel® hydrocolloid dressings and traditional saline gauze dressings. The choice of dressings studied was dictated by the available published literature. The construction of treatment protocols and assumptions on treatments otherwise missing from published papers has been achieved through the use of an expert panel. Results show Granuflex® to be 50% more cost-effective, at £422 per healed wound, than Comfeel® (£643) and 500% more so than saline gauze (£2548) in the treatment of pressure sores. Granuflex® at £342 was also more cost-effective than gauze (£541) or Apligraf® (£6741) in the treatment of venous leg ulcers. These data will provide a valuable adjunct to published clinical evidence, offering further information upon which carers can base their choice of wound dressing.
Does seclusion have a role to play in modern mental health nursing?
Authors: Griffiths Lloyd
Published: May 2014

The seclusion of patients with mental health problems is a controversial and emotive subject, and is a practice that was condemned by the Ashworth Inquiry (Department of Health (DoH), 1992). Despite this condemnation, it is still widely practised today. Opinions on the practice of seclusion vary greatly. Consequently, there is a need to review the theoretical and empirical literature regarding the use of seclusion in order to gain an understanding of the current state of the knowledge base in this substantive and controversial area. This article systematically reviews research published between 1994 and 1999 and discusses the findings under three headings: staff/patient attitudes to seclusion; the alternatives to seclusion; and the efficacy of seclusion. The reviewed material shows that seclusion is seen as a legitimate intervention by some hospital staff, but is ‘dreaded’ by mental health patients. What is also evident is that seclusion is largely believed to be effective and that no true alternatives to its use exist. However, there appears to be no formal means of determining what constitutes an effective intervention in the management of violent incidents. Implications for practice and areas for future study are also discussed.
Nutritional awareness of critically ill surgical high-dependency patients
Authors: Kinn Sue , Scott Jules
Published: May 2014

It has been recognized that malnutrition in hospital is a serious problem that may go undetected. There is growing evidence that early nutritional support in high-risk patients helps reduce postoperative complications; however, malnutrition is often diagnosed only once it is well established. This study showed that, both retrospectively and prospectively, there were no formal nutritional assessments of patients in a high-dependency unit (HDU), that time to feeding was generally within the recommended 5–7 day postoperative period, and that the most common form of supplementary feeding was total parenteral nutrition (TPN). Prospectively, the choice of supplementary feeding was dependent on the type of surgery and the individual patient's condition. Since this study was completed, a dietician has been allocated to the HDU and carries out formal nutritional assessments on a daily basis. Further research is required to assess the impact of the dietician on patient nutrition.