bluuebunny/crossref_metadata_2025 huggingface dataset:
The role of paramedics with extended practice: exploring the healthcare context
Authors: Catterall Matthew
Published: May 2014

With National Health Service (NHS) providers facing the challenge of measurement through clinical outcomes, measures of effective service provision, this article explores the political influences; background and current approaches which have expanded paramedics’ scope of practice.As there are conflicting demands upon ambulance service NHS trusts provision of healthcare, these features are related to experiences within the London Ambulance Service, and where relevant to national experiences.

The educational requirements, practitioner attributes, leadership development and service user perception are explored.In an environment where paramedics are expected to deliver innovative healthcare, partly driven by political influence it is important to understand how an extended scope of practice has involved and can be delivered while ensuring patient safety.

In helping to shape the future delivery of out-of-hospital healthcare while integrating in the changing urgent and emergency provision, paramedics must remain aware of these multifaceted drivers upon their practice.
Framework for assessment of the 12 lead ECG in transient loss of consciousness
Authors: Edwards Tim
Published: May 2014

Following the introduction of pre-hospital thrombolysis, the acquisition and interpretation of the 12 lead ECG has become a routine part of UK paramedic practice. Although there is a growing body of evidence that confirms the diagnostic ability of paramedics in this area, little is known regarding the ability of paramedics to scrutinise the 12 lead ECG for other abnormalities. Recent publication of NICE guidance ( NICE, 2010 ) relating to transient loss of consciousness (T-LOC) requires practitioners responsible for assessment of the 12 lead ECG post T-LOC to be competent in identifying a range of abnormalities. This paper describes a novel assessment framework in the form of a mnemonic designed to assist paramedic students in scrutinising the ECG for abnormalities post T-LOC. The need for further research to validate this assessment framework in educational and clinical settings is emphasised.
Interpersonal skills education for undergraduate nurses and paramedics
Authors: Ross Linda
Published: May 2014

Interpersonal skills can be described and defined in numerous ways; however a common premise throughout the literature is that they are linked to human interaction and contribute substantially to establishing a high quality caring relationship with patients. Furthermore they are paramount to nurses’ and paramedics’ abilities to operate within diverse, challenging environments and highly charged emotional situations. The aim of this review was to explore how undergraduate programmes are teaching these skills and with what outcomes.

Methods

A literature search was conducted using electronic databases, Medline, EMBASE, PsycINFO and ERIC.

Results

2838 articles were initially identified with only 6 remaining for analysis after applying the inclusion/exclusion criteria. No relevant data pertaining to paramedic undergraduate interpersonal skills was located for inclusion. Undergraduate nursing programmes used more traditional classroom approaches in conjunction with engaging, highly realistic activities. The use of evaluation tools in combination with student self-reporting appeared to be the most thorough and accurate way of evaluating such humanistic skills which are more difficult to quantify than clinically based skills.

Conclusion

This literature review has highlighted the lack of research into the teaching and development of interpersonal skills in undergraduate paramedic programmes and a need for this to occur in the future.
Guideline alert: British thoracic society emergency oxygen use in adult patients
Authors: Ricketts William
Published: May 2014

In 2008 the British Thoracic Society produced the first guideline on the emergency use of oxygen. The main focus of the guideline is attempting to debunk the myth that where oxygen is concerned ‘more is better’ introducing the concept of target oxygen saturations, with target saturations of 94–98 % being recommended for most patients and 88–92 % in those at risk of type 2 respiratory failure. The guideline acknowledges that high concentration oxygen is likely to be beneficial in critical illness and cardiopulmonary resuscitation. The aim of this article is to draw further attention to this guideline in the hope that compliance with its recommendations can be further improved.
CURE (Community Urgent Response Environment): portable work stations
Authors: Hignett Sue , Fray Mike , Benger Jonathan , Jones Andrew , Coates David , Rumsey John , Mansfield Neil
Published: May 2014

The Community Urgent Response Environment (CURE) concept is a new technology system developed to support the work of Emergency Care Practitioners with portable pods and packs and mobile treatment units. This paper describes a project to transfer research outputs from an academic setting into practice through collaboration between two universities, two manufacturers and the United Kingdom (UK) National Health Service. An iterative prototyping process was used with 12 Emergency Care Practitioners evaluating prototypes in two user trials by carrying out four clinical scenarios in three simulated environments (confined domestic, less confined public space, and vehicle). Data were collected with video recording, field notes and post-trial debriefing interviews and analysed thematically. The final prototypes (pod/pack 1.3 and vehicle 1.6) have potential to support a new way of working in the provision of non-critical, pre-hospital care. The user trials also identified possible efficiencies through the use of CURE by providing support for a wider range of assessment, diagnosis and treatment.
Kerbside consultations: advice from the advanced paramedic to the frontline
Authors: Jackson Mike , Jones Colin
Published: May 2014

Aim

To observe the issues, benefits and challenges of providing dynamic telephone clinical advice to frontline clinicians by advanced paramedics of the North West Ambulance Service NHS Trust.

Method

In order to focus on the key issues the study used a mixed method approach. A group of 11 advanced paramedics took part in two focus groups which was then followed up with a questionnaire to frontline clinicians. Using focus groups in the research not only allows for the possibility of multiple realities but also for participant validation. Using a qualitative approach allowed theory to develop and emerge which was then codified into themes and the data was then used to develop a questionnaire for frontline clinicians who had received clinical advice in the past in order to provide an element of quantitative data.

Findings

Five themes emerged from the stud: function, responsibility, barriers, education and support.

Conclusion

The study finds that clarity is required in relation to responsibilities and clinicians would benefit from a structured model to communicate information over the telephone—we believe the introduction of remote advice has improved patient safety and support to staff and has created opportunity for additional learning.
Evaluating the incidence of unrecognised oesophageal intubation by paramedics
Authors: Nichols Martin , Acker Joe , Bendall Jason , Asha Stephen
Published: May 2014

Objective: To determine the incidence of unrecognised oesophageal intubation by paramedics in a metropolitan setting.

Methods: A retrospective observational analysis was conducted. Patient health care records from the Ambulance Service of New South Wales were used to identify patients who had been intubated by paramedics between 1 January 2007 and 31 December 2010, and transported to St George Hospital, Sydney. Medical records from St George Hospital were reviewed to determine the position of the endotracheal tube (ETT) on arrival in the Emergency Department.

Results: During the study period, 196 patients were identified as having an ETT in-situ on arrival to the emergency department. There was inadequate documentation for 67 patients to determine ETT placement. Of the 129 patients included in the final analysis, 4 (3.1%, 95% confidence interval (CI) 0.9–7.8%) had an unrecognised oesophageal intubation. The final ETT positions of the remaining 125 patients were 85.3% (95% CI 78–90.9%) located in the trachea, 10.1% (95% CI 5.5–16.6%) located in a primary bronchus, 0.8% (95% CI 0–4.2%) in the larynx and 0.8% (95% CI 0–4.2%) in the pharynx.

Conclusion: The incidence of unrecognised oesophageal intubations in this study was consistent with other reports in the literature, although higher than expected given the training and equipment used in this setting. An incidence of unrecognised oesophageal intubations of zero should be the goal of emergency medical services. The incidence of unrecognised oesophageal intubations may be reduced through recursive training programs and the use of quantitative waveform capnography.
The challenges of pre-hospital paediatric trauma care
Authors: Reavley Paul
Published: May 2014

The challenges paediatric trauma presents to pre-hospital and emergency clinicians have remained constant over the years. Recently, there has been a nationally increased focus to improve the quality of trauma care in the UK, leading to the development of regional trauma networks in 2012. This focus includes children. This article will discuss the challenges and issues of dealing with paediatric trauma and how some of the problems encountered might be mitigated.
Clinical forum: automated chest compression devices
Authors: Barrett Kevin , Bishop Andy , Hernandez Joanna , Chamberlain Douglas
Published: May 2014

Kevin Barret, course leader for the BSc(Hons) Pramedic Practice course at the University of Brighton, chairs a discussion on automated chest compression devices, considering their efficacy, ease of use and when they should be employed.
Student perceptions in relation to Paramedic Educator (PEd) roles
Authors: Lane Matthew
Published: May 2014

This article examines student paramedics' perspectives of the Paramedic Educator (PEd) role, focusing on specific mentoring qualities that impact upon their learning. Furthermore, it aims to identify ‘mentoring’ issues specific to the paramedic profession. The study used semi-structured interviews with university paramedic students. The key attributes of a ‘mentor’ as identified in the nursing and healthcare literature were found to be relevant to the paramedic profession. Participants identified current challenges in practice specific to the paramedic profession. Questions are raised regarding the extent to which the culture of mentorship within ambulance services is sufficiently established to support students and PEds; the status quo poses significant challenges for students wishing to join the profession.
The progress of nurse prescribing in the United Kingdom
Authors: Mullally Sarah , Mason Carolyn , Froggatt John
Published: May 2014

Nurse prescribing in England has made great strides in recent years. Building on the success of district nurse and health visitor prescribing – more than 23000 community nurses are now qualified to prescribe from the Nurse Prescribers’ Formulary for district nurses and health visitors – we implemented the extension to nurse prescribing from April 2002. This enabled nurses in secondary care, and midwives, to prescribe for the first time. The Nurse Prescribers’ Extended Formulary (NPEF), from which they can prescribe, includes all Pharmacy and General Sales List medicines that are prescribable by GPs, and a list of around 140 Prescription–only Medicines to treat conditions in four clinical areas: minor injuries, minor illness, health promotion and palliative care. Training to prescribe from the NPEF involves 25days of university-based education and 12days learning in practice, with the support of a medical prescriber. Around 800 nurses and midwives have already trained to prescribe from the NPEF. They include practice nurses, nurse practitioners and specialist nurses from acute hospitals, as well as nurses from emergency departments and Walk-in Centres.
Influences on community nurse prescribing
Authors: Hall Jason , Cantrill Judith , Noyce Peter
Published: May 2014

The factors that community nurses consider when prescribing were discussed during semi-structured interviews with a purposive sample of 21 nurses. The interviews were analysed using the framework method to identify key themes. For district nurses, the need to facilitate patient concordance was an important influence, while for health visitors it was responding to patient pressures to prescribe. Some nurses were reluctant to prescribe for patients that were very old/young, already receiving several items from their GP or without a GP diagnosis. The limited time available in clinics prevented some prescribing but the time available during home visits permitted a comprehensive patient assessment and a full explanation in the use of the product. The high priority nurses place on achieving concordance is important when determining the effectiveness of their prescribing. However, extended clinical roles could be undermined if there is a failure to manage patient pressure to prescribe.
A critical analysis of legal and ethical issues regarding consent in childhood
Authors: Pocock Maggie
Published: May 2014

With the advent of nurse prescribing nurses now find themselves at the forefront of decision-making regarding issues of consent to treatment. In the course of the health visitor’s work, many prescribing situations occur involving young children. This critical incident analysis examines such a situation. The concept of ‘consent to treatment’ is defined, and consideration given to who can legally consent to a child’s treatment, the consequences of failing to obtain consent and the concept of ‘capacity’ to consent. Relevant statute and case law is discussed. What legal recourse a health professional might have if a parent refuses consent to treatment for their child is identified and ethical dilemmas concerning best outcomes for the child/parent/wider society, examined. Assessment of a child’s capacity to consent to treatment has significant implications for practice. This article, therefore, focuses on analysing a range of factors affecting the capacity of Alice, the subject of the incident. Health professionals’ own values and beliefs about childhood and their knowledge about children’s ability to make rational choices can influence how children are involved in the consent process. Names have been changed to ensure confidentiality.
Supporting and developing new nurse prescribers in secondary care
Authors: Underwood Frazer
Published: May 2014

This article presents how one large acute NHS trust in England set out to support and develop its new nurse prescribers. By reviewing the literature around continuing professional development and support, it summarizes some of the contemporary issues faced by nurse prescribers today. The evolvement of this trust’s nurse prescriber’s forum is described, reflecting on similar themes identified through research in primary care when it was facing the same issue for its district nurse and health visitor prescribers. The article concludes by considering the future demands on continuing professional development and support for such networks as the non-medical prescribing agenda rolls on.
A nurse prescriber's guide to the legal implications of parental responsibility
Authors: Griffith Richard
Published: May 2014

Parental responsibility is described by the Children Act 1989 as all the rights, powers and duties a parent has over a child and its property. Those rights include the right to consent to treatment for a child right up until the child's eighteenth birthday. It is essential, therefore, that nurse prescribers are aware of who has parental responsibility for a child in their care and the extent to which parental responsibility allows a parent to refuse treatment for a child.
Teaching applied pharmacology and therapeutics
Authors: Banning Maggi
Published: May 2014

The nurse prescribing course is a set programme of academic study at gradute level, the aim of which is to prepare nurses for their new prescribing roles. The course identifies core theoretical principles in applied pharmacology and therapeutics, medicines management and evidence-based practice that must be taught in order to provide students with a scientific foundation for competent prescribing. This paper reinforces the principles of this foundation along with teaching and learning strategies that can be used to help students articulate the principles of applied pharmacology and therapeutics, and also to develop critical thinking skills which are necessary for pharmacologic reasoning.
Depression: a treatable condition that affects the whole person
Authors: Sage Jill
Published: May 2014

As statistics of depression continue to soar on a global basis, in this paper the author illustrates through her clinical work that in fact even the most challenging of conditions can be successfully treated by using a symptomatic, combined approach that is individually tailored.
Exploring the science of laxatives: mechanisms and modes of action
Authors: Chowdhury Shefali
Published: May 2014

Constipation is common, affecting around a fifth of older people. Approaches to the management of constipation include both non-pharmacological and pharmacological interventions. The second article in this series explores the pharmacology of laxatives. The main groups of laxatives and their appropriate use are considered.
Herceptin and the case of Ann Marie Rogers: the price of victory
Authors: Ainsworth Steve
Published: May 2014

In the past few months, Herceptin has made the headlines as a ‘miracle drug’ for breast cancer patients, thanks mainly to the high profile case of Ann Marie Rogers. But was the High Court right to rule in favour of Ms Rogers= Steve Ainsworth looks at this intriguing case, and asks if all breast cancer patients should receive this treatment.
Antimicrobial dressings in wound care
Authors: Fletcher Jacqui
Published: May 2014

It is widely accepted that resistance to antimicrobials has increased through the overuse and misuse of systemic antibiotics. The use of topical antimicrobial dressings in the field of wound care is now undergoing a revival and there are a multitude of products available containing a range of agents that are broad spectrum antimicrobials (primarily honey, silver and iodine).This article details some of the dressings available and their efficiency in wound healing.
Service delivery by nurse prescribers for diabetes care
Authors: Carey Nicola , Courtenay Molly
Published: May 2014

The overall aim of the research was to provide a national evaluation of Nurse Independent and Nurse Supplementary Prescribing in diabetes in the UK. A key component was to examine service provision by nurse prescribers for patients with diabetes.The NMC database was used to randomly select and distribute questionnaires to 1992 registered Nurse Independent/Nurse Supplementary Prescribers. 1400 questionnaires were returned. Medicines for patients withdiabetes were prescribed by 439 respondents. This paper reports on the findings of these 439 nurses. The majority (63%) of nurses worked in general practice. Over 90% of services were provided to patients in the community. Over 30% made treatment alterations over the telephone to patients they had not met. Nurses with specialist training in diabetes viewed themselves as more competent than nurses without (P=0.000). Nurses who reported higher levels of competence were more likely to make treatment alterations over the telephone (P=0.000). Nurse independent and nurse supplementary prescribers working in a variety of roles are actively involved in the delivery of services to patients with diabetes. This care is predominantly provided in the community. It is evident from our findings that nurse's competence affects their scope of professional practice in the management of these patients.
Delayed prescribing in out-of-hours care: a case study
Authors: Watson Helen McCarthy
Published: May 2014

Delayed prescribing is an increasingly common way of encouraging patients to try self-care before taking antibiotics for self-limiting conditions and it can reduce antibiotic consumption by 40% and reduce re-consultation rates compared with similar patients who are not offered this option. This paper explores in detail a consultation with a young woman who insisted her symptoms warranted antibiotic treatment. Key issues around the prescribing of antimicrobial drugs are discussed including differential diagnosis, minor illness management, self-care, the evidence around risks and benefits of antimicrobial prescribing, communicating these risks to patients, gaining concordance in treatment planning, legal and ethical issues raised in public health-informed prescribing.
Laxatives: choice, mode of action and prescribing issues
Authors: Waterfield Jon
Published: May 2014

This article provides an overview of the main types of laxative. There is a consideration of the factors involved in the choice of laxative, including their mode of action. Different prescribing scenarios are summarized in four flowcharts, and a case study provides the opportunity to consolidate prescribing issues in the management of constipation.
Non-medical prescriber audit: evidence of CPD
Authors: Wainwright Jackie , Canning Debbie
Published: May 2014

Primary care trusts (PCTs), other staff employers and individuals have a duty to ensure that the non-medical prescriber (NMP) remains both competent and up to date. This audit was therefore created to support the NMP by raising personal awareness of individual prescribing patterns in relation to the Sheffield prescribing formulary and levels of evidence-based practice when prescribing outside the PCT, by contributing to its local clinical governance initiative, and finally the strategic health authority by providing a mechanism to assist in the implementation of its regional non-medical prescribing strategy. A simple self-reporting questionnaire (with guidance to aid completion) was developed to facilitate safe, effective and appropriate prescribing; the audit has defined objectives, criteria and standards. Results reveal an insight into the top 10 items prescribed and their associated conditions, the depth of evidence-based knowledge when prescribing non-formulary items and levels of compliance achieved by the PCT.
Schizophrenia: early history of diagnosis
Authors: Snowden Austyn
Published: May 2014

Schizophrenia is a uniquely alienating disorder. The Japanese have abandoned the label altogether, preferring the term ‘integration disorder’. This highlights one of the major diagnostic issues, that there is no absolute agreement on what it is. The western diagnostic manuals are reconsidering the current criteria at present. This paper provides a brief history of the main issues in order to support critical analysis of current DSM and ICD-10 diagnostic criteria.
Safety and quality in independent prescribing: an evidence review
Authors: Latter Sue
Published: May 2014

There are indications that the increasing number of nurse prescribers has had a positive impact on patient access to medicines and that patients are satisfied with nurse prescribing. However, in order to impact on clinical outcomes, nurses' prescribing consultations need to be not only safe, but also demonstrate a range of quality indicators derived from the evidence on effective prescribing. A number of frameworks that outline the competencies to guide safe and effective prescribing have been developed, which nurses and those responsible for the governance of prescribing in practice could use to assess and monitor the safety and quality of nurse prescribing. Research into nurse prescribing suggests that nurses use a range of competencies and skills in their prescribing consultations that are necessary to underpin quality and safe prescribing of medicines. However, evidence also indicates a need for greater consistency in the frequency with which nurses apply the full range of skills necessary for effective prescribing.
Confidence and competence in paediatric drug calculations
Authors: Dopson Amy
Published: May 2014

Nurse prescibers have a unique role for many reasons, one of which being that they, unlike other prescribing professionals, may be responsible for more than one stage of the drug administration process. They are one of the few groups of clinicians who may prescribe, dispense and administer drugs to their patient, and on occasion may perform more than one of these roles. This holistic function is one of the joys of the autonomous advanced practice role, yet without ensuring that adequate provision is made for patient safety and risk assessment, this fluid procedure also leads to greater vulnerability for the practitioner and the service user, when considering the potential for medication error. This risk is increased if the individual prescriber is not confident in his/her ability to perform drug calculations, particularly in relation to another susceptible group, namely babies and children.
Assessing decision-making capacity: adults and young persons
Authors: Griffith Richard
Published: May 2014

In his last article, Richard Griffith considered how nurse prescribers must assess the decision-making capacity of children under 16 years by following the rule in Gillick. This article discusses the legal framework for assessing the decision-making capacity of adults and children 16 years and older set out under the Mental Capacity Act 2005
Placebo response and improving outcomes with active medication
Authors: Greener Mark
Published: May 2014

The placebo response is one of the most enigmatic, fascinating and ubiquitous aspects of prescribing. The placebo response contributes to the efficacy of every therapeutic intervention nurses make and can account for more than half the benefit in certain conditions. Researchers devised several theories to account for the placebo effect, including regression to the mean, classical (Pavlovian) conditioning and the patient’s expectation that symptoms will improve. Recent imaging studies suggest that several brain areas in the frontal cortex and changes in levels of certain neurotransmitters contribute to the placebo effect. Numerous sociological, cultural and anthropological factors also infl uence the placebo response, including the expectation of receiving a more potent drug, the number of tablets, dose route, formulation, whether the patient receives a ‘branded’ placebo, the supposed cost and patient’s age. An individual’s knowledge about and understanding of medicine, their experiences and their expectations colour what the healing processes and therapeutic interventions mean to each patient and, therefore, their placebo and treatment responses. Nurses can harness such insights to improve outcomes with active medication.
Atrial fibrillation and the use of antiarrhythmic drugs
Authors: Panchmatia Shailesh
Published: May 2014

This article aims to give the reader a brief overview on the use of antiarrhythmic drugs in the management of atrial fibrillation (AF). The basic pathophysiology, diagnosis and classification of AF are covered. The four aspects of therapeutic management of AF: thromboprophylaxis, ventricular rate control, cardioversion, and sinus rhythm maintenance, are discussed. The major focus, however, is on the discussion of the drugs used in sinus rhythm control. The debate of rate vs. rhythm control is also addressed.
How nurse prescribing influences the role of nursing
Authors: Stenner Karen , Carey Nicola , Courtenay Molly
Published: May 2014

Because role change can be disruptive, the introduction of nurse prescribing could potentially lead to confusion and conflict over role boundaries and definitions. This article considers how adopting prescribing has influenced the role of nurse prescribers who treat and manage patients with diabetes. Interviews with 10 nurse prescribers, nine doctors and three non-prescribing nurses were collected as part of a case study of nine UK sites where nurses prescribed medicines for patients with diabetes.

We found that nurses resisted the ‘medicalization’ of their role. They strove to ensure that their consultations continued to follow a ‘nursing model’ which involved holistic assessment, health promotion and patient-centred care. There were perceived differences in the level of decision-making between doctors and nurse prescribers.

To conclude, nurses adopted prescribing while maintaining a nursing approach to practice. For specialist nurses, this expanded role included higher levels of decision-making more traditionally associated with doctors.
Professionalism and ethical issues in nurse prescribing
Authors: Young Andy
Published: May 2014

Professionalism in the context of advanced nursing practice is a complex topic, and must include a consideration of both individual and collective nurses', societal and patient rights and obligations. While attempting to propose a definition to capture the many aspects of this issue, this article also examines conflict of interest between prescribers and the pharmaceutical industry, and the controversial subject of conscientious objection and opting out of the clinical encounter. These may be overlooked by advanced practitioners or dealt with on a systemic level by the nursing collective, but they also have a real and lasting impact at the level of the individual clinician. Conversely, while much of the attention in nurse professionalism is paid to the individual practitioner, there is also an important role to be played in policy development and national and international advocacy efforts by organizations such as the Association of Advanced Practice Educators (AAPE) and the International Council for Nurses (ICN).
Understanding diabetes mellitus and its management: an overview
Authors: Meetoo Danny , Allen Gemma
Published: May 2014

Diabetes mellitus is a lifelong metabolic disorder characterized by a chronically elevated blood glucose level resulting from an absolute or relative shortage of insulin. This condition is fast becoming a global health concern threatening to reach pandemic proportions. Today there are around 250 million people worldwide who are living with this condition and this figure is predicted to rise to 366 million in the next twenty years. This increase will be particularly evident in developing countries which experience the double burden of diabetes and infectious diseases. A more concerted, strategic and multi-sectorial policy approach, underpinned by solid research is essential to improve human behaviour and lifestyle to reverse the negative trends in the global incidence of diabetes. There is also a need for nurses and prescribers to be proactive in ensuring that people with diabetes become experts at managing their condition. In so doing, healthcare systems and resources could be used more effectively to reduce human, social and economic impact of this devastating condition.
Using insulin in people with type 2 diabetes
Authors: Morris David
Published: May 2014

As the duration of type 2 diabetes increases, beta-cell function deteriorates, resulting in a fall in endogenous insulin and worsening of glycaemic control. Ultimately, this leads to a need for exogenous insulin. In practice, the decision to start insulin depends on a variety of factors, both medical and social, including an individualized HbA1c target, and is arrived at after a full discussion with the patient, taking account of their personal circumstances. Insulin can be safely and conveniently initiated in primary care, but requires a holistic educational package, usually provided by the diabetes nurse specialist. A basal insulin is a common starting point in type 2 diabetes, although intensification of treatment may subsequently be necessary. Oral therapies, notably metformin, can, in the absence of contraindications or intolerances, be continued alongside insulin therapy.
Atopic eczema in adulthood: a case study
Authors: Van Onselen Julie
Published: May 2014

An adult man in his twenties with life-long atopic eczema attends a primary care dermatology clinic for a review with a specialist nurse. The nurse assesses his eczema and current skin treatments, and offers psychological support and patient education, to reinforce self-management. A combined technique to help Daniel cope with chronic scratching, called habit reversal, is introduced, and a course of behavioural treatment is embarked on with excellent results, leading to a vast improvement in Daniel's atopic eczema.
The problem of polypharmacy in the elderly
Authors: Perry Margaret
Published: May 2014

Polypharmacy in the elderly is of concern, with many older patients requiring treatment for multiple health conditions. This article aims to give an overview of the problem, look at the effects on quality of life, and offer some guidance on solving the issues linked to the problem.
Prescribing glycoprotein IIb/IIIa inhibitors in ACS
Authors: O'Donovan Kate
Published: May 2014

The advent of glycoprotein IIb/IIIa inhibitors in the treatment of acute coronary syndromes and in those undergoing percutaneous coronary intervention has added a new dimension to antiplatelet therapy. These agents work by blocking the final common pathway of platelet aggregation in thrombus formation. This is achieved by preventing the binding of fibrinogen to the activated glycoprotein IIb/IIIa receptors on the platelet surface. Three agents are currently licensed for use: abciximab, eptifibatide and tirofiban. Clinical trials have demonstrated a reduction in death, myocardial infarction and urgent or repeat coronary revascularization in those who received these agents, compared with placebo. Two potential complications with these agents are bleeding, particularly from the femoral artery access point, and thrombocytopenia. For nurses working in cardiac catheterization laboratories and cardiovascular wards, there needs to be an awareness of the benefits of receiving these agents, of which patients should receive them, and of their effect on platelets.
Nurse-led management of gonorrhoea and chlamydia
Authors: Keefe Alison
Published: May 2014

Despite moves to reduce the anxiety surrounding a visit to a sexual health clinic, many patients are still reluctant to attend. Many practices can be adopted to reassure patients, ranging from visible measures to ensure confidentiality, to developing a good relationship with patients that encourages them to be open about their sexual practices and partner history. The timely and effective treatment of sexually transmitted infections, such as gonorrhoea and chlamydia, is important to prevent onward transmission, avoid long-term sequelae, and to curb the development of resistance to current treatments.
Prescribing for mild-to-moderate childhood atopic eczema
Authors: Van Onselen Julie
Published: May 2014

Childhood atopic eczema is an often distressing skin condition that is extremely common in the UK. Nurse prescribers have the potential to support children and their parents/carers in managing childhood atopic eczema and reducing family stress. Nurse prescribers can provide parents/carers with education on childhood atopic eczema, advice on general skin care and topical treatments to manage the condition, and psychological support. Nurse prescribers can offer treatment options for mild-to-moderate childhood atopic eczema, and advise when referral for severe childhood atopic eczema is necessary. In order to achieve this, nurse prescribers need to expand their knowledge of childhood atopic eczema and evidence-based eczema treatments. These need to be advised and prescribed according to the severity of the condition and the National Institute for Health and Clinical Excellence (NICE) guidelines on atopic eczema in children ( NICE, 2007 ).
Nurse prescibing in the USA: a nurse prescribing practice report
Authors: Ross Jane
Published: May 2014

Thanks to a Queens Nursing Institute (QNIS) Scholarship, I was able to attend the 4-day American Psychiatric Nurses Association (APNA) prescribing conference in South Carolina. My time was spent shadowing nurse prescribers working in clinics. I interviewed nurse prescribers from several states, and the transcripts of the interviews were analysed with framework analysis. Barriers and drivers to prescribing in the USA are described. Financial reward and enhanced career perspectives are major incentives to prescribe in the USA. The same cannot be said for the UK.
Concordance in action: case study of medication management
Authors: Roy Dionne , Snowden Austyn
Published: May 2014

This article discusses a case study describing discontinuation symptoms relating to the abrupt withdrawal of the antidepressant venlafaxine. The article explores alternative explanations for the symptoms presented, and highlights the importance of systematic and collaborative assessment. This case study shows that without these essential aspects of concordance, the aims of non-medical prescribing are not met.
Managing children with constipation in the community
Authors: Paul Siba Prosad , Dewdney Cathy , Lam Candy
Published: May 2014

Constipation in children is generally idiopathic, with a prevalence of up to 30%. It can cause chronic pain and can be debilitating to the child. This will have significant implications on the quality of life for both the child and his/her family. This condition often remains under-recognized as families may delay presentation, be looking for more serious pathologies or may feel embarrassed to receive a negative response from the health professionals. A detailed history taken with the help of the parents, along with a review of the Bristol stool form scale will help to establish a clinical diagnosis of constipation in the child. Any children with red flag symptoms should be immediately referred to the specialist services. Dietary interventions alone are not sufficient, and laxative therapy is recommended as the first line in its management. Early diagnosis and treatment is associated with a favourable outcome. This article aims to give an overview of the pharmacological management, along with a discussion about the importance of recognizing cow's milk protein allergy as a cause for chronic constipation. Some non-medical interventions which may help to achieve success in managing childhood constipation are also included.
Treating to target in rheumatoid arthritis
Authors: Firth Jill
Published: May 2014

Treating to target is an established concept in a number of long-term conditions, aiming to improve outcomes and prevent disease progression. In rheumatoid arthritis (RA), treatment targets are controlling the signs and symptoms of significant inflammatory disease activity, with the ultimate goal of remission from disease. This article briefly outlines the disease process of RA and examines the role of disease-modifying anti-rheumatic drugs, steroids and biologic agents in controlling disease activity. The rational use of analgesia and non-steroidal anti-inflammatory drugs is highlighted.
Reducing drug administration errors in patients with dysphagia
Authors: Wright David , Kelly Jennifer
Published: May 2014

Recent UK research has shown that patients with dysphagia are three times more likely to suffer medication administration errors. Inappropriate formulation selection, poor preparation prior to administration, administration more than 1 hour late, and dispersing different tablets together were the main reasons for errors. Nurse prescribers treating older patients need to identify those patients who cannot swallow medicines whole and select the most appropriate formulation. Where tablet dispersion is the preferred option, the safety of such practice should be confirmed prior to authorization. System review and provision of administrator training could also enhance the care of patients with dysphagia.
Pharmacology of paracetamol and prescribing considerations
Authors: Bennett Stephen
Published: May 2014

In this article, the pharmacology of paracetamol, and considerations for prescribing this drug, are discussed.
A case study on prescribing strong opioids for an older patient
Authors: Marczewski Kathryn
Published: May 2014

This case study, written as part of my independent nurse prescribing course, will examine a decision to prescribe a strong opioid for an older patient with chronic pain: that is pain that lasts beyond the expected time of tissue healing, or pain due to an ongoing chronic condition ( International Association for the Study of Pain, 1994 ). This case is relevant to my practice as there are a significant number of older patients on my caseload within a primary care-based pain service.
How to select and choose appropriate wound dressings
Authors: Beldon Pauline
Published: May 2014

Wound management to the novice may at first appear easy, a case of matching the appropriate dressing to the patient's wound. However, as knowledge and experience grows, the health professional becomes increasingly aware that wound management holds several responsibilities: clinically to the patient—to provide safe, knowledgeable and competent practice—economically to the employer, and professionally to patients, colleagues and their employer. This article outlines how health professionals can safely address these responsibilities.
Assessing and diagnosing wound infection (part one)
Authors: Reynolds Val
Published: May 2014

Wound infection is not only a costly burden to the NHS, but it can significantly impact patients’ quality of life, causing pain and psychological stress ( Moffatt, 2005 ; White, 2009 ). Against a background of rising costs, increasing bacterial resistance, indiscriminate use of antibiotics, and the fact that bacteria can delay healing, it is imperative that nurse prescribers consider a holistic approach when assessing and managing wound infections ( National Prescribing Centre, 2010 ).
The pharmacology of bronchodilators
Authors: Kaufman Gerri
Published: May 2014

This article will provide prescribers with an overview of the pharmacology of bronchodilators, which are central to the management of two major inflammatory conditions of the respiratory system: asthma and chronic obstructive pulmonary disease (COPD). The two main types of bronchodilator—beta2 agonists and muscarinic receptor antagonists—will be discussed. In addition, the article will briefly explore the pharmacology of leukotriene receptor antagonists, such as montelukast and zafirlukast, and methylxanthine theophylline, which also produce bronchodilation and have a role to play in the management of respiratory disease. Reference will also be made to the bronchodilators indacaterol, glycopyrronium bromide, and aclidinium bromide, which are therapies recently launched for the treatment of COPD.
Independent nurse prescribing in HIV care
Authors: Jones Martin , Ormiston Cathy
Published: May 2014

In this article we set out to briefly describe the HIV/AIDS epidemic in the UK today, HIV nursing care provision, and the role of highly active antiretroviral therapy—the medication used to suppress HIV infection. The majority of the text describes independent nurse prescribing in HIV care and the risks of drug interactions.
Managing psoriasis in children and young people
Authors: Van Onselen Julie
Published: May 2014

Psoriasis is an inflammatory condition which manifests in the skin and joints. Psoriasis can affect children and young people; the late teens and early twenties are a peak time for psoriasis developing for the first time. Psoriasis can affect quality of life in children and young people. Nurses can support children, young people and their families in managing psoriasis, supporting and educating on general skin and joint care and topical treatments to manage the condition. Psoriasis treatments for children and young people often have licensing restrictions, but National Institute for Health and Care Excellence guidelines on the assessment and management of psoriasis give guidance on all treatments for psoriasis.
Nurse-led chemotherapy clinics: issues for the prescriber
Authors: Farrell Carole , Lennan Elaine
Published: May 2014

Government policy has guided the development of cancer services over the last 15 years. Most importantly for chemotherapy services is the National Chemotherapy Advisory Board report ( Department of Health, 2009 ). The focus of this report is safety, and it endorses the introduction of nurse-led chemotherapy clinics. This endorsement was welcomed, but many areas have struggled to develop services prompting the United Kingdom Oncology Nurses Society to produce a position statement to offer a framework for implementation. Within this position statement, non-medical prescribing is considered the gold standard for practice. This article discusses the evidence for nurse-led chemotherapy clinics and outlines practice and the assessments tools used.
Nurse prescribing in mental health: why it makes sense
Authors: Inman Paul
Published: May 2014

This article highlights the benefits of nurse prescribing within mental health through working in partnership with service users by enhancing the level of choice in non-pharmacological and pharmacological treatment options. This article will also discusses how independent nurse prescribers might offer clients a more holistic assessment and enhanced support compared to the historical medically-led outpatient experience. It also explores the reasons why qualified nurse prescribers within both primary and secondary mental health care are not currently prescribing.
Managing difficult and severe eczema in children
Authors: Lawton Sandra
Published: May 2014

Atopic eczema is a common skin condition affecting approximately 20% of school-age children. The management of complex atopic eczema can be challenging. This paper aims to provide guidance on the management of complex cases and when to refer children for specialist advice. Emollients should form the basis of management and be used even when eczema is clear. When children experience a flare of their eczema, topical treatments should be stepped up accordingly. With clear guidance relating to management and referral, it is important when caring for these children that the health practitioner has a depth of knowledge and expertise to provide a comprehensive plan of care, is able to answer the many questions children and their parents may have, and intervene and refer appropriately.
Research roundup: April 2014
Authors: Mark Greener
Published: May 2014

In brief

▪ Side effects of antidepressants may be more frequent than previously reported ▪ Nurses have a variety of approaches to increase patient adherence to psychiatric medications ▪ Women who have smoked at some time during their reproductive years are more likely to experience spontaneous abortion, ectopic pregnancy and stillbirth ▪ Reduction in onset-to-treatment time in stroke patients results in an increase in disability-free life ▪ Prehypertension increases stroke risk ▪ Drug-drug interactions are a significant cause of hospital admissions
Treatment of asthma in pregnancy: A case study
Authors: Odedra Katy Mara
Published: May 2014

Asthma affects more women than men in adult life and is one of the most common disorders that can complicate pregnancy. Prescribing any treatment during pregnancy carries risks that must be balanced against the benefits of symptom control on pregnancy outcome. Despite the good safety profile of most of the medications used in asthma during pregnancy and breastfeeding, there is an alarming lack of use in practice, often resulting in morbidity to both the mother and the child. In order to prevent this occurring, careful education, monitoring and support is essential, together with maintenance on appropriate medication and prompt emergency treatment where required. This article provides an overview of the treatment of asthma in pregnancy and discusses a case of pregnancy induced asthma and rhinitis in a 38-year-old woman.