bluuebunny/crossref_metadata_2025 huggingface dataset:
Evidence-based practice is a time of opportunity for nursing
Authors: Tod Angela , Palfreyman Simon , Burke Linda
Published: May 2014

The debate regarding evidence-based practice (EBP) continues to rage within nursing. This article reviews the existing situation regarding policy and the ability of nurses to engage with EBP. Recommendations are made regarding moving the debate away from a focus on barriers to EBP towards seizing it as an opportunity. The article suggests that a fundamental change in attitude is required by nurses in order for the nursing profession to progress. There is a need to recognize that the nature of health services are changing and that nurses need to grasp the opportunities this makes available, but in order to do this nurses need support.
Assessment of chronic neuropathic pain and the use of pain tools
Authors: White Sarah
Published: May 2014

Chronic neuropathic pain is experienced by a large number of patients. It can affect the individual physically, psychologically and socially. This review examines the evidence base for the assessment of chronic neuropathic pain and discusses some of the main tools and their suitability for use for this particular type of pain. The central role the nurse has in pain assessment and management to improve the patient's quality of life is explored. The evidence recommends that chronic pain is assessed using a multidimensional assessment tool. Currently the only tool specifically designed to measure neuropathic pain is the Neuropathy Pain Scale. The author describes how the evidence was applied to make changes in her own area of practice and why the Brief Pain Inventory was considered more suitable than the Neuropathy Pain Scale.
Nurses must aim to become more clinically effective
Authors: Castledine George
Published: May 2014

Over the past 30 years there have been dramatic changes in nursing practice. At one time there was a considerable emphasis on procedures and nursing trolleys. For example, Rosenheim, writing in 1941 in a forward to a book on aids to tray and trolley settings, said: ‘Miss Houghton [the author] has provided every nurse with her own “trolley book”, a book that not only details the requirements for almost every activity in the wards, but which, by explaining the indications for the various procedures, by photographs or ready-prepared trolleys and by a well-illustrated glossary of instruments, helps the nurse to understand and thus to remember.’
A topical metronidazole gel used to treat malodorous wounds
Authors: Bale Sue , Tebble Nicky , Price Patricia
Published: May 2014

Patients with malodorous wounds often experience social isolation, depression, shame, embarrassment and poor appetite, all of which can have a negative impact on their quality of life. The healthcare professionals caring for them face difficult clinical challenges in terms of treating the cause and managing the symptoms. This study employed a randomized, placebo-controlled double-blind design to investigate the effectiveness of metronidazole gel on wound malodour, the main focus of this article. In addition, changes in self-report of mood state were also explored. There was a 100% success rate for the metronidazole gel, mostly within 3 days, with no adverse events reported. As there was a 76% success rate in the placebo group, there was no significant difference in success rates between the two groups. Odour ratings given by patients and nurses were significantly correlated (P<0.001). There was no significant difference in mood state between the groups over time. This study provides some evidence to support the use of metronidazole gel in the treatment of patients with malodorous wounds, but indicates the need for further research in this area.
Aseptic technique: evidence-based approach for patient safety
Authors: Preston Rosemary M
Published: May 2014

The fact that there is a relationship between the standards of aseptic technique performance and the rise in hospital infection rates has been suggested by the Department of Heath's (DoH's, 2004) Winning Ways document. This literature review considers how the aseptic technique is performed in the UK, and examines the nature of ritualistic and evidence-based practice underpinning this skill-based procedure. The findings have identified an emerging glove culture and continuing poor hand-hygiene practices. The alternative ‘clean technique’ is also adopted widely in clinical practice which confuses the aseptic theory–practice gap. While it is hard to pinpoint an actual time or event that causes infection, it is unlikely nurses will ever become involved in litigation as a result of a poorly performed aseptic technique. However, the review concludes that nurses should not become too complacent. It briefly considers how performance of the aseptic technique can be improved, through creative educational strategy, applied risk assessment and clinical audits of nurses' practices.
Exploring nursing roles: using physical assessment in the respiratory unit
Authors: Wheeldon Anthony
Published: May 2014

The role of the nurse continues to change, with the point where nursing stops and medicine begins becoming increasingly blurred. Arguably, the main driver for this change could be the recent reduction in junior doctors' working hours. However, modern nursing is ripe for innovation and nurses are taking on more and more tasks and skills that were traditionally part of the doctor's remit. One example is physical assessment, which has very little evidence to support its use in any setting. Analysis of the utilization of physical assessment in the respiratory unit indicates that although it could facilitate earlier recognition of peri-arrest symptoms, its usage highlights training and legal issues. Furthermore, this article will explore whether the continual adoption of tasks, such as physical assessment, constitute mere role extension, with nurses becoming physicians' assistants rather than advanced autonomous practitioners.
Waterlow assessment: not a predictor
Authors: Waterlow Judy A
Published: May 2014

The article in BJN by Deidre Thompson,‘An evaluation of the Waterlow pressure ulcer risk assessment tool’ (Vol 14(8): 455–9),was well written, full of facts, figures and references.
Breast cancer: new treatments, new strategies
Authors: Harmer Victoria
Published: May 2014

Breast cancer is increasing in incidence, with about 41000 new diagnoses per year in the UK, making it the most commonly diagnosed cancer in women, with a lifetime risk of 1 in 9 (Cancer Research UK, 2005). As a result, extensive research has been conducted into its treatment and, with crucial new long-term data now available, the way in which the disease is treated seems set to change. The news that Arimidex (anastrozole) has received an extension to its existing licence has been received with great excitement from the medical community because it is the first alternative to Tamoxifen for postmenopausal women with hormone sensitive breast cancer for 30 years.
Understanding pain, part 2: pain management
Authors: Godfrey Helen
Published: May 2014

This article is the second in a two-part series which explores pain and its management from a physiological perspective. Nurses play an important role in assessing and managing pain. Effective pain management by nurses requires them to have an understanding of the biological basis of the pain interventions which may be used to control pain. This article emphasizes the importance of pain assessment as a precursor for effective pain management and explores the biological basis of pain interventions which contribute to pain control. The role of non-pharmacological approaches in alleviating pain and their actions which contribute to pain relief are explored. The three main types of pharmaceutical agents used, non-opioids, opioids and adjuvant drugs, are introduced and their mechanisms of actions discussed.
Identifying eating disorders
Authors: Jenkins Alison
Published: May 2014

While most nurses are familiar with anorexia and bulimia, how many nurses have heard of compulsive overeating, also known as binge eating? This is not a new condition but the medical profession has been very slow to recognize it as a problem, let alone as an eating disorder. This article looks at the different types of eating disorders, their differences, how to identify sufferers and where to refer them. Identifying patients with eating disorders is a very hard task since sufferers have learned the art of secrecy, denial and deception.
Nurses' views of longitudinal genetic screening of and research on children
Authors: Stolt Ulrica Gustafsson , Liss Per-Erik , Ludvigsson Johnny
Published: May 2014

There is a lack of empirical data exploring ethical issues of genetic screening and longitudinal research involving children. Therefore, this pilot interview study explored the perceptions of nurses and midwives in relation to their involvement in an ongoing genetic preventive screening process involving children — the All Babies in South-east Sweden (ABIS) study (n=17005). Data were collected through semistructured interviews with 10 nurses involved in all information and sampling procedures. While providing the preliminary nature of this study, it supports the idea of the importance of further research, both from a nursing professional perspective as well as from other parties involved in clinical research. The findings made in this study suggest that for such studies it is vital that nurses and midwives are fully informed about aims, methods, and potential intervention/prevention since in many cases they have a central role in several areas of screening and clinical longitudinal research involving children, e.g. information to potential research participants, obtaining informed consent, and data collection. With a thorough understanding of the research, including both basic aims and methods as well as potential future prevention aims, the nursing staff involved will be better placed to help participants make an informed choice and to provide additional information to the participants. Further research may be needed that aims to develop effective methods in preparing data collectors. It is also suggested that the design of the information process, and especially in longitudinal research involving young children, is of upmost importance before such studies are commenced.
Paediatric asthma: overcoming barriers to an improved quality of life
Authors: Clayton Sadie
Published: May 2014

Paediatric asthma has a considerable impact on both society, in terms of healthcare resources, and on patients and their families, in terms of impaired quality of life. The principle goals of asthma treatment are to achieve and maintain control of symptoms. Achieving these goals may involve long-term use of appropriate medication in the form of an inhaled corticosteroid (ICS) and a long-acting b-agonist (LABA). However, many patients with paediatric asthma are not currently achieving symptom control. The main barriers to asthma control are under use of effective therapies, inappropriate choice of drug delivery devices and a lack of patient or parent/guardian education regarding the disease and its treatment. By addressing and overcoming these barriers to asthma control, the quality of life of patients and their families may be significantly improved.
Review of homecare packages for paediatric HPN patients
Authors: Sexton Elaine , Coad Jane , Holden Chris
Published: May 2014

This study explored the existing nursing homecare packages required by children who receive home parenteral nutrition and their families, in order to evaluate the effectiveness of the support required. The study forms the basis for ongoing financial discussions with PCTs to ensure high-quality nursing services are available and meet the needs of families. Families' views about homecare packages developed in response to the needs of care for parenterally fed children were explored. Findings indicated three emergent themes that families face: physical, psychological and burden of care. Homecare packages developed in response to family needs were highlighted as being essential. A 24-hour on-call service with expert paediatric nursing staff was a key factor for families to feel secure. It was felt that the individualized homecare packages supported the vulnerable patient group. Families felt that nursing their child at home was a major advantage in the homecare package, but improved delivery of social and medical care was necessary to meet individual child and family needs.
The management of obesity: the role of the specialist nurse
Authors: Banning Maggi
Published: May 2014

Obesity is a global problem, independent of age. The numbers of obese individuals are now reaching epidemic proportions around the world. This is contributing to the risk of inherent comorbidity. The pathophysiology of obesity, although widely debated, is still unclear with suggestions that multiple genetic mutations may have a key role in the development, but as yet no one genetic mutation is felt to be entirely responsible. Biochemical manifestations such as diabetes may play a role. The first goal of management of the obese patient will involve dietary and behavioural modification and a programme of physical exercise. In primary care settings, nurses are suitably placed to assess and manage obese patients (National Institute for Clinical Excellence (NICE), 2001a). The nursing profession needs to rise to the challenge and prepare nurses for a specialist role in obesity management.
Nurses need advanced skills in disaster health care
Authors: Davies Kevin , Moran Lorraine
Published: May 2014

It is recognized that there are robust systems in place to address the immediacy of major incident medical management and support (MIMMS) within the emergency services (Advanced Life Support Group, 2003). The fundamental requirement to save lives and mitigate suffering places health care at the top of the agenda in such circumstances. However, the need for care and support that exists at all points on a continuum from disaster preparedness and response, to the long-term physical, psychological, spiritual and sociocultural consequences of the event often falls to the nursing workforce.
A new flangeless adhesive coupling system for colostomy and ileostomy
Authors: White Marlene , Berg Kirsten
Published: May 2014

A large clinical study evaluated the performance and patient acceptance of a flangeless stoma system — the Esteem synergy® system (ConvaTec). Key parameters for previous one-piece users were product versatility assessed by ease of application/removal, security, convenience of use and overall subject preference. Key parameters for previous two-piece users were product flexibility assessed by profile, comfort, rigidity, security, and overall subject preference. Wear time and safety were also assessed. In 44.5% of one-piece users, the test product was rated at least as good as their usual product. In two-piece users the test product was statistically significantly better than their usual product in terms of flexibility and was rated at least as good as their usual system by 56.3% of subjects. The overall mean wear time was approximately 2 days. The test system was well tolerated. In summary, Esteem synergy® successfully combined the attributes of both one- and two-piece stoma systems.
Differentiating between a consultant nurse and a clinical nurse specialist
Authors: Maylor Miles E
Published: May 2014

With the introduction of nurse consultants, and regulation of the use of the designation ‘specialist nurse’, experienced practitioners such as clinical nurse specialists have seen their position eroded. Nurse consultants are a new NHS-employment category, and are expected to be at the top rank of the profession both in status and in salary. However, this article argues that nurses at various levels have the same core functions, and that these do not differ for nurse consultants. Distinguishing between practitioners that might have the same job description could be better done by measuring outcomes. More care needs to be taken over the use of words such as ‘expert’, which is used differently in different contexts, and it is suggested that competencies be developed by which to measure the effects of expertise. Although nurse consultant appointments are often driven by various political directives and they are employed to meet local and national priorities, difficult issues need to be faced. First, if nurse consultant jobs are the top of the clinical career ladder, will clinical nurse specialists (CNSs) need to accept a lower rung on it? Further, perhaps the title CNS should become obsolete or be regulated? Can CNSs claim parity of pay using the Agenda for Change framework?
Leg ulcers and the Urgocell Non-Adhesive wound dressing
Authors: Fays S , Schmutz JL , Vin F , Thirion V , Sigal-Grinberg M , Ingen-Housz-Oro S , Esteve E , Sauvadet A , Bohbot S
Published: May 2014

The objectives of this clinical trial were to evaluate the efficacy and tolerance of the Urgocell Non-Adhesive (NA) dressing in the local management of venous or mixed leg ulcers. The study was a non-comparative, prospective, multicentre (15 centres) phase III, clinical trial. The studied population was composed of non-immunodepressed adults presenting a venous or mixed leg ulcer, uninfected, non-cancerous, present for less than 18months. Patients were followed-up for 6weeks witha weekly visit, including a clinical examination, area tracings and photographs. Evaluation by nursing staff and patients was performed at each dressing changed. Forty-three patients were included, presenting a leg ulcer with a mean surface area of 10.7cm2. The surface area was reduced by a mean of 38% after 6weeks of treatment. Four local adverse events were deemed to be related to the tested treatment and acceptability was noted very good for patients and nursing staff. The Urgocell NA dressing, combined with compression therapy, promoted the healing of the chronic wounds under study. The good tolerance and acceptability of the tested dressing were greatly appreciated.
Setting up a community nurse-led healed leg ulcer clinic
Authors: Flaherty Elaine
Published: May 2014

The success of compression therapy and emphasis on healing rates of venous ulcers in studies has shifted the emphasis from prevention to cure. Venous insufficiency is, in the majority of cases, a chronic condition. From a patient's perspective, unless they are suitable for corrective surgery, he/she will never be rewarded with a cure. Patients often need to make permanent life-style changes to reduce the risk of ulceration or reulceration and may require differing levels of support to achieve this. The implementation of a designated clinic for patients with healed leg ulcers in a primary care trust in the east end of London is the first step in promoting a collaborative approach to prevention of leg ulcer recurrence.
Healing an intractable wound using bio-electrical stimulation therapy
Authors: Hampton Sylvie , King Lynn
Published: May 2014

Clinicians involved in the conservative care of chronic wounds have many treatment interventions from which to choose, including debridement/irrigation, dressings and pressure-relieving devices, to name a few. All are physical treatments that create an ideal wound healing environment. Unfortunately, many wounds heal very slowly, do not heal, or worsen. This situation relates to the woman in this case study who had a non-healing leg ulcer for 12months. One of the interventions commonly used to treat chronic wounds is bio-electrical stimulation therapy (BEST), and the rationale for use of this method is based on the fact that the human body has an endogenous bioelectric system that enhances healing of bone fractures and soft-tissue wounds. When the body's endogenous bioelectric system fails and cannot contribute to wound repair processes, therapeutic levels of electrical current may be delivered into the wound tissue from an external source.
A concept analysis of spirituality
Authors: McBrien Barry
Published: May 2014

According to the holistic model of care, nurses must consider their patient's spiritual needs in order to provide total patient care (Govier, 2000). There is growing awareness of the contribution that spiritual wellbeing can make to a patient's actual and perceived health and quality of life (Chibnall et al, 2002; Mount, 2003). Spirituality and spiritual care has gained much momentum in the current nursing arena. Draper and McSherry (2002) assert that it has emerged from the shadows to occupy a prominent part of contemporary health care. Moreover, within the nursing profession, a focus on individuals as biopsychosocial-spiritual beings is gaining recognition. This notion is based on the premise that there should be balance of mind, body and spirit for the maintenance of health in a person (Stoll, 1989; Stooter, 1995). However, there is evidence that many nurses, including nurse educators, have difficulty with the concept of spirituality and consequently, may neglect this aspect of care (Greenstreet, 1999; McSherry, 2000). The aim of this article is to contribute towards clarifying the concept of spirituality.
Multiple sclerosis: living the reality
Authors: Fawcett Tonks N , Lucas Maree
Published: May 2014

Multiple sclerosis (MS) is a highly variable and unpredictable disease and is considered one of the most life-altering diagnoses a person can receive (Holland and Madonna, 2005). The hallmark of this disorder is its unpredictability. This article explores the journey one individual (ML) takes from the time that seemingly trivial symptoms took on a new and disturbing meaning to the point where, as someone newly diagnosed with MS, the potential challenges of the journey ahead have to be viewed with realism, optimism, and meaning.
Prescribing is not the only issue for nurses and drugs
Authors: Castledine George
Published: May 2014

A leading consultant physician once told me that if it wasn't for nurses then doctors would be making terrible mistakes in their prescribing of drugs. He went on to point out how senior nurses throughout his medical career had helped him with his prescribing by either pointing out where he had got a dose wrong or had incorrectly prescribed medication for a patient. Throughout my nursing career I have spent a considerable amount of time correcting and helping doctors with their prescribing. In fact, just last week there was a situation in my practice where a doctor wrote up a prescription sheet wrongly.
Consent to use complementary therapies on critical care wards
Authors: Dimond Bridgit
Published: May 2014

This article explores the use of complementary therapies as part of care within the NHS and the legal issues which arise. The employer is entitled to give or refuse consent to the use of complementary therapies by its employees on NHS patients and to lay down the conditions on which such therapies could be practised.
Care of patients with haemoglobin abnormalities: nursing management
Authors: Khattab Ahmed D , Rawlings Barry , Ali Ibtisam S
Published: May 2014

This second of two articles on sickle cell disease (SCD) aims to provide advice on nursing care for patients. All health professionals should be aware of the various manifestations of the disease, the life-threatening complications and their optimal management. Prophylactic strategy is of paramount importance as it may avert many possible adverse outcomes. Recurrent episodes of acute, severe pain require frequent hospital admissions. The care of individuals with SCD must extend into the community and take account of domestic, employment and educational issues. Affected pregnant women should be looked after by units experienced in the care of women with this condition. The diagnosis of haemoglobin type is simple and inexpensive and a comprehensive national screening programme to detect SCD in pregnant women and newborn babies was started in April 2002 as part of the Government's broader aims to tackle inequalities in health and community.
Psychoneuroimmunology and health from a nursing perspective
Authors: Langley Pauline , Fonseca Jenny , Iphofen Ron
Published: May 2014

Psychoneuroimmunology is the science that links psychological processes and the immune system. It is important to nursing as it offers underpinning theory to support good caring and empathetic nursing. This article describes the science of psychoneuroimmunology (PNI) and provides an overview of how interactions between psychological states and physiological function take place and some of the consequences for health status. It also reviews the relevance of research to nursing and considers its potential to strengthen the evidence base for therapeutic nursing and complementary therapies.
Audit of peripheral venous cannulae by members of an IV therapy forum
Authors: Bravery Karen , Dougherty Lisa , Gabriel Janice , Kayley Jill , Malster Michele , Scales Katie
Published: May 2014

This article describes a clinical audit of peripheral venous cannulae (PVC) undertaken by members of a national intravenous therapy forum. PVC care was reviewed using the RCN ‘Standards for Infusion Therapy’ and the Department of Health's ‘Winning Ways’ report, action area 2 (DH, 2003; RCN, 2003) to define best practice. Data were collected by members of the forum and submitted for analysis by the members' coordinator. The findings of the audit highlighted several areas for improvement in PVC care. The most significant finding was poor documentation of the insertion of the cannula. An additional concern was that the person who performed the cannulation could not be identified for 236 (37.7%) of PVC audited. Draft recommendations with strategies for implementation have been proposed and feedback sought from participants with plans to re-audit in 2007.
Issues of phenomenology for an undergraduate nursing dissertation
Authors: Ferrari Enrico
Published: May 2014

Undertaking a research project based on phenomenology presents many challenges to undergraduate nursing students, especially with regard to the evaluation of the rigour of the research. This article will analyse this problem in relation to the author's experience of carrying out a phenomenological research project for an undergraduate dissertation. In particular it will focus on the issues of having a limited number of participants, that the researcher and the participants were student nurses belonging to the same cohort, and the lack of validation of the results by the participants.
The Welsh Nursing Academy: a focus for excellence
Authors: Davies Ruth , Clark June
Published: May 2014

This article traces the development of the Welsh Nursing Academy (WNA) and links this to other changes that have occurred within the professions of nursing, midwifery and heath visiting, as well as the political landscape of Wales. The mission of the WNA is to serve the people of Wales by promoting excellence in nursing and health care through the generation, synthesis and dissemination of nursing knowledge. How this will be translated into practice through the activities of its membership will be shown in relation to each of the academy's five purposes. This is the first nursing academy to be established in the UK and it is likely that others will follow in England, Scotland and Northern Ireland. As the article concludes, this may lead to a federation of academies across the UK which will collaborate and support each other and link up with existing nursing academies in other countries.
Death with dignity: devising a withdrawal of treatment process
Authors: Hunter Joanna K , Dean Tamsin , Gowan Jenny
Published: May 2014

In 2002, a study was undertaken at St Thomas' Hospital to ascertain whether nurses felt adequately prepared in caring for patients in the intensive care unit (ICU) during the withdrawal of treatment (WoT) process (Dean, 2002). The study concluded that nurses on the ICU were unclear of the process and lacked confidence and knowledge of WoT. This study inspired the establishment of a WoT steering group to address the many issues involved in this process.
Should nurses receive perks?
Authors: Castledine George
Published: May 2014

We are all aware that nursing is a very stressful occupation and there are very few rewards. Recently I was talking to several occupational health doctors who not only confirmed this view, but also made the point that nursing was probably one of the most hazardous occupations in the UK. The reasons they gave for this opinion were that nursing involved a lot of heavy lifting, long hours on your feet, exposure to hazards such as radiation, infections and viruses, verbal abuse, aggression, demanding people, bureaucratic and political constraints.
Smoke-free hospitals and the role of smoking cessation services
Authors: Neubeck Lis
Published: May 2014

The NHS must be smoke free by the end of 2006 (Department of Health, 2004). The necessary elements to introducing a smoke-free policy, which is workable and equitable, are the management of the policy and offering support to smokers. Smoking and second-hand smoking are responsible for many illnesses, premature deaths and reduced productivity. Employers have a responsibility to ensure the health of their employees by protecting them from exposure to cigarette smoke in the workplace. Although smoking restrictions in the workplace are popular, it is important to ensure good communication with everyone who will be affected, since there are many fears associated with the introduction of the policy. Help must be offered to people who wish to quit through behavioural and pharmacological interventions and support must also be given to the smoker who must abstain from smoking on the premises during work or hospital stay.
What information patients require on graduated compression stockings
Authors: May V , Clarke T , Coulling S , Cowie L , Cox R , Day D , Husk J , Laslett S , Mansell S , McHenry M
Published: May 2014

Graduated compression stockings are used prophylactically on a variety of patients within acute hospitals. Anecdotal evidence suggests patients have a limited understanding of this treatment. The aim of this qualitative study was to explore patients' experiences of compression stockings and to ascertain perceptions of their use. Information was gathered using telephone interviews from a sample of 12adults who had been patients within the past 2months, and who had worn compression stockings for more than 48hours. The results showed that patients received little or no information from healthcare staff regarding compression stockings, but that they did have knowledge from other sources, such as long-haul flight advice. This raises issues of informed consent and patient empowerment and highlights the need for both verbal and written information. The information gained informed a patient information leaflet, which was developed in partnership with a patient focus group.
Central venous catheter infection in adults in acute hospital settings
Authors: Jones Clare A
Published: May 2014

As well as the human cost, central venous catheter (CVC)-related bloodstream infections significantly inflate hospital costs, mainly through increased length of stay in hospital, particularly in intensive care. This literature review appraises recent research on measures used to minimize CVC-related infection and compares it with current best practice. Randomized controlled trials and systematic reviews published on the subject between 2000 and 2005 were reviewed, concentrating on non-tunnelled, short-term CVCs in the acute hospital setting. The new evidence mainly backs up current best practice. However, skin disinfection could be improved by using alcoholic chlorhexidine followed by aqueous povidone-iodine before CVC insertion. Also, alcoholic chlorhexidine is the preferred solution for cleaning the hubs/connectors before accessing the CVC. Good hand hygiene and quality control and education programmes are vital to improve patient care. More research is needed to clarify the effectiveness of certain interventions and technologies, such as antimicrobial CVCs.
What makes a good nurse? Views of patients and carers
Authors: Rush Brenda , Cook Joan
Published: May 2014

Ninety-six patients, service users and carers were consulted about what makes a good nurse in an exercise designed to inform a Diploma in Nursing curriculum at the University of Nottingham, but the results are relevant across the nursing profession. Good communication, respect, appropriate appearance, attention to hygiene and detailed knowledge of patients' conditions and treatments were the areas that generated the most frequent comments. Participants give an insight into the experiences of care they had received and by implication provide a worrying indictment of current nursing practice. The authors recommend that the findings be used to inform nursing curricula and to highlight patient and carer needs for a quality nursing service.
Poles apart: alcohol withdrawal and psychosis in A&E
Authors: Noonan Ian PS
Published: May 2014

At 2am on a Saturday morning, Gregor, a 27-year-old Polish man, was referred to me for a mental health assessment in my role as a psychiatric liaison nurse in an accident and emergency department. Gregor had been found wandering around London, talking and laughing to himself, giving away his property, and gesticulating with his hand as if holding an imaginary phone to his ear.
Complications of adapting pressure ulcer risk assessment scales
Authors: Maylor Miles E
Published: May 2014

This article challenges recommendations to adapt a pressure ulcer risk assessment scale (RAS) according to the clinical context. The transformation of the Cubbin and Jackson (1991) RAS is used to illustrate problems in scale development. When new factors are added to an existing scale, this can lead to unnecessary complexity. When words are changed by a person developing a scale this illustrates their differing beliefs and value judgements. Arbitrary scores for factors are misleading and in some cases mystifying, yet appear to be objective. This article suggests that the relationship between sub-scales and the whole scale have not been adequately accounted for — they can't simply be added up arithmetically. The paradox of risk is debated, namely, that the more something is thought to be a risk, the less risky it becomes. RASs should be replaced by risk reduction scales linking a risk factor with its outcome following intervention.
Non-medical prescibing in nurse-led community leg ulcer clinics
Authors: Walsh Julia
Published: May 2014

Over the past decade, nurse prescribing in the community has improved clinical care, providing timely access to many products required for patients to receive appropriate treatment. Until recently, nurses who have qualified as nurse prescribers have only been able to prescribe from a limited list of products. Within the leg ulcer clinic environment, the majority of prescriptions written have been related to wound care. This article describes the introduction of extended independent prescribing (now known as non-medical prescribing) and how this type of prescribing has scope for revolutionizing clinical practice in all healthcare settings. There are, however, many contentious issues for clinicians practising in this new role, including systems for communication, clinical governance, and attitudes of other professionals.
Versajet hydroscalpel: treatment of diabetic foot ulceration
Authors: McCardle Joanne E
Published: May 2014

Treatment of diabetic foot ulceration continues to be a challenge to healthcare professionals. Wound healing can be affected in a number of ways, and it is of paramount importance that wound healing is achieved as quickly as possible to minimize the risk of amputation. One key aspect of management is wound debridement. A number of techniques can be employed, including, in severe cases, surgical debridement. These case histories illustrate where the novel VersajetTM hydroscalpel (Smith & Nephew) would be a useful tool for debriding a foot ulcer effectively without the patient undergoing orthopaedic surgery. The Versajet debrides quickly and efficiently, and a pink and granulating wound base was achieved in all cases. It should be considered for use in specialist centres where complex diabetic foot ulcers are treated and the expertise is available to use it.
Best interests: a review of issues that affect nurses’ decision making
Authors: Fullbrook Suzanne
Published: May 2014

interests’ is a term that is often misunderstood and incorrectly applied in practice. This article is the first of three dedicated to an explanation of the legal principles and practical applications of the term when applied to the provision of treatment and care of patients. Elements of the debate are explored that relate to aspects of daily treatment and care and to circumstances where the issue(s) relate to end of life considerations. This first article aims to raise awareness of issues that relate to the idea of acting in a person’s best interests. Potential areas of concern and apprehension on the part of healthcare providers are reviewed with the aim of preparing the reader for the more legally concentrated second article, and further to alert the reader to the possibility of uncomfortable reflection to be undertaken in a professional vein.
Hand adornment and infection control
Authors: Jane Ward Deborah
Published: May 2014

Studies have shown that despite infection control guidelines recommending that false fingernails, nail varnish, stoned rings and wrist watches not be worn by clinical staff, a large proportion of them continue to do so. The recently updated epic guidelines (Pratt et al, 2007) state that hand jewellery and false finger nails should be kept short, clean and free from nail polish. This article discusses the research evidence surrounding these recommendations, looking at issues, such as bacterial carriage, contributions to outbreaks of infection and interference with proper hand hygiene practices, thereby explaining why these recommendations are made in infection control policies and guidelines.
The role of the nurse post-renal transplantation
Authors: Murphy Fiona
Published: May 2014

The previous article explored the role of the nurse pre–renal transplantation which addressed the physical, psychological and educational support that the patient and family members require prior to this life-changing surgery. The following article explores the continual role of the nurse in caring for and educating the patient post-renal transplantation. Renal transplantation is considered the optimal treatment of choice for patients with end-stage renal failure (ESRF) and who are receiving dialysis. The nurse plays a pivotal role in assisting the patient in facing the many challenges that are associated post-renal transplantation, including the complications and the long-term physical and psychosocial implications.
A real tonic to the profession
Authors: Allen Mark
Published: May 2014

The first time I met Sir George Castledine was at a hotel in the centre of Manchester in 1979. For some strange reason, it being 11am, we drank gin and tonic, a tipple I have indulged in hardly ever before or since.
A comparative review of clinical governance arrangements in the UK
Authors: Pridmore Julia Ann , Gammon John
Published: May 2014

This article provides a comparative review of the interpretation and implementation of clinical governance frameworks within the four home countries of the UK - England, Northern Ireland, Scotland and Wales. Clinical governance has become one of most significant and important concepts in modern health care. The article considers the policy background and the many definitions of clinical governance, but specifically compares the various strategic and operational approaches to delivery of clinical governance in different parts of the UK. It is suggested that these variations in approach, by each of the four UK countries, can lead to confusion for healthcare professionals in trying to understand, implement and monitor elements of clinical governance in practice.
Assessing the effectiveness of the British Army’s mental health service
Authors: Finnegan Alan , Oak Selly , Finnegan Sarah
Published: May 2014

The Ministry of Defence’s commitment to modernizing and improving mental health (MH) care for Armed Forces personnel has resulted in considerable changes to frontline services. The last remaining United Kingdom (UK) military psychiatric hospital closed on 1 April 2004 with the move to a clear, integrated care pathway between primary healthcare, military departments of community mental health (DCMHs) and secondary healthcare. The Army’s eight UK DCMHs provide a patient-centred, occupational MH service grounded in the military MH philosophy of local, easily accessible, effective treatment (O’Brien, 1998). These MH services have been exposed to significant media interest and this article will attempt to quantify the correct state of affairs through patient, customer and staff satisfaction surveys. Clinical groups in the customer survey recorded a satisfaction rate of 87%, the staff survey 72% and the patient survey 94%. The Army has excellent access to specialist MH support and a common theme emerging in these surveys is the perception that the MH teams provide a high quality of service. The three surveys provide valuable direction to improve patient care and highlight strengths such as 97% of patients receiving appointments compatible with their duties.
Globalization, commodification and mass transplant of nurses: Part 2
Authors: Cutcliffe John , Yarbrough Susan
Published: May 2014

This two-part article examines the mass transplantation of nurses within the context of globalization. Part one focused on the international data regarding the global shortage of nurses, the increase in nurse migration from ‘underdeveloped’ to ‘Western’ countries, definitions and descriptions of global health and summarized the debate so far, such as it is. Part two draws attention to how this group of migrating nurses is more often than not comprised disproportionately of women and accordingly, draws on critical feminist ideas to demonstrate how such mass transplantation of nurses adds to the idea of women as a commodity. It then draws attention to other similar examples of the commodification of women and highlights the impacts of the loss of this labour force on the ‘exporting’ countries. The article concludes by joining with others who have proffered constructive suggestions for addressing this problem.
Is nursing still the dominant voice?
Authors: Karstadt Lyn
Published: May 2014

Nursing and midwifery education has evolved over the past few decades, making many in the profession – as well as education – slightly confused as to what is going on. In this second column, Lyn Karstadt continues to shed light on these issues and discusses the decision by the Council of Deans and Heads of UK University Faculties for Nursing and Health Professions to change its name and the implications of this for nursing.
Real life death: has reality TV gone too far?
Authors: Castledine George
Published: May 2014

There are many difficulties these days in publicizing a subject that is not only very sensitive but also considered a taboo in our society. The ITV screening on 8 August 2007 of the documentary and award-winning film, which shows the last few days before a victim of Alzheimer’s disease dies, is controversial. The film follows Malcolm – a brilliant pianist and lecturer who developed the debilitating illness at just 51 and his journey from being a highly skilled composer, husband and father to the last years of his life. Malcolm’s battle with Alzheimer’s and his wife’s dedication to him, was the subject of an ITV programme eight years ago, titled Malcolm and Barbara: A Love Story. Now at the age of 66, Malcolm is at the end of his life and the film crew returned to capture his final moments (although ITV state that the film did not show the actual death of Malcolm).
Rotavirus diarrhoea and future prospects for prevention
Authors: Diggle Linda
Published: May 2014

Rotavirus is a highly contagious cause of vomiting and diarrhoea in young children (Glass et al, 2006). It is transmitted via the faecal–oral route and almost every child will experience an episode of rotavirus infection before the age of 5 years. Although this infection leads to millions of deaths per year in developing countries, good access to rehydration therapies in the UK means that we experience few rotavirus deaths. Nevertheless, rotavirus infection can cause misery for the child and presents indirect costs for parents. It also poses a substantial burden on primary care and paediatric wards, particularly during the busy winter period, with nosocomial infection adding on average, a further 4 days to a child’s stay in hospital. With no antiviral treatment available, management of the poorly child must focus on prevention of dehydration. Recently, two new generation rotavirus vaccines have been licensed with each undergoing extensive and large clinical trials. These vaccines offer new hope for the prevention of this condition.
Common law and a duty of care: the application of principles
Authors: Fullbrook Suzanne
Published: May 2014

In this series, the author has bought two themes to the reader: first, an awareness of the elements of the common law that operate to inform us of our duties as health providers, and second, current information that is applicable in each of the areas of law that has been discussed. This conclusion is designed to bring together strands of debate that the series has brought to the attention of the reader.
Death by denomination: a Jehovah's right to die
Authors: Fullbrook Suzanne
Published: May 2014

The recent death of a 22-year-old mother just hours after giving birth to twins because doctors were forbidden from giving her a blood transfusion as a Jehovah’s Witness has received much media coverage (Anonymous, 2007; Attewill, 2007; Murphy, 2007).
The Mental Capacity Act 2005: the new Court of Protection
Authors: Dimond Bridgit
Published: May 2014

The new Court of Protection is now considered in the series of articles on the Mental Capacity Act 2005. The Court of Protection was established on the 1 October 2007 and has a much wider jurisdiction than its predecessor. It can now hear cases concerned with the personal welfare of those who lack the mental capacity to make their own decisions, as well as issues relating to property and finance which were the sole concern of its predecessor. This article considers the powers, procedure, practice, rules and directions of the Court and its power to appoint deputies and their role. It also considers the new Office of Public Guardian and its role in keeping a register of Deputies and Lasting Powers of Attorney. It also considers the appointment of Special and General Visitors. The implications of these new institutions are reviewed in the light of a common situation involving healthcare practitioners.
Skin antiseptics used prior to intravascular catheter insertion
Authors: Adams Debra , Elliott TSJ
Published: May 2014

The recent epic2 publication (Pratt et al, 2007) provides evidence-based guidelines for the prevention of healthcare-associated infections. One of the new recommendations related to the prevention of central venous catheter (CVC) associated infection states that 2% chlorhexidine gluconate (CHG) in 70% isopropyl alcohol (IPA) should be used for cutaneous antisepsis prior to device insertion. This article reviews cutaneous antisepsis prior to intravascular catheter placement.
Clinical skills: bed making and patient positioning
Authors: Pellatt Glynis Collis
Published: May 2014

Providing a clean, comfortable bed and positioning a patient in the optimum posture for prevention of complications and to enable maximum independence are fundamental nursing skills. Bed making is a daily routine that requires practical and technical skills. Selecting the correct posture for a patient in bed or in a chair is essential for physiological functioning and recovery. In this article bed making is described, as are positioning and re-positioning in relation to patients in bed, armchairs and wheelchairs. Infection control and moving and handling issues are also considered