bluuebunny/crossref_metadata_2025 huggingface dataset:
Issues involved in promoting patient autonomy in health care
Authors: Hewitt-Taylor Jaqui
Published: May 2014

Respecting patient autonomy is a central part of the Royal College of Nursing's definition of nursing (RCN, 2003). Although autonomy is a fundamental ethical principle in health care, it stands alongside the principles of beneficence, non-maleficence and justice (Wilmot, 2003), and these principles may be interpreted differently by individuals and professional groups. In seeking to promote patient autonomy, it is therefore necessary for nurses to consider how these principles interlink, and to understand the potentially differing interpretations that they may encounter in practice. This article sets out to address these issues and suggests that facilitating patient autonomy includes engaging in debates which include uncertainties, considering the resource implications of patient autonomy and the responsibilities that patients have themselves. It also identifies that nurses who aim to promote patient autonomy and holistic decision making need to be able to facilitate discussion that may include questioning the dominant biomedical view of health. This will be problematic if nurses do not themselves feel empowered or autonomous.
Healthcare workers' knowledge of inoculation injuries and glove use
Authors: Trim Joanna C , Adams Debra , Elliott Professor TSJ
Published: May 2014

Healthcare workers' (HCWs') occupational risk of exposure to blood-borne pathogens has been well documented. Subsequent educational programmes, awareness campaigns and policy implementation made limited impact on HCWs' level of knowledge of these risks and compliance with universal precautions. Two hundred HCWs completed a questionnaire to evaluate their level of knowledge. Results demonstrated that despite a comprehensive education programme for nurses and training for medical staff, knowledge of inoculation injuries and associated issues remained inadequate. Indeed, policies and procedures were not followed. Furthermore, gloves were not routinely worn in the clinical setting. Educational programmes are essential to inform HCWs of occupational risk of exposure to blood-borne pathogens and guide practice following an inoculation injury. However, efficacy of such programmes must be reviewed, alternative strategies evaluated, and the cause of HCWs' limited knowledge determined.
Impact of discharge from day surgery on patients and carers
Authors: Mitchell Mark
Published: May 2014

This article outlines the increase in the amount and complexity of day-case surgery currently being undertaken in the UK. The continuing increase in day surgery has led to a corresponding rise in patient and lay carer involvement throughout the pre- and postoperative period. The impact day surgery expansion is having on patients and their carers' contribution to care are therefore highlighted as challenging issues for modern day-case surgery. Utilizing the evidence available from the literature, the article focuses specifically on the contemporary issues concerning patient and lay carer experiences of discharge from a day surgery facility. The main challenges identified are pain management, recovery behaviour and community care provision. The clinical application of the issues raised within these themes is considered and recommendations for future practice are highlighted.
Development of a tissue viability nursing competency framework
Authors: Finnie Alison , Wilson Alice
Published: May 2014

In 1999, a sub-group of the National Association for Tissue Viability Nurse Specialists (Scotland) agreed to lead the production of a competency framework. The aims were to define tissue viability specialist nursing, to provide a framework for tissue viability nurse specialists (TVNSs) that would form a basis for clinical supervision and mentorship, and to inform curricula for tissue viability education. Using a combination of models, a framework evolved which defines the multifaceted nature of the role. The framework lists competencies, which are further broken down into specific role elements, matched with measurable performance criteria for the TVNS. The competency statements that are provided within the publication describe the attitude, knowledge and skills required to fulfil the TVNS role. The document, ‘A Route to Enhanced Competence for Tissue Viability Nurse Specialists’, was published in June 2002. This initiative meets the national need for definition of specialist practice and provides a standard by which the public can be assured of quality care from TVNSs in Scotland.
Low-frequency ultrasound to manage chronic venous leg ulcers
Authors: Johnson Sue
Published: May 2014

Chronic leg ulceration costs the NHS around £500 million per year (Moffatt and Dorman, 1995) so it is not surprising that the condition attracts attention from manufacturers of medical devices. However, the evidence available for many novel technologies is scant and a systematic approach to product evaluation is essential to avoid the adoption of ineffective and therefore costly measures. A low-frequency ultrasound device was presented in clinic as an aid to stimulate and accelerate healing in otherwise recalcitrant wounds. There followed a systematic evaluation of the product including a literature review of the mode of action, safety and efficacy, followed finally by a product evaluation with case studies used as outcome measures. In this case, the product proved to be a useful tool in the management of chronic wounds, not only for healing but also for pain, pigmentation and odour reduction. The importance of understanding fully a novel technology and how it fits with clinical practice cannot be underestimated.
Why nurses need to understand the principles of bereavement theory
Authors: Greenstreet Wendy
Published: May 2014

This article considers the value of bereavement theory to nurses. The contexts in which nurses care for the bereaved are identified and the terms ‘bereavement’, ‘grief’ and ‘mourning’ are defined. A selection of psychological and sociological bereavement theory and models are considered in relation to their value in nursing practice. The increasing richness of bereavement theory strengthens potential understanding of the process of grief. Critical and creative use of this theory can offer valuable guidance to nurses caring for the bereaved and can help promote confidence, thus enabling them to provide appropriate support.
Learning disability care: is Valuing People working?
Authors: Jukes Mark
Published: May 2014

It has been 4 years since the documentary ‘MacIntyre Undercover’ revealed to the public celluloid evidence of the abuse of people with learning disabilities within a learning disability care home. Since that programme was broadcast, Valuing People: A New Strategy for Learning Disability for the 21st Century (Department of Health (DoH), 2001) has been published. It presents an ambitious agenda for change within health and social care service provision for people with a learning disability, their families and carers across England.
Nursing home manager who failed to protect the interests of patients
Authors: Castledine George
Published: May 2014

Barry was the operational support manager of a group of nursing homes which cared for patients with mental health problems. Following a visit to one of the homes to review the progress of the new care manager, Barry had several concerns. The new manager of the home, Stefan, was upset that he had to work weekends. Barry said that in the future he hoped to be appointing a senior nurse to help out at weekends.
Vascular birthmarks: a care study of an infant with haemangioma
Authors: Stephen-Haynes Jackie
Published: May 2014

This care study describes the application of an evidence-based approach to the care of an infant with a sacral haemangioma. It explores four key aspects of management: specific therapeutic modalities; local wound management; pain management; and management of infection. Clinical governance and evidence-based practice are now important elements of care delivery in the NHS (Department of Health (DoH), 1997). Current evidence relating to haemangiomas and wound management is critically appraised and applied to an individual patient within the primary care setting. The appropriateness of theories and models of nursing are considered in relation to holistic assessment. Recent evidence regarding the management of pain at dressing change (Moffatt et al, 2002) and its relevance to haemangiomas are highlighted. Reflective practice is an integral part of experiential learning and the development of practical knowledge (Ghaye, 2000). Reflective practice and critical analysis have facilitated the provision of high-quality care and allowed a deeper and clearer understanding of both practice and theory, and their relationship within clinical practice. It is concluded that reflective practice aids the delivery of high-quality care at a personal, professional and practice development level.
The theory-practice gap still exists in nursing education
Authors: Higginson Ray
Published: May 2014

Nursing education is being directed towards the development of nursing practitioners competent to nurse effectively in the reality of our present society. A major challenge to the nursing profession is to find ways of merging theory and practice in the delivery of nursing education and clinical patient care.
Setting standards for assessment of ward patients at risk of deterioration
Authors: Ryan Helen , Cadman Catherine , Hann Linda
Published: May 2014

Improving the care of critically ill patients is a key objective of the Department of Health (DoH, 2000). Research findings and anecdotal evidence suggest that the key indicators of developing critical illness (respiratory rate and fluid balance) are being missed on busy general medical and surgical wards. In order to address this issue, the East Somerset NHS Trust critical care outreach team, in collaboration with ward staff, created the Amber Project. This project aimed to identify clearly patients who were at risk of deterioration and provide qualified nurses with a clear framework and minimum standard for assessment and observation. The project ran from June to September 2003. Results indicated that on the ward using the amber system the frequency of patient observations increased compared to those found on two other general wards. Nursing staff reported feeling more confident with regard to assessment and prioritizing care. Junior medical staff, physiotherapy and nursing staff reported that multiprofessional communication had improved, resulting in identification and treatment of critically ill patients. The authors suggest that the Amber Project, which incorporates the use of a ‘track and trigger’ warning system, has been an effective initiative in identifying patients at risk of developing critical illness on general wards. Its positive impact on the performance and confidence of qualified nurses working in difficult environments has resulted in the extension of the project to all other wards in the hospital.
Hypersexuality and dementia: dealing with inappropriate sexual expression
Authors: Higgins Agnes , Barker Philip , Begley Cecily M
Published: May 2014

Sexuality is always a difficult and challenging issue for nurses to address with older patients. This is particularly the case in relation to responding to incidents of hypersexuality or inappropriate sexual expression as a result of dementia. Although research suggests that hypersexuality is a rare occurrence, when it happens it has the potential to jeopardize the quality of life of all concerned. The focus of this article is on exploring the literature on hypersexuality in people with dementia in the residential care setting. Information and principles of care are offered that may help nurses respond in a sensitive manner that protects the rights, dignity and autonomy of all concerned.
The mental health needs of people with severe learning disabilities
Authors: Higgins Steve
Published: May 2014

People with severe learning disabilities can present with complex behavioural and emotional needs that are best understood within a biopsychosocial framework. This article outlines the range of issues involved in the presentation and identification of mental health needs in people with severe learning disabilities. The use of a multidisciplinary and multimodal approach to assessment, care planning and case management is promoted in order to provide effective, comprehensive care in meeting the mental health needs of this client group. The key knowledge and skills required to meet the mental health needs of this client group are outlined and the role of the nurse as a key professional in the coordination of the assessment and care management process is explored.
Creating an inclusive environment for black and minority ethnic nurses
Authors: Chamber Claire , Alexis Obrey
Published: May 2014

Black and minority ethnic nurses are an important part of today's NHS and acknowledging the part that they play and creating an environment where they feel valued is essential for multiprofessional working. Celebration of the diversity that nurses from different ethnic backgrounds bring to nursing care and to team working is often absent from the cultural environment in which nurses work. In fact, nurses can feel discriminated against and feel that their ethnic background is adversely affecting their career progression (Beishon et al, 1995). Creating a culturally competent environment should be central to the ethos of the NHS and cultural awareness and cultural empowerment are key components of an enhanced level of cultural competence. Educational and career development opportunities are essential in enhancing confidence and self-esteem and in creating career progression equality for nurses from different ethnic backgrounds.
The benefits of VAC therapy in the management of pressure ulcers
Authors: Smith Noleen
Published: May 2014

This study investigates whether vacuum-assisted closure (VAC) therapy, alginate or hydrocolloid dressings are most effective in the treatment of pressure ulcers. A total of 281 patients were included in this study. The response of each patient's wound was monitored, satisfactory wound closure was examined and the time taken to attain satisfactory wound closure was also taken into consideration. An original analysis of the published data was carried out. Most of the pressure ulcers showed some response in all of the categories investigated, with pressure ulcers in the VAC therapy group showing a greater response in all aspects than those in the other two groups.
Continence nurse treatment of women's urinary symptoms
Authors: Matharu Gurminder S , Assassa R Philip , Williams Kate S , Donaldson Madeleine K , Matthews Ruth J , Tincello Douglas G , Mayne Christopher J
Published: May 2014

The aim of this study was to establish how accurately a trained continence nurse could allocate appropriate second-line conservative treatment to women without urodynamic investigations. Depending on the number of patients coming taking up the service, there were between five and 12 nurses operating at any one time. Women aged 40 years and over, of which there were 2421 reporting lower urinary tract symptoms, were randomly allocated to a new nurse-led continence service. Of these women, 450 subsequently underwent urodynamic investigation, before which the nurses documented which second-line conservative treatment would be appropriate.The results showed that of all women with detrusor overactivity, 79.1% were correctly allocated anticholinergic treatment, and 64.8% were allocated pelvic floor exercises (PFE). Of all women with urodynamic stress incontinence, 88.8% were correctly allocated PFE, and 43.4% were allocated anticholinergic therapy. Of all women with mixed incontinence, 44.8% were correctly allocated both PFE and anticholinergic therapy, while 52.1% were allocated only one treatment. This study showed that a trained continence nurse is able to allocate conservative treatment appropriately to the majority of women without the need for urodynamic investigation. This indicated that the management of urinary dysfunction by a team of trained, dedicated nurses has the potential to reduce waiting lists for urodynamic investigation, avoid unnecessary investigations and achieve greater patient satisfaction.
Nurse who took on responsibilities beyond her competence
Authors: Castledine George
Published: May 2014

Jane was an experienced professional nurse. She had qualifications as a general nurse, midwife and district nursing sister. She had worked in the community for around 25 years as a district nurse and midwife before being asked by a local GP to work at his busy practice. Jane was keen to try something different and jumped at the prospect. Jane had no specific qualification to do the job, but she tried to keep herself up to date with the Nursing and Midwifery Council (NMC) guidelines. She regularly attended a two-monthly supervision group within her locality.
Do physicians' assistants have a role in the UK?
Authors: Paniagua Hilary
Published: May 2014

The move to create physician assistant (PA) roles in the UK is becoming quite a contentious issue. While the Government seems intent on unleashing its barrage of incentives and policies that entice primary care into developing new practitioner roles with the aim of trying to solve the current crisis in recruitment and retention of doctors, it does nothing to support the development of the PA role.
Men's attitudes towards health and the implications for nursing care
Authors: Peate Ian
Published: May 2014

This article considers men's health and the effects that men's attitudes and behaviour may have on their health status. Many men still take too many risks with their health, e.g. they may drive too fast and drink too much alcohol; this may be the result of social structuring that stereotypes men and boys into being strong and in control. Traditional attitudes concerning gender still prevail and may explain why a number of men engage in risk-taking behaviour that can have detrimental effects on their physical and mental health and why men are often unwilling to access healthcare services. Men's health is also linked to their social class and the type of work they undertake. A greater understanding of male gender and health should encourage nurses to develop innovative, gender-sensitive approaches to healthcare provision for men, in partnership with men themselves and with other healthcare agencies.
The role of the expert patient in the management of chronic illness
Authors: Fox Jane
Published: May 2014

The concept of the expert patient is an increasingly important one in healthcare policy and delivery. To date, however, there has been relatively limited consideration of the nature and characteristics of the knowledge and skills underpinning the role of expert patient or the relationship to more traditional health professional expertise. This article considers the emerging concept of the expert patient in the UK, its relationship to the emergence of the expert patient elsewhere (notably in Canada), together with exploration of the supporting rationales, assumptions and possible implications associated with the initiative.
Nurses must strengthen the nurse/patient relationship
Authors: Castledine George
Published: May 2014

It has often been stated that the difference between frustration and despair may be the degree to which individuals feel they have some control over matters affecting them and their life. Involving the patient whenever possible is an essential factor of nursing care. The British Government is using the terms ‘participation’ and ‘involvement’ as policy drivers not only in general political strategy but also, more particularly, in the modernization of the NHS. This means that all hospital and community care trusts have to provide evidence that the public and patients are involved in assessing the health service's strengths and weaknesses.
A project to establish a skills competency matrix for EU nurses
Authors: Cowan David T , Norman Ian J , Coopamah Vinoda P
Published: May 2014

Enhanced nurse workforce mobility in the European Union (EU) is seen as a remedy to shortages of nurses in some EU countries and a surplus in others. However, knowledge of differences in competence, culture, skill levels and working practices of nursing staff throughout EU countries is not fully documented because currently no tangible method exists to enable comparison. The European Healthcare Training and Accreditation Network (EHTAN) project intends to address this problem by establishing an assessment and evaluation methodology through the compilation of a skills competency matrix. To this end, subsequent to a review of documentation and literature on nursing competence definition and assessment, two versions of a nursing competence self-assessment questionnaire tool have been developed. The final competence matrix will be translated and disseminated for transnational use and it is hoped that this will inform EU and national policies on the training requirements of nurses and nursing mobility and facilitate the promotion of EU-wide recognition of nursing qualifications.
Understanding pain, part 1: physiology of pain
Authors: Godfrey Helen
Published: May 2014

This article is the first in a two-part series which explores pain and its management from a physiological perspective. Pain is a common experience which is often inadequately managed in hospital and community settings. While nurses are in a key position to contribute to successful pain management there are frequent accounts in the literature that nurses lack knowledge about pain management. Knowledge of pain physiology is fundamental to its successful management. This article introduces nurses to the components in the pain pathway and describes nociceptors which respond to pain stimuli and identifies pain fibres which carry pain information to the spinal cord. The processing of pain in the spinal cord is explained and the role of the brain in the manifestation of the pain experience is also explored. The gate control theory of pain and the more recent neuromatrix theory are discussed.
Clinical nursing rounds, part 4: teaching rounds for nurses
Authors: Close Ann , Castledine George
Published: May 2014

Clinical rounds are being introduced in the Dudley Group of Hospitals to improve patient care, involve patients and improve communication. There are four types of rounds, Matrons rounds, Nurse Management Rounds, Patient Comfort rounds and Teaching rounds. This article describes Teaching rounds and is the final article in the series of four. Nurses and midwives learn in a variety of ways: through courses and accredited programmes, seminars, conferences, self-directed study and so on. One of the most effective ways, however, is to participate in special clinical teaching rounds. These are aimed at all learners, whether pre-registration students or qualified staff. Their aim is to learn from direct patient contact with facilitation from an experienced nurse teacher. In this article an account is given of how a Professor of Nursing linked to a hospital Trust uses this approach to teach and evaluate nursing care and is the last in the series of four on clinical nursing rounds. It is felt the rounds are particularly useful in developing clinical practice, evidence-based care, understanding patients and the conditions they experience, while linking theory and practice.
Chronic leg ulcers, part 2: do they affect a patient's social life?
Authors: Brown Annemarie
Published: May 2014

This article describes a qualitative study into how chronic venous leg ulceration impacts on the social dimension of a patient's life and is presented in two parts. Part one discussed the background to the study, gave an overview of the literature and described the methodology. This second part will discuss the findings in relation to the literature together with implications for practice.
The role of education, technique and equipment in pressure area care
Authors: Wilson Gaynor , Logan Heather
Published: May 2014

This paper aims to reflect on the successful management of pressure ulcer equipment within a district general hospital. Insight is given into what is considered an effective, efficient and economic use of static and dynamic mattress, underpinned by a fundamental education package into pressure ulcer management and prevention techniques.
Where is the power of positive thinking?
Authors: Forbes Sara
Published: May 2014

As a regular reader of the British Journal of Nursing, I have become increasingly angered by the contribution made by your consultant editor, George Castledine. I have been qualified for 5 years and I certainly agree that nursing, as a profession, leaves a lot to be desired and as a nursing lecturer, Mr Castledine seems to be damning the entire community of nurses. Does he ever have anything positive to say? We have all come across ‘bad care’ but what seems to escape his notice is that there are an awful lot of people out there who do care a great deal and do their best to treat their patients with dignity and respect and provide the care the patients deserve.
Improving the continuing care for individuals with spinal cord injuries
Authors: Williams Sue
Published: May 2014

The author of this article responded to a need to address a service deficit for individuals with spinal cord injury, by setting up a nurse-led outpatient clinic to review, assess, advise and help patients develop problem-solving strategies to enable them to maintain their level of independence in the community, prevent unnecessary admissions and minimize the development of more serious complications that arise as a consequence of ageing with a spinal cord injury. The clinic sessions provided an effective service which demonstrated its value by achieving the following outcomes: provided a practical problem-solving approach to changes in physical function; prevented unnecessary hospitalization; and identified issues that required referral for additional specialists/services. Unfortunately, despite its short-term success, there were a number of issues (staffing and funding) which prevented the continuation and further development of the service. However, although not yet currently published, the key themes of the National Service Framework (NSF) for individuals with neurological conditions advocate the type of approach to patient care that has been reflected within this clinic (lifelong support from specialist practitioners and person-centred care). Hopefully the publication of such an influential document will support the development of future initiatives within this specialist field.
Nurses are overtired and not getting enough sleep
Authors: Castledine George
Published: May 2014

Nursing has always been a tiring and demanding occupation. More recently, there have been complaints by nurses that the situation is getting worse. For example, one ward sister of 30 years' experience told me that ‘no-one seems to care about how we feel anymore; all senior management are interested in is bed vacancies and when patients will be ready for discharge’. She went on to describe a typical day on her ward, pointing out how tired the nurses were and how impossible it was to give the holistic nursing care that patients required.
What medical roles should nursing be incorporating?
Authors: Castledine George
Published: May 2014

The difference between nursing and medicine has often been expressed as the nurse ‘cares’ and the doctor ‘cures’. Some observers would see it as a difference between models of health care, or the way each profession approaches the patient. The predominant model used by doctors in the UK is a biomedical one, emphasizing diagnosis and treatment based on scientific evidence. It is important to acknowledge, however, that there are those doctors who reject this approach and use a much more holistic and alternative Eastern model. There is a great deal of evidence to suggest that the biomedical model has, and continues to be, the model on which many nurses base their practice. Research studies in nursing have frequently reported nurses viewing their patients as physical beings with medical problems to solve, rather than nursing and healing patients’ wider personal and individual problems.
Dementia and long-term care: costs and compassion
Authors: Pointon Barbara , Keady John
Published: May 2014

In the UK, the care of people with dementia has had an inglorious past that was influenced by its association with asylum-based care (Nolan, 2003). Time has freed people with dementia (and their visiting families) from the shackles of the institution, but public policy has removed health care from the equation and presented the continuing care of people with dementia (and their needs) as a socially based system of support. This has had a profound impact on those living with the diagnosis and on nursing involvement.
Exploring the legal status of healthcare documentation in the UK
Authors: Dimond Bridgit
Published: May 2014

This article considers the legal status of documentation and the point at which records become legal documents. It outlines the powers of the courts that require any documentation or other records to be produced if relevant to an issue arising in a dispute. It also discusses hearsay evidence and the fact that usually evidence on records needs to be corroborated.
Issues of patient consent: a study of paediatric high-dependency care
Authors: Rushforth Kay , McKinney Patricia A
Published: May 2014

This article reports on the issues relating to obtaining informed, signed consent for a study of paediatric high-dependency care and provides practical guidance on confidentiality for health service researchers. Consent and confidentiality are not new concepts but recent changes to the legislation and guidance offered from nursing and medical regulatory bodies have caused concerns and confusion for researchers with respect to both issues. Balancing health service research and the development of services against the requirements of patients for confidentiality is essential yet challenging. This was a time consuming, costly exercise. Resource implications may ultimately mean that studies which are of benefit to patients in relation to the delivery of their care may not be undertaken. Health professionals need to be continually updated and made aware of the legislation and confidentiality requirements for health service research involving the collection of patient-identifiable details.
The wearing of compression hosiery for leg problems other than leg ulcers
Authors: Tyler Patricia , Hollinworth Helen , Osborne Rachael
Published: May 2014

Many people have leg problems other than ulceration. Practitioners from one primary care trust in Suffolk considered nursing assessment of these patients and the fitting of prescribed compression hosiery where appropriate as a health promotion initiative. However, ongoing assessment adds to heavy clinical demands on community practitioners. Engaging with people to take greater responsibility for their health, and recognition that practice should be underpinned by credible evidence, provided the backdrop to a two-staged retrospective audit. Results are based on the nursing records of 101 patients wearing prescribed compression hosiery other than for previous venous ulceration. It was concluded that following an initial detailed holistic assessment, including ankle brachial pressure index, those patients who meet identified characteristics can be empowered to return for reassessment only if there is a change in their health status, or skin changes to their legs. An information leaflet is considered critical to this strategy.
The Hampton-Gledhill 2-stage pressure risk-assessment system
Authors: Gledhill Lee , Hampton Sylvie
Published: May 2014

Pressure ulcers are largely preventable and, therefore, patients dying of large, necrotic pressure damage is an unacceptable situation. Lee Gledhill is both a nurse and a barrister and has been involved in many cases involving nurses facing court proceedings when their patients' primary cause of death is pressure ulcers. Sylvie Hampton, has acted as expert witness in some of these cases. It became obvious to the two authors that had healthcare assistants (HCAs) been more aware of how pressure damage could be detected and then prevented, some of the supervising nurses would not have been facing legal charges. The authors decided to produce a simple method of assessing first-stage skin changes for HCAs to not only recognize these changes, but also to have a framework in place describing the actions they need to take. This framework was produced as a card (the Hampton-Gledhill 2-stage pressure risk-assessment system). The card is being validated in many nursing homes and hospitals around the UK and in Jersey.
Using honey to heal a chronic wound in a patient with epidermolysis bullosa
Authors: Hon Jennie
Published: May 2014

This case study details the healing of a chronic wound (20 years' duration) in a patient with dystrophic epidermolysis bullosa (EB). Many different dressings and creams had been used, and on occasions the wound began to heal but never progressed to closure. A honey impregnated dressing was used and the wound healed in 15weeks. A brief overview of the dystrophic form of EB is given and some evidence for the efficacy of honey is presented.
The transition from student to qualified nurse: a militaryperspective
Authors: Moore Charlotte
Published: May 2014

This article explores some of the issues surrounding my transition from student nurse to qualified Royal Air Force staff nurse. It supports much of the research showing that the transition to staff nurse is stressful, with the time for preceptorship and supernumerary status varying. The education and support received during this period is still largely dependent on staff availability and this remains an area of concern. For military nurses the transition period is extra challenging, as there are military as well as nursing demands. This includes working predominantly in a civilian environment, while being aware that we may be deployed overseas with the military. However, the ability to adapt and adjust to changing circumstances is what essentially makes military nurses unique and distinctive. Provided that support is in place and appropriate clinical experience is obtained, we can fulfil our primary military roles.
Integrated healthcare: herbal remedies for menopausal symptoms
Authors: Tiran Denise
Published: May 2014

Women approaching the menopause frequently resort to complementary therapies and natural remedies, especially herbal medicines (Amato and Marcus, 2003). Nurses working with mature women, both in the community and in hospital, may find themselves drawn into a debate about these remedies, yet may feel unable to answer women's questions, or be unsure where to find information. However, with the increased use of complementary therapies generally, it is imperative that nurses recognize the parameters of their personal practice and appreciate the possible problems which may arise from ill-informed use of natural remedies, such as herb—drug interactions. This article provides an overview of herbal remedies popularly self-administered by women in the peri-menopausal period. The effects and safety of several remedies are explored to facilitate nurses to offer accurate, comprehensive and evidence-based information to patients. The issue of integration of herbal medicine into mainstream management of menopausal symptoms is also debated as a means of providing optimum and safe care to women at this time.
Iatrogenic hypotension in an elderly man with diagnosed angina
Authors: Lewis Frances
Published: May 2014

Jim is a 68 year old man who was admitted to a general medical ward with acute alcohol withdrawal. On admission Jim suffered from a range of physiological and psychological symptoms including malnutrition, double incontinence, ataxia, tremors, delusions, hallucinations and aggressive behaviour (Alexander et al, 2002). A 12-month history of falls and depression preceded this admission resulting in three acute admissions in the past 12 months. His recurrent falls had been attributed to an increasing intake of alcohol since the death of his wife two years previously.
NHS hospitals will challenge nursing organization
Authors: Castledine George
Published: May 2014

The NHS is building more hospitals than the rest of the G7 nations put together, claims a report in the Times (2006). The Government's justification for this is that for many years there was very little investment in new hospitals. The billions of pounds which are now being spent on hospitals may not be as effective nor as economical as first thought. There is a danger that such new buildings may become ‘white elephants’ according to a new report (Bosanquet, 2006). The sheer cost of such developments is a major reason for the deficits in many NHS units around the country. What is needed, says the report, is a more flexible approach to developing large numbers of buildings, which in the future may not be required as the nature and time patients spend in hospital is reduced.
Creating the evidence base: the journey from practice to research
Authors: Rust Julie , Rose Karen
Published: May 2014

The ability to deliver accurate, evidence-based information when helping patients make decisions about their care is fundamental to the role of the clinical nurse specialist. For patients with ulcerative colitis who are considering surgery to form an ileo-anal pouch, it is essential to give them information about the psychosocial, as well as the physical, effects of such surgery. As many of these patients are of working age, understanding the likely consequences for paid employment is a priority. However, very little evidence is available on this subject. The authors therefore decided to develop a research study aimed at filling this gap. A proposal to conduct a phenomenological study into the subsequent employment experiences of patients who have undergone ileo-anal pouch formation has been developed. This article seeks to explore how the research idea and its methodology stemmed from practice and highlights the importance of seeing research and practice as complementary components of good nursing care.
Centres of excellence for the care of people with progressive ataxias
Authors: Greenfield Julie , Treacy Colm , Giunti Paola
Published: May 2014

This article provides a description of the progressive ataxias and how such a diagnosis impacts on a person's life. The nurse's role in helping these patients, who can face numerous difficulties in everyday life, is highlighted. Moreover, the authors discuss the development of Ataxia Specialist Centres of Excellence for the diagnosis and management of people with ataxia, and the benefits believe these centres will bring to the care of these patients.
Risks and benefits of needle use in patients after axillary node surgery
Authors: Cole Tracey
Published: May 2014

Lymphoedema may be triggered by any type of injection. This is not just an issue for the cured breast cancer patient but for any patient who has undergone under-arm (axillary) lymph node removal to any degree for any type of cancer. Standard advice given to patients following axillary node removal is to avoid any injection or blood pressure measurement on the ipsilateral arm. The evidence base in this area is severely lacking. Patients have reported frustration that nurses are not informed of contraindications in carrying out such procedures on patients at risk of developing swelling. This article discusses the current evidence available on the subject of non-accidental skin puncture (NASP) relating to the patient at risk of lymphoedema and provides guidelines for any professionals conducting such procedures for patients with a history of cancer. The results from a small audit of the guidelines are cited and they reveal that out of 14 patients who underwent NASP procedures in the at risk arm, no patients reported swelling to that limb within a month of these procedures.
Community nurses’ understanding of the community stoma care nurse
Authors: Skingley Sarah
Published: May 2014

The aim of this research was to explore community nursing staff's understanding and perception of the role of the community stoma care nurse and make recommendations to develop a closer working relationship. Prior to this research it was assumed that community nursing staff had little understanding of the community stoma care nurse role and saw the role as one that deskilled community nurses. Findings of this research revealed that community nursing staff have a good understanding of the role and view it as a valuable resource that supports patients and nursing staff and offers an expert service. Recommendations based on this study are that, even though community staff have a good understanding of the community stoma care nurse role, both still need to improve communication so that the teams work more effectively and efficiently for the benefit of patients.
Oesophageal cancer: experiences of patients and their partners
Authors: Hodgson Tracey
Published: May 2014

Oesophageal cancer (OC) is a debilitating disease with significant social, psychological and physical impacts on health and lifestyle (Mills and Sullivan, 2000). The research presented in this paper uses a survey method, and reveals that patients require honest communication and more help with everyday living from nurses to facilitate recovery. Each patient is unique but commonalities can be established that improve experience and outcome. Three themes emerged from the data: food, activity and positivity. To meet long-term needs, the Oesophageal Patients Association is fundamental for patients and carers in order adapt to this major life changing event.
Preparing for practice: how well are practitioners prepared for teamwork
Authors: Caldwell Kay , Atwal Anita , Copp Gina , Brett-Richards Madeline , Coleman Kate
Published: May 2014

This article reports on the findings of a study that aimed to explore how relevant initial training is in relation to teamwork, and to explore the perceptions of newly qualified practitioners about their confidence to work as a member of a team. A cross-sectional postal survey was used to ascertain the views of nurses, social workers, occupational therapists and physiotherapists who had been qualified between six months and two years prior to the survey, and had qualified at one of three London universities. Fifty questionnaires were sent out to each professional group (a sample of 200 overall) and there was a 43% response rate. Findings revealed that respondents reported positive experiences of team working, with only one area – equality of status within teams – being highlighted as problematic. While no other area generated this level of disagreement, there were two other areas in which respondents felt unsure: cooperation within the team and conflict resolution within the team.
Assessment of altered conscious level in clinical practice
Authors: Palmer Rachel , Knight Jessica
Published: May 2014

This article will critically appraise the literature focusing on the use and application of the Glasgow Coma Scale (GCS). Historically the GCS tool was created in a 14-point format and later revised to a 15-point format. Critical analysis of this potentially confusing aspect will be explored. The GCS tool enables the healthcare practitioner to effectively monitor the level of consciousness. The authors believe that anatomical and physiological knowledge is required to competently interpret assessment of level of consciousness. The article will review the anatomical basis of consciousness and consider some of the issues of application of GCS in practice, including painful stimuli.
Improving patient safety in the NHS
Authors: Tingle John
Published: May 2014

Nurses, like other healthcarers, have an important role to play in guaranteeing the safety of patients in the NHS. Patient safety and improving the quality of patient care are prime NHS health policy drivers. The National Audit Office (NAO) have recently published a report, A Safer Place for Patients: Learning to Improve Patient Safety (NAO, 2005), on the progress made by the NHS in this area. NHS trusts are found to be predominantly reactive in their response to patient safety incidents and parts of some organizations still operate a blame culture.
Being a research participant: the nurse's ethical and legal rights
Authors: Griffiths Pauline
Published: May 2014

Nurses and their patients/clients are increasingly being approached to participate in research projects conducted in the clinical setting. However, such research involving human participants raises many ethical and legal concerns. This article provides nurses with an overview of their rights when asked to participate in such research. The ethical and legal principles that must be respected when such research is being conducted are presented and questions to ask of the researcher suggested. The role of the nurse, as required by their professional duty of care, to protect patients' rights during research in the clinical setting is highlighted.
Cardiac patient assessment: putting the patient first
Authors: Scott Curie , MacInnes Julie D
Published: May 2014

Nursing roles are expanding and there is a growing expectation that nurses, with appropriate education and experience, are able to perform assessments that were traditionally conducted by doctors. This article discusses patient history, vital signs and physical examination related to the cardiac patient. This will enable practitioners to enhance their knowledge and understanding of this valuable assessment influencing patient care.
Dignity is inseparable from nursing
Authors: Castledine George
Published: May 2014

I am sure I am not alone when I read with some surprise that the Government was calling for a ‘Dignity Nurse’ to be appointed in every health service hospital Womack (2006).
What price do we place on wound dressings?
Authors: Beldon Pauline
Published: May 2014

The recent Department of Health (DH) consultation document ‘Arrangements for the Provision of Dressings, Incontinence Appliances, Stoma Appliances, Chemical Reagents and Other Appliances to Primary and Secondary Care’ (2005), has caused a stir in more than one nursing field. Aside from the implications of change in the provision of stoma and incontinence devices, the commercial directorate of the DH appears to have on its agenda the reduction of wound dressing prices. There is a discrepancy between the reimbursement prices for primary and secondary care, there is also a discrepancy between the additional services provided by some companies and not others, such as support from company nurse advisors, help with case reports, patient information literature, education (both formal and informal), to name but a few examples.
Skin barrier function and the use of emollients in dermatological nursing
Authors: Lawton Sandra
Published: May 2014

Nurses will be observing the skin on a daily basis while caring for their patients. Many may appear to have a dry skin or have a skin disease with dryness being the presenting feature in conditions such as atopic eczema, contact dermatitis (irritant and allergic) psoriasis and the ichthyoses. This article explores the barrier function of the skin, factors which influence skin barrier function and the use of emollients for dry skin and skin conditions.
Preventing falls in hospital – time to change step?
Authors: Hayes Nicky
Published: May 2014

Total prevention of patient falls, like total prevention of pressure sores, is an unobtainable holy grail of patient safety. It is unreasonable to expect that, when rehabilitation and mobilization are a vital part of recovery, a zero falls rate can ever be achieved. But even so, we are nowhere near close to it. We now know, thanks to the National Patient Safety Agency’s (NPSA) comprehensive trawl through hundreds of thousands of falls reports (NPSA, 2007) that, on average, an 800-bed acute trust can expect to have at least 1260 inpatient falls every year. That is 4.8 falls per thousand bed days, and these are only the ones that the NPSA hears about.