bluuebunny/crossref_metadata_2025 huggingface dataset:
Abuse by care professionals. Part 1: an introduction
Authors: F Barber Christopher
Published: May 2014

It is often the most vulnerable members of society that suffer from the physical, psychological, sexual, financial, neglectful and/or discriminatory maltreatment that characterizes the multifaceted nature of abuse. Individuals dependent on care, whether in the remit of health and social care or educational support, may suffer from abuse at the hands of care professionals. This article introduces a series on abuse with a focus on the various definitions of abuse and the historical and international context of mistreatment.
Regulatory codes of conduct and the common law. Part 2: confidentiality
Authors: Fullbrook Suzanne
Published: May 2014

In part one, three aspects of the principles that underpin the law of confidentiality were identified from a review of case law. Public interest(s), public safety and the protection of vulnerable people were identified as producing a matrix whereby health providers could see that the rules relating to confidentiality were viewed by all in society as being of the utmost importance. This article concentrates on the codes of conduct that two regulatory bodies have produced to guide the practice of health professionals. The General Medical Council (GMC) and the Nursing and Midwifery Council (NMC) have codes of conduct that are very similar in their guidance. This is not surprising given that the central importance of confidentiality is reflected at the highest possible levels of judicial and political thinking.
Change management in cancer care: a one-stop gynaecology clinic
Authors: A Knight Jenny
Published: May 2014

Creating a Patient-Led NHS (Department of Health, 2005b) advises us to develop services with the patient at the centre of all that we do. In today’s current agenda for reform and improvement, with the additional pressure on organizations to achieve Government performance targets where there is increasing demand and limited resources, it is sometimes difficult to provide the optimum patient experience. This article describes how a district general hospital used continuous quality improvement methodology to improve quality of care when developing a one-stop diagnostic clinic for patients urgently referred with suspected gynaecological cancer. As well as increasing clinic capacity and meeting access targets, redesigning the patient care pathway to improve services also provides the opportunity to build in patient choice and convenience. The article also discusses how clinical teams can involve patients when planning and evaluating services, and explores user involvement as a core component of continuous quality improvement methodology.
Abuse by care professionals. Part 4: an exploration of available resources
Authors: Barber Christopher
Published: May 2014

This fourth article will explore the resources available to those who are abused and also the measures available to prevent abuse by healthcare professionals. It was found that, despite good intentions, available measures, which include training and supervision of those likely to abuse, changes in environment, relying on the victim’s own support network and generalist professional support networks, are far from adequate. There are a number of measures available to prevent abuse by care professionals from happening. These include clinical supervision, continuing professional development and training, current research awareness and implementation and vastly improved communication between care providers. The only organization that appears to be working in the field of abuse by healthcare professionals is the London-based voluntary sector organization WITNESS.
Is health care a right?
Authors: Castledine George
Published: May 2014

It is that time of year again when the political parties are holding their annual conferences and one of the hottest subjects is of course health care. With lots of promises of more money and resources, the question of whether health care is a right continues to be debated. Almost all industrial nations face questions of limited resources and escalating costs. These issues create ethical challenges worldwide involving the allocation of healthcare resources. One particular concern, which has recently been debated, is the issue over the priority given to the treatment of people who abuse their own health, particularly through smoking and overeating.
Development of a critical care nursing research strategy: a tripartite approach
Authors: Richardson Annette , Turnock Chris , Gibson Vanessa
Published: May 2014

The building of nursing research capacity is important, as it improves the quality of nurse education, the talent of nurses and the standard of patient care. A local critical care nursing research strategy was developed using a tripartite model applied to practice. This was a collaborative approach to critical care research as a model to direct, deliver, facilitate and support nursing research in practice through planned and protected investment in nursing research time. The tripartite model was evaluated and recommendations made with the aim of sharing findings so that other nurses can utilize these experiences to set up similar secondment opportunities for the promotion of nursing research.
A multidisciplinary approach to self care in chronic pelvic pain
Authors: Pearce Chris , Curtis Maxine
Published: May 2014

Chronic pelvic pain is one of the most difficult conditions encountered by health professionals working with women both in primary and secondary care. The cause is variable, and for some women a diagnosis is never determined. While it is acknowledged that it is a symptom and not a condition, many women and professionals continue to seek a cause and cure. It is contended that this client group is best supported by a multidisciplinary approach to symptom control that incorporates the skills of the gynaecologist, physiotherapist, nurse, psychologist and pain management specialist. This is often difficult to achieve within a resourcelimited environment. An alternative approach is suggested using current resources which provides patient education and support, thus empowering women to influence their health behaviours and situations
Prostate cancer telephone helpline: nursing from a different perspective
Authors: Ross Tania
Published: May 2014

Prostate cancer is now the most common male cancer in the UK with 32 000 men diagnosed annually (Cancer Research UK, 2006). The increasing numbers of men diagnosed, as well as those requiring ongoing support, places a huge burden on NHS services. The best options for managing the disease are not yet known, and the development of newer treatments has increased the difficulty men face in making the right choice. The important role The Prostate Cancer Charity’s confidential nurse-led helpline plays in providing information and support to men and their families will be demonstrated in this article. The specialist nurses who deliver this service are highly skilled, knowledgeable and experienced. The training and support they need to deliver this service effectively is provided through a variety of methods which will be described. Our priority is to assure the ongoing quality is maintained for every caller and an effective skill set is maintained.
Ten steps to convert your assignment into a journal article
Authors: Devitt Patric , Hardicre Jayne , Coad Jane
Published: May 2014

Nurses spend a great deal of time and effort in constructing a variety of assignments and dissertations as part of courses, both at undergraduate and postgraduate levels. It is not uncommon to read comments from lecturers such as ‘this requires only minimal work to be published’. It might be assumed that many assignments and dissertations would therefore go on to appear in print; however it is questionable just how many of them ever do materialize in journals. The reality is that this transition can be a challenging process. This is highlighted when a search of the literature for use in preparation for this article the authors discovered a dearth of advice to help potential authors make the transition from good quality assignment to published article. With this in mind we will try to guide you through a process that will assist you in converting your academic work into an article fit for publication.
Psychological and physical care of malodorous fungating wounds
Authors: Lazelle-Ali Clare
Published: May 2014

To be given a diagnosis of cancer is devastating, but to develop a malodorous fungating tumour can only serve as a constant reminder of the power this disease has over a person’s life. It can have a profound effect on quality of life, and the patient often experiences depression, shame, embarrassment and alteration of body image, sometimes leading to social isolation. A literature review looking at the management of these wounds demonstrated limited clinical research on which to base evidence of the best care and although much is written about the psychological effects, there is little to show that these needs are being met. The aim of this article is to explore if nurses are equipped to care for the psychological problems of these patients and briefly considers the psychological issues the nurses caring for these patients may have.
The use of antiembolic stockings. Part 2: a clinical audit
Authors: Walker Linda , Lamont Sue
Published: May 2014

Aim: To audit current practice regarding selection and use of graduated elastic compression stockings (GECS) in the authors’ Trust. Following a literature review it was important for the Trust that the authors audited current practice before the development and implementation of any new guidelines.

Background: A literature review enabled the authors to establish best practice principles for the use of GECS and develop guidelines for use across their Trust. However, feedback from various sources highlighted conflicting practices regarding the methods by which patients either did or did not receive stockings, and which lengths and brands were used. As the guidelines aimed to allow implementation of standardized change across the Trust, it was important to establish current practice with regard to GECS selection and use. Therefore, an audit tool was developed carried out on the use of GECS

Methods: An audit tool was developed and implemented to establish the practices before the implementation of the guidelines

Results: The audit demonstrated that there was no consistent policy within the surgical services directorate for the correct use of GECS

Conclusions: It is important that all healthcare providers have a local policy for GECS use, which makes it clear how an assessment for patients requiring GECS needs to be conducted and how that assessment is documented.
MUST scoring – a ‘must’ or a waste of nursing time?
Authors: Williams Geraint , Keir Elisabeth
Published: May 2014

Hospital malnutrition is a major clinical and public health problem, affecting at least 2 million people in the United Kingdom. The subject captures national attention and has provoked escalating efforts towards prevention (Banks, 2006). A significant number of patients admitted to hospital are either malnourished or at significant risk of becoming so. Malnutrition predisposes to disease, delays recovery from illness, and adversely effects wellbeing and clinical outcome. Attention to nutrition may be deficient due to the diffuseness of responsibility, other care priorities, and lack of staffing resources (Guenter et al, 1982).
Therapeutic positioning of the multiply-injured trauma patient in ICU
Authors: Christie Robert James
Published: May 2014

Critically-ill patients who have sustained multiple traumatic injuries have complex, and often conflicting, physiological needs. These have profound implications on the way in which nursing staff approach the physical positioning of these patients to minimize the risks of further physiological injury and damage, maintain homeostasis and promote optimum recovery. This article reviews and discusses the evidence base underpinning therapeutic positioning of the multiply-injured trauma patient within the intensive-care unit (ICU), focusing on patients with a known or suspected unstable spinal injury, pelvic injury, traumatic brain injury, chest injury, or multiple limb fractures. Included are guidelines on the therapeutic positioning of the multiply-injured trauma patient within the ICU, based on the current available evidence and also drawn from practical experience within the author’s own place of work. There is also a brief discussion of how such guidelines may be introduced into clinical practice.
Advance decisions to refuse treatment component of the Mental Capacity Act
Authors: Bennett Carolyn , Bray Jane , Lobo Ben , Finn Greg
Published: May 2014

In January 2007 a project team was commissioned by the Department of Health to develop specialist guidance for advance decisions to refuse treatment (ADRT). ADRT is one component of the Mental Capacity Act (MCA) 2005, which provides a statutory mechanism protecting the advance decision-making process for people, particularly those who have a long-term condition and those approaching end of-life care. The ADRT project team is hosted by the Mid-Trent Cancer Network and works in close association with Care Services Improvement Partnership East Midland. ADRT is an integral part of advance care planning and its creation can protect patient choice before capacity is lost, often allowing death with privacy and dignity. Since October 2007 professionals and organizations have a legal duty to support ADRT and the MCA implementation. The aim of this article is to provide a practical introduction to ADRTs, focusing on the content of the ADRT specialist guidance and how this can be used to support implementation, education and training related to ADRT. Advance care planning is a significant component of the recently published End-of-Life Care Strategy.
Professional regulation. Part 4: Self-regulation and the Consumer Council
Authors: Fullbrook Suzanne
Published: May 2014

The thinking behind the Nursing and Midwifery Council, which came into being on 1 April 2002, was directed into two main veins: firstly, nurses who offended against the rules of the council would be disciplined according to a set of proscribed rule, with the spectre of being removed from the register ever present. The second vein was that of an increased presence and deliberate influence into the workings of the regulatory body, to the point of a lay input into the issue of sanctions being applied to nurses for perceived aberrant behaviour in addition to the influence asserted by Government by way of legislation (delegated legislation) and Department of Health policies and protocols. This resulted in layers of guidelines and ‘principles for practice’. This article reflects on the theoretical concept of ‘professional self-regulation’ in the context of a suggested framework – produced by the National Consumer Council.
Promoting presumed consent in organ donation
Authors: Noble Helen
Published: May 2014

For people suffering organ failure, transplantation is the accepted treatment to improve quality and length of life. Ironically in the UK we have a situation where improved healthcare is saving the lives of more people who may have been suitable donors in the past (London Health Sciences Centre, 2004). Alongside this, obligatory road traffic laws and hard-hitting anti-drinking-and-driving campaigns have contributed to fewer fatalities and consequently fewer donors.
Diagnosing and treating a patient with primary biliary cirrhosis
Authors: Sargent Suzanne , Fullwood Danielle
Published: May 2014

Primary biliary cirrhosis is a chronic cholestatic disease of unknown aetiology. It is believed to be of autoimmune origin, primarily affecting middle-aged women. The disease is typically characterized by progressive damage to intrahepatic bile ducts, leading to liver fibrosis and eventual cirrhosis. It accounts for 2% of all cirrhosis deaths worldwide. Disease symptoms are varied, with many patients being asymptomatic in the early disease stages, which is reflected by the 25% of patients who are diagnosed from incidental abnormal laboratory findings. Pharmacological therapies are useful in slowing disease progression and improving liver function tests; however, for many people liver transplantation is the only viable treatment for end-stage liver disease. This article provides an overview of the hypothesized aetiological factors, disease presentation, diagnosis and current treatment options.
Letter to the Editor
Authors: White Richard
Published: May 2014

The editorial in our last Tissue Viability Supplement in November, written by Miles Maylor, created quite some discussion. Here, Richard White discusses why the debate on clinical evidence is so topical and stresses that many are still skeptical about the true value of hierachy of evidence
What’s affecting future care delivery in tissue viability?
Authors: Stephen-Haynes Jackie
Published: May 2014

This year is the 60th anniversary of the NHS and there is enormous expectation of it in the United Kingdom to provide high quality care in an increasingly complex health environment; indeed the NHS is accowuntable for clinically cost-effective care across healthcare settings, including acute, primary care, mental health, hospices and independent care homes. This is accompanied by budget resource constraints which will affect future care delivery. Tissue viability faces several challenges, lacking both a medical lead and a national service framework. Engaging politicians, healthcare professionals and the patient is important (Gray, 2005).
Shared decision making and its role in end of life care
Authors: Kay Frank Rosanna
Published: May 2014

Currently, ‘shared decision making’, which involves the multidisciplinary team, i.e. the patient, nurse and doctor making joint decisions is advocated in many governing policies to improve the care of the dying patient. The UK population is ageing at an everincreasing rate, which means that more people are experiencing a progressive death typical of that associated with chronic disease. These patients are suitable for participation in end of life decision making due to the pre-existing knowledge of impending death. Health-care professionals can assist the patient to achieve a ‘good death’ based on the patient’s preferences, wishes and needs. The aim of the literature review discussed in this article was to identify the extent to which shared decision making currently exists during end of life care in the acute/hospice setting. Particular attention is paid to patient participation, the nurse’s role, and the doctor/nurse relationship – factors that may facilitate or prevent shared decision making. Eighteen qualitative research papers published between 1997–2007 were reviewed and analysed, and demonstrated a strong link between shared decision making and a ‘good death’. However, the research reviewed identified that although shared decision making can exist within end of life care, there are a number of reasons why this is not being achieved throughout the secondary care setting.
When last offices are more than just a white sheet
Authors: Nyatanga Brian , Vocht Hilde de
Published: May 2014

The recently published End of Life Care Strategy in the UK encourages people to talk openly about death and dying (Department of Health, 2008). The idea should not only be applicable to palliative care settings, but to other healthcare environments and the public sector. It is through talking that attitudes may shift and dismantle the taboo around death. There are numerous areas to consider, but for this commentary, one fascinating area of death is the meaning and impact of last offices.
Recognizing and responding to hyperglycaemic emergencies
Authors: Kisiel Maria , Marsons Lorraine
Published: May 2014

Diabetic ketoacidosis (DKA) and hyperglycaemic hyperosmolar state (HHS) are both diabetic emergencies associated with hyperglycaemia and can be fatal if healthcare professionals fail to recognize and intervene appropriately. While many students and qualified nurses may be able to recall common signs and symptoms related to DKA and HHS – for example polyuria, polydipsia and elevated blood sugars – understanding the physiological mechanisms behind abnormal observations and restoring homeostasis through appropriate management is far more complex. Health educators can play a significant role in contextualizing difficult concepts, such as DKA and HHS, so that these complex conditions can be recognized with greater confidence and competence in clinical practice.
Airway management of an elective surgical patient
Authors: John Pritchard Michael
Published: May 2014

Airway management is a skill that all healthcare professionals need to learn. This skill is used in two specific areas. First, in emergency situations such as cardiac arrest or respiratory arrest. Second, and the subject of this article, the postanaesthetic patient. This article explores not only the anatomy of the respiratory system but the different techniques and methods employed to manage a patient’s airway. Airway management can be divided into three distinct phases. The first phase deals with the management of the airway while the patient undergoes an operation; this is managed by the anaesthetist. While the second phase deals with the patient’s airway in the immediate recovery period, it usually occurs in a recover room and is managed by a recovery nurse. The third phase is when the patient returns to the ward, and for the first 24–48 hours after a general anaesthetic. It is only by recognizing the signs and symptoms of respiratory distress and initiating effective treatment that serious consequences can be avoided
Increasing the academic level of nursing
Authors: Karstadt Lyn
Published: May 2014

Nursing and midwifery education has evolved over the past few decades, leaving many in the profession — as well as education — slightly confused as to what is going on. In her ongoing column, Lyn Karstadt considers the possible impact of new standards for initial nurse education, both on nursing skills and attitudes to nursing in general.
Recognizing nurses’ contribution to patient care
Authors: Black Peter
Published: May 2014

Yet another cold, wet, windy winter. In fact, last month was the wettest November on record in the UK (Met Offi ce, 2009). With December’s weather looking precarious, is the state of our health care also ending the year in a maelstrom of uncertainty?
An evaluation of nurse prescribing. Part 2: a literature review
Authors: Creedon Rena , O’Connell Elizabeth , McCarthy Geraldine , Lehane Brenda
Published: May 2014

Aim: This is the second of a 2-part literature review, which aims to provide a summary of the research conducted into nurse prescribing and patients’ perspectives, the prescribing practice and benefits of prescribing. Background: Prescriptive authority for nurses was first introduced by America in 1969, followed later by the UK, Canada, New Zealand, Australia and Sweden. A review of research conducted internationally was performed to inform the development of prescribing policies and practice and to guide future research. Method: A number of electronic databases were searched in March 2009 and 155 results were retrieved. Forty-four studies satisfied the criteria for inclusion. Twenty-two of those studies are included in this part of the review. Findings: Sixteen studies reviewed were UK based, four from the USA and just two from Australia. Twentyone of the studies focused solely on primary/secondary care, with just one on the hospital setting alone. Twelve studies incorporated nurse prescribers’ views, while nine elicited patients’ views and one explored the views of the general public and nurse prescribing. Findings of studies relating to patients’ perspectives on prescribing were generally positive but methodologies in these studies were very diverse. Varied and context-specific evidence of the practices of nurse prescribers was presented in studies investigating this aspect of nurse prescribing. Conclusion: This review has demonstrated the diversity of research conducted in the area of patients’ perspectives on nurse prescribing, prescribing practices and benefits of nurse prescribing. It has identified areas that require further investigation which, in turn, will inform the future development of nurse and midwife prescribing.
An appraisal of the first annual report of the Standing Commission on Carers
Authors: Glasper Alan
Published: May 2014

Policy is an integral component of nursing. Practitioners need to be aware not only of the content of new policy, but the wider context and political aspects in order to recognize how policy impacts on professional practice. In the first of this new BJN column, Alan Glasper, Professor of Nursing at the University of Southampton, examines the implications of a new report on carers in the NHS.
Breast cancer-related lymphoedema: risk factors and treatment
Authors: Harmer Victoria
Published: May 2014

Lymphoedema is a condition where there is an obstruction of the flow of lymph, partnered with a swelling of the limb. Within the breast cancer arena lymphoedema can occur in the arm where the cancer was/is. The various approaches to treating lymphoedema include skin care, elevation of the affected arm, the use of compression hosiery, multi-layer bandaging, massage (manual lymphatic drainage), or even surgery. This article will discuss the treatments for lymphoedema along with relevant evidence and illustrate current practice.
Teaching transanal irrigation for functional bowel disorders
Authors: Coggrave Maureen , Norton Christine
Published: May 2014

Transanal irrigation of the bowel in the management of functional bowel disorders is currently receiving increased attention following the recent introduction of the Peristeen irrigation kit (Coloplast Ltd) in April 2007. Irrigation provides a welcome additional choice in the limited range of available interventions for the management of these patients. However, evidence to support clinical practice around irrigation is limited and nursing knowledge and experience of irrigation is only just developing. This paper reports a series of master classes conducted to support and develop the use of irrigation in the UK, and demonstrates the value of the master class as an educational tool when introducing a novel therapy.
Are nursing students still a special case?
Authors: Karstadt Lyn
Published: May 2014

Despite the fact that many student nurses can take on extra work to get through their studies, many still receive a superior financial package to other health-care students, whose bursaries have long been means tested. But, asks Lyn Karstadt, as nursing, like midwifery, is poised to become an all-graduate profession, should nursing students still receive special financial support?
Executive pay is rising – guess who’s footing the bill?
Authors: Beckford-Ball Jason
Published: May 2014

With the credit crunch hard upon us and the news full of failing businesses, G20 protests and all-round financial anxiety, you would think that now would be a good time for everyone to tighten their belts, cancel any exotic holiday plans and put thoughts of a pay rise on the back burner. Well, you’d be wrong. Unfortunately, it seems that one group of public sector employees has forgotten to read the newspapers lately and, uncomfortably for any of us connected to the NHS, we are not talking about fatcat hedge fund managers or Russian billionaires, but the very people in charge of our health services – Trust chief executives.
The Mental Capacity Act – a balance between protection and liberty
Authors: Walters Thomas Paul
Published: May 2014

The stated aim of the Mental Capacity Act is to provide greater protection to those who may lose their mental capacities, particularly in terms of informed consent, patient affairs, advanced decisions and research. This article attempts to explore this new statute by way of examining the scope to which the Act departs from the previous Common Law. Three key themes are identified within this new Act, which differentiate it from Common Law: patients’ best interests, which is paramount to any care or treatment; proxy consent, whereby donees can now be appointed to take charge of medical decisions; and advanced directives, where so-called living wills can be enforced provided that they are specific, written, signed and witnessed. However, upon examining the statute it appears that rather than increasing patient autonomy and self-determination, evidence suggests that power is still being held by the medical profession. Whether patients have full autonomy or not, the main issue could be how to strike an effective and workable balance between protection and liberty
Tissue viability can often be a leap into the unknown
Authors: Young Trudie
Published: May 2014

We often hear of other tissue viability nurses adapting techniques and working outside conventional methods, usually driven by the need to deal with complex situations that cannot be remedied with a 10cm X 10cm dressing. It is from these novel and often ground-breaking developments that new working practices emerge.
Lower urinary tract symptoms in women with multiple sclerosis: part 1
Authors: Rantell Angie
Published: May 2014

Multiple sclerosis (MS) affects about 85,000 people in the UK, and is the commonest progressive neurological disease affecting young people (Compston and Coles, 2002). Bladder dysfunction can be found in up to 75% of patients with MS (DasGupta and Fowler, 2003). In a study by Hemmett et al (2004), 87% of people with MS reported bladder symptoms and 70% felt that they had a moderate to high adverse effect on their quality of life. This article, the first in a two-part series, examines how MS can affect normal bladder function, looking at what symptoms patients may present with. It also provides an overview of how nurses can assess and diagnose these bladder problems. The conservative, pharmacological and surgical interventions for the management of lower urinary tract symptoms will be discussed in the second part of this series.
Sharing best practice in stoma care nursing
Authors: Willams Julia
Published: May 2014

A problem shared is a problem halved; a very poignant proverb that forms the essence of this year’s World Council of Enterostomal Therapists (WCET) UK conference in Coventry. Sharing experiences from practice is invalid if clinical practice is to grow and develop. It raises awareness, offering the opportunity to question and review practice. Sharing practice offers opportunities to enquiring minds
Using ActivHeal®> dressings in a London teaching hospital: a cost analysis
Authors: Lewis Sarah
Published: May 2014

Lower-cost ‘generic’ wound dressings are now available in the dressing categories of foams, films, alginates, gels and hydrocolloids. This offers the possibility of achieving significant financial savings while retaining good clinical standards of wound care. To test the potential for cost saving in a typical London teaching hospital, the ActivHeal®> range of dressings was substituted for normal ‘branded’ dressings over a 3-month period, during which dressing cost and clinical effectiveness were assessed. The result was an equivalent yearly cost saving of £55 221 (54%), with retention of performance standards across the dressing range. Two years after the trial, wards in University College London Hospitals NHS Foundation Trust continue to benefit from significant annual cost savings on dressings by using the ActivHeal range of products, while maintaining a high standard of clinical care.
Psoriasis: impact and management of moderate to severe disease
Authors: Wheeler Tracey
Published: May 2014

Psoriasis is an autoimmune chronic inflammatory skin disease that typically exhibits a flare and remission pattern, with a number of known genetic and environmental trigger factors. While mild psoriasis is a manageable disease that is coped with well by the majority of sufferers, moderate to severe disease has a profound physical and psychological impact; there are, in addition, a number of important comorbidities. Treatments include topical, ultra-violet light, and systemic therapies including recent advances in biological drugs. This article summarizes these treatments and the nursing care required for the patient in severe flare; it discusses the considerations the nurse should have in enabling a patient to self manage their condition, offering support that is practical and psychological, with health education often including family and carers
Opportunistic infections in HIV disease
Authors: Wingfield Tom , Wilkins Ed
Published: May 2014

Since the emergence of the HIV pandemic in the 1980s, there have been great advances in the treatment of HIV through potent and effective antiretroviral therapy. This has led to HIV-infected individuals presenting with fewer opportunistic infections and, subsequently, leading longer lives in better health. Nevertheless, there are HIV-positive people in both high- and low-resource settings who may present late with marked immunodeficiency or have no access to adequate medical care and antiretroviral therapy. Within these populations, opportunistic infection rates still remain unacceptably high. This article outlines the varie;ty of opportunistic infections that can be seen in clinical practice, and highlights the way in which these infections can be pre-empted, diagnosed and treated according to best practice guidelines.
In memory of Estelle Walker
Authors: Scott Julie
Published: May 2014

It is with sorrow that I write about our esteemed colleague Estelle Walker, who died earlier this month aged just 58.
The NMC quality assurance framework for nurse education
Authors: Glasper Alan
Published: May 2014

Professor Alan Glasper, an NMC reviewer, surveys the history of nursing regulation in the UK and examines the workings of the NMC’s rigorous quality assurance framework for nurse training programmes
Lansley’s ambition for the NHS
Authors: Castledine George
Published: May 2014

Since the general election, it has been rather quiet with regard to the new Government’s proposals for health care. Perhaps it was all the uncertainties of the coalition-building and the UK’s present financial problems that had left a vacuum or a feeling of suspension. Anyway, the first indication or hint of what is ahead for us came from a speech by Andrew Lansley, the new Secretary of State for Health, at the Bromley-by-Bow Centre on the 8 June
NHS Direct: striving to meet future care demands
Authors: Young Helen
Published: May 2014

I wanted to respond to the comment piece by Richard Hoey, Editor of Pulse, debating the merits of NHS Direct
Knowledge and attitudes to reporting adverse drug reactions
Authors: Pulford Andrew , Malcolm William
Published: May 2014

The reporting of adverse drug reactions (ADRs) by health professionals forms an important component of ongoing surveillance of post-marketing drug safety. The extension of responsibility for all health professionals to report ADRs has coincided with national immunization programmes, such as the national childhood immunization, human papillomavirus (HPV), and seasonal and H1N1 influenza programmes. The study objective was to evaluate knowledge of, and attitudes to, reporting ADRs among the professional groups most likely to see suspected reactions to vaccines. This included nursing professionals, whose views have not been included in previous studies. A survey of 91 practice nurses, health visitors, school nurses and GPs working in Ayrshire and Arran during June, July and August 2007 was undertaken. The respondents’ knowledge of ADR reporting varied considerably. Although the majority of respondents recognized that it is the responsibility of health professionals to report suspected ADRs, there were lower levels of knowledge about the purpose of the Yellow Card system specifically; less than 50% of the respondents reported good knowledge about the system. The study suggests implications for practice with regard to the implementation of large?scale immunization programmes and potential solutions to under-reporting among these professional groups
Psoriasis: the burden of disease and treatment
Authors: Wheeler Tracey
Published: May 2014

We’ve all met them: the patient with chronic disease that simply will not help themselves. Why don’t they listen to us? Why, when it’s clear they understand the principles, do they seem to do everything in their power to make life difficult for themselves—and, in turn, for us? Of course, as enlightened nurses we take the trouble to understand the individual, and learn that their failure to follow a treatment programme is connected to their feelings about their disease and their body. If they ignore the answer they are also ignoring the problem and, in some way, they are taking control of their situation, making choices and asserting themselves
Valuing the practice of nursing
Authors: Castledine George
Published: May 2014

New term, new nurses, new academic emphasis is very much the direction of nurse education these days. I wonder what will be said to those prospective pre-registration nurses who will be starting out on their careers in nursing over the next few weeks. It may seem a long time since many of us commenced our nurse training and education, and I am sure the early experiences of that time varied according to the school of nursing. The matron’s first talk or the principal tutor’s first address usually contained references to the state of the nursing profession and the role and behaviour expected of the student. With the merger into higher education and the involvement of a more academic content in nurse education, I am sure that the welcoming address has shifted its slant to a more evidence-based approach to care and a more scholarly responsibility
Patient and carer input and the NHS: A vital tool in improving care
Authors: Glasper Alan
Published: May 2014

In every other industry, ‘the customer is king’– so why should health care be any different? With reference to the Department of Health’s newly published legislation, Real Accountability: Guidance on the NHS duty to report on consultation, Alan Glasper examines the importance of patient and carer input into NHS services.
Nursing practice makes perfect
Authors: Karstadt Lyn
Published: May 2014

As the new decade dawns, Lyn Karstadt leaves negativity behind and looks forward to a brighter future for nursing; where despite common fears, practice remains absolutely pivotal.
The UK’s Supreme Court: how it works and why it exists
Authors: Hodgson John
Published: May 2014

This article looks at the new Supreme Court. It explains why the judicial House of Lords was replaced by the new Court and how the Court operates. It also explores whether the change of name also involves a change in either the jurisdiction of the court, or its role within the United Kingdom’s constitutional arrangements, particularly the relationship between the Judiciary and the other organs of the state, i.e. Parliament and the Executive.
Knowledge of heart disease risk in patients declining rehabilitation
Authors: Almerud Österberg Sofia , Baigi Amir , Bering Charlotte , Fridlund Bengt
Published: May 2014

Knowledge of heart disease risk in patients declining rehabilitation Background Participation in cardiac rehabilitation programmes (CRPs) allows patients to increase their knowledge of the importance of established risk factors to help them maintain healthy lifestyle changes after coronary heart disease (CHD). Aim To explore perceived importance and knowledge of known risk factors for CHD among non-attendees in CRPs. Method Consecutive non-attendees in CRPs (n=106) answered a questionnaire focusing on patients’ attitudes towards risk factors and cardiac rehabilitation. Results The non-attendees lacked knowledge of non-physical characteristics such as depression and social isolation. They also had poor knowledge about biological causes and hereditary factors. However, those who said they knew enough about CHD to prevent recurrent illness did have sufficient knowledge about the established risk factors. Conclusion There is a lack of knowledge about social isolation and depression and their importance in the development of CHD among the non-attendees. They show greater knowledge about biological risk factors than the importance of companionship, joy and happiness. CHD and loneliness are intimately correlated, so creating a sense of belonging must not be underestimated as a measure to prevent CHD
Medication errors: types, causes and impact on nursing practice
Authors: Agyemang Rebecca Esi Owusu , While Alison
Published: May 2014

Medication safety is a worldwide concern and a health priority, particularly in the UK. Safe and accurate medicine administration depends on correct prescribing and dispensing. Medication administration in hospital is the final stage of the medication process; nurses should be able to recognize errors in this process and prevent these errors from reaching the patient. Focusing on the serious consequences for those nurses involved in medication errors not only results in low reporting rates, but can also hamper effective improvements in medication safety, and lead to failure to discover the underlying contributory factors. This article explores the personal and organizational factors that contribute to medication errors among within hospital ward settings.
The PM's Commission
Authors: Castledine George
Published: May 2014

The Stafford inquiry has given numerous examples of poor front line nursing care. But now, as if to answer some of the questions raised in that inquiry, and to set the agenda for the future direction of nursing, comes the recent publication of the Prime Minister’s Commission on the future of Nursing and Midwifery in England. The report is aptly named, Front Line Care and is the first overarching review of nursing and midwifery in England since 1972
Patient safety and professional practice across European borders
Authors: McHale Jean
Published: May 2014

Patient safety issues have increasingly become an issue of concern by the European Union (EU). This paper explores some recent EU proposals in the area of patient safety. It suggests that these proposals may have broad implications at member state level and ultimately may impact on professional practice standards in the UK.
Quality: a changing world?
Authors: Fox Jane
Published: May 2014

Jane Fox discusses quality of care today
The imperative of human obesity: an ethical reflection
Authors: Meetoo Danny
Published: May 2014

Good health for all has become an accepted international goal. Arguably there have been broad gains in life expectancy over the past century. However, the escalating epidemic of adult obesity, estimated at more than 1 billion worldwide, has become a major public health concern. Obesity affects people of all ages and socioeconomic backgrounds. It is invariably perceived as a product of biological, psychological and social conditions, thereby casting aside its ethical imperatives. Without undermining the role of medicine in managing obesity, this article proposes to discuss the need for nurses to consider relevant ethical principles when supporting people with obesity.
Nursing issues: immigration
Authors: Castledine George
Published: May 2014

One of the biggest issues for any government today is the question of what to do about increasing numbers of legal and illegal immigrants coming into Britain. There is a fear that they are taking our jobs and not integrating into our society. The Labour Party’s manifesto put forward the proposal that in future all public sector workers should be able to speak English. The Tories spoke of tighter controls, and the Liberals proposed a regional system where immigrants would be restricted to working in certain areas of the country, depending on regional and local needs
The impact of nurses’ values on the prevention of pressure ulcers
Authors: Samuriwo Ray
Published: May 2014

Values are perceived to be a key determinant of people’s behaviour and actions. There is a limited amount of research into the value that nurses place on the prevention of pressure ulcers, but past studies have suggested that nurses place a low value on pressure ulcer prevention. This article describes a study that was undertaken to ascertain what value nurses place on pressure ulcer prevention. The participants in this study (n=16) were recruited from the non-acute adult medical wards of 14 hospitals of one NHS trust and a local university. Data were gathered via semi-structured interviews, then transcribed and analysed via Straussian grounded theory. The findings of this study show that the value that nurses place on pressure ulcer prevention is important because all nurses attempt to work in line with the value that they place on pressure ulcer prevention. The nurses who place a high value on pressure ulcer prevention appear to be more proactive and determined to deliver care that protects the care of their patients’ skin. However, the findings suggest that the efforts of nurses to prevent pressure ulcers are often impeded by environmental factors like bed management, and the differing values placed on ulcer prevention by colleagues. It also shows that interventions to protect the skin of patients are often undertaken by healthcare assistants and students because nurses are too busy carrying out other tasks.
Writing for professional publication. Part 5: Creating interest
Authors: Fowler John
Published: May 2014

The first four parts of this series on writing for professional publication focused on the research and preparation required before beginning to write a potential article. In this fifth part of the series, John Fowler, an experienced nursing lecturer and author, explores the final step in preparation for writing: that of creating interest.
Monitoring health services' use of the Mental Health Act
Authors: Tingle John
Published: May 2014

John Tingle discusses the Care Quality Commission’s first report on the exercise of its functions in keeping under review the operation of the Mental Health Act 1983.
Children's nursing research: toward development, drudgery or demise?
Authors: Long Tony
Published: May 2014

This paper, based on a presentation to the UK Association of Chief Children's Nurses, is the author's personal reflection on the nature and future of children's nursing research. Key constitutive elements of this concept are considered to arrive at the conclusion that children's nursing research is research undertaken by children's nurses into questions of relevance to children's nursing practice and services, or wider issues in which children's nursing has a vital role. Three possible futures are presented, of which only the last is positive and desirable: development in line with the reality of practice and population needs. An integrated approach is necessary, with responsibilities both for those in positions of authority in the service and for researchers themselves. In particular, this partnership is essential for children's nursing to evidence the impact of research and for children and young people to reap the greatest benefit from evidence-based practice.
Supporting self and others: from staff nurse to nurse consultant. Part 6: Giving and receiving feedback
Authors: Fowler John
Published: May 2014

This series of articles explores various ways of supporting staff who work in the fast-moving and ever-changing health service. In previous articles, John Fowler, an experienced nursing lecturer, author and consultant examined the importance of developing a supportive working culture and the role of preceptorship, mentoring and clinical supervision. This article examines how giving and receiving feedback can be a supportive experience.