bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical skills: bed bathing and personal hygiene needs of patients
Authors: Pegram Anne , Bloomfield Jacqueline , Jones Anne
Published: May 2014

The maintenance of personal hygiene is essential for a patient’s health and wellbeing. Nurses play a key role in ensuring that the individual hygiene needs of patients are met. In this article the process of bed bathing a patient is described.
Avoiding the pitfalls and perils of catheter care
Authors: Nazarko Linda
Published: May 2014

Twelve per cent of hospital inpatients and 4% of community patients have an indwelling urinary catheter. Urinary catheterization increases morbidity threefold. The main hazards of catheterization are tissue damage, bladder damage, infection, encrustation and blockage. Obtaining informed consent before catheterization is extremely important. Restricting catheterization to those who clinically require this invasive procedure can reduce the number of people who are exposed to the hazards of catheterization. The use of silvercoated catheters can reduce the risk of infection and encrustation. Ensuring that practice is evidence-based further reduces the risks of catheterization.
Cellulitis and treatment: a qualitative study of experiences
Authors: Carter Kim , Kilburn Sally , Featherstone Peter
Published: May 2014

Although cellulitis is usually a relatively mild condition, it is potentially life threatening, often necessitating emergency treatment in either the acute or community care settings. The treatment of cellulitis with antibiotics is well established, with effectiveness generally measured against purely biochemical and clinical outcomes (Cox, 2002). Although important, these outcomes are centred purely on the disease process from the medical perspective and little is known about patients’ experiences of cellulitis. This qualitative study explores patients’ views on the management of community-acquired cellulitis in the secondary healthcare setting. Data were collected through semi-structured groups and individual telephone interviews. Participants were selected through purposive sampling and the Framework Analysis Technique was used to analyse the data. Three superordinate themes emerged: initial presentation/motivation for seeking help; confidence and satisfaction; anxiety and dissatisfaction. Severe pain was almost universally a cause of distress and flu-like symptoms delayed recognition. Health information and communication was generally poor. Participants largely welcomed a move from inpatient to day-patient or outpatient care provided there was adequate information and support. To meet the diverse needs of cellulitis patients, services must be more flexible and tailored to the needs of the individual. Patients are often not told what they can do to prevent recurrence.
Smoke and mirrors or real science?
Authors: Davis Paul J
Published: May 2014

I enjoyed a new experience at this year’s European Wound Management Association (EWMA) conference. Although a professional scientist and part-time academic, I was part of a team launching a new woundcare product called OxyzymeTM (Ivins et al, 2007). Our new technology for achieving oxygen balance in difficult wounds was ushered into a harshly sceptical world. Its arrival highlighted a dilemma faced by any purveyor of new technology in this sceptical environment – how to present it with enthusiasm and conviction, while avoiding the excesses of over-optimistic marketing.
A review of the four layer vs the short stretch bandage system
Authors: Gannon Robert
Published: May 2014

This article reviews current evidence in the treatment of venous legulcers. In particular, discussion focuses on whether the four layer bandage system (4LB) or the short stretch (SSB) system should be considered as the first-line treatment of venous leg ulcers. Using research terminology, relevant studies are analyzed for academic merit. In addition, a concluding discussion is held to consider the practical benefits of selecting a bandage strategy.
Nursing electives: an innovative and creative learning opportunity
Authors: Peate Ian
Published: May 2014

Nursing elective can provide the nurse (learner or registered nurse) with a host of new opportunities to experience and observe practice from a variety of different perspectives. The nursing elective should be planned well in advance and much time and thought should be given to preparing for this activity. There are a number of resources (human and material) available to help with the planning of the event and as such careful and thorough planning at an early stage can make the activity much more successful. The funding of the elective event needs to be thought about early on in the planning stage if this is likely to be an issue. Practical considerations, such as insurance cover, honorary contracts, travel and other documents must also be considered carefully. The elective opportunity has the potential to provide the individual with a unique experience, a chance to delve deeper in relation to a particular area of interest as well as potentially experiencing the provision of health care through an alternative lens. The success of the elective largely depends upon the amount of effort the individual puts into it.
Emergency care of the patient with subarachnoid haemorrhage
Authors: Cook Neal F
Published: May 2014

Subarachnoid haemorrhage (SAH) is a devastating neurological disorder which frequently leads to serious neurological impairment and is associated with high mortality and morbidity. One in twenty patients who present to emergency care environments with SAH are misdiagnosed. The emergency care environment presents as a challenging setting for the management of the needs of those following SAH, requiring proactive, knowledgable and holistic care to work effectively within a multidisciplinary context to achieve positive patient outcomes. This article highlights the key aspects of the nurse’s role in caring for a patient with a subarachnoid haemorrhage.
Understanding the coexistence of alcohol misuse and depression
Authors: Watts Malcolm
Published: May 2014

This article sets out to discuss some issues of this comorbid disorder. Initially the article defines both alcohol misuse and depression and provides indications of symptomatology, many of which overlap. The article identifies that prevalence is high and draws attention to issues of risk, self-harm and suicide. There is a short discussion on causative factors and the article describes the interrelation of these two disorders and goes on to compare the evidence for a cyclic comorbid disorder, where one increases the severity of the other. It goes on to identify issues of assessment, case management and treatment, including a brief discussion on pharmacotherapy and three psychological therapies.
Trials and errors: accidents in administration
Authors: Dickens Geoffrey
Published: May 2014

It is becoming increasingly clear that medication administration errors are common in routine clinical practice. I was co-investigator on a recent study (Haw et al, 2007) which found that errors occurred in one quarter of all administered doses in an inpatient psychiatric elderly unit. This is not an isolated result: error rates ranging from 3.5–27% of all prescribed doses have been reported in various medical and surgical settings (Barker et al, 2002; Prot et al, 2003; Tissot et al, 2003). In the most serious cases medication errors can have grave consequences for patients and clinicians.
Examining factors that influence the uptake of smoking in women
Authors: Field Carol
Published: May 2014

Smoking kills over half a million women around the world each year. This number is increasing rapidly as more women take up smoking while, at the same time, established smokers find it hard to quit. The health problems associated with smoking have, historically, been viewed as a male concern for two reasons. First, cigarette smoking prevalence among women in many countries, particularly developing countries, is still low compared with men. Second, there is a time lag between smoking becoming a widespread habit and the emergence of tobacco-related health problems. So, no country has yet experienced the full impact of smoking on women’s health. This article explores these reasons and examines whether the factors that influence the uptake of smoking are the same for men and for women, and thereby identifying if smoking is a gender-sensitive issue requiring gender specific strategies for tobacco control. This will have a bearing on the development of national strategies for reducing smoking prevalence and, by implication, health planning in the longer term. Given that nurses worldwide see millions of women on a daily basis, and in a variety of settings, they are in a crucial position to be able to promote smoking cessation and have an impact on the evolution of this public health crisis.
Professional regulation. Part 6: transition of regulatory bodies
Authors: Fullbrook Suzanne
Published: May 2014

The last article ended with mention of two distinct issues: the connections between the past (in terms of professional regulation in nursing) and the futuristic concept of regulation by external control (the Council for Healthcare Regulatory Excellence [CHRE]) – in the context of the Bristol Inquiry’s findings and recommendations that nurses should not be responsible for their professional selfregulation. This article illustrates, by way of documentary review, the comparisons between the previous and the current nursing regulatory bodies in terms of the attitude towards professional regulatory control. The next article will concentrate on the recent review into the conduct of the Nursing and Midwifery Council, conducted by CHRE, in the context of professional regulation.
The die has been cast? Rediscovering the essence of psychiatric nursing
Authors: Cutcliffe John R
Published: May 2014

Examination of the international literature that focuses on the historical ‘developments’ in psychiatric nursing shows a ‘back and forth’ shift in emphasis from interpersonal/therapy-based models to a concentration on pathophysiology, pharmacology and biological causation. Within this context, a number of ontological questions appear with conspicuous regularity and these are worthwhile considerations as they are tied to the very nature of psychiatric nursing. Examination of the relevant literature reflects this historical duality and indicates the existence of (at least) two versions of psychiatric nurse, each with a distinct emphasis. Given this documented duality, it is the duty of each nurse to ask themselves: What type of psychiatric nurse am I? What type do I want to be and what type would I want participating in the care of someone I love? Consequently, this article draws on bodies of literature pertaining to the extent of mental health problems, the views of mental health service users, and the different types of psychiatric nurse, in order to assist nurses in considering these questions. In the light of the clear emphasis evident within contemporary mental health policy and psychiatric nursing curricula, the article concludes that it may not be possible to reconcile the activities associated with both types of psychiatric nurse
Chronic diseases: the silent global epidemic
Authors: Meetoo Danny
Published: May 2014

In most industrialized nations and many developing countries chronic diseases or non-communicable diseases (NCDs) are the leading cause of death. In 2005, chronic diseases, such as cardiovascular disease, cancer, respiratory disease and diabetes caused 58 million deaths worldwide (World Health Organization, 2005). Despite strong evidence for the magnitude of this burden, the preventability of NCD causes and the threat they pose to already strained healthcare systems, national and global responses have been slow. This article provides a global overview of chronic diseases. It further explores the impact of globalization as an important determinant of NCD epidemics. Finally, in addition to working alongside policy-makers, the fundamental roles of nursing to promote health, prevent disease and alleviate suffering call for expression of caring for humanity and environment through political activism at all levels to bring about reforms of current global economic order.
Interruptions during drug rounds: an observational study
Authors: Kreckler Simon , Catchpole Ken , Bottomley Matthew , Handa Ashok , McCulloch Peter
Published: May 2014

Drug administration errors are a common problem; they contribute to unintended patient harm and may in part be due to distractions during the drug administration round. In this study, a prospective sample of 38 drug rounds on an acute surgical ward were observed, and their duration, time spent dealing with interruptions and nature of the interruptions were recorded. On average, 11% of each drug round was spent dealing with interruptions. There were one or more interruptions in two-thirds of the rounds studied (average 2.61 interruptions per round), with a mean duration of 1 minute per interruption. The interruptions came from doctors (21%), other nurses (17%), patients (11%), telephone enquiries (8%), relatives (3%) or were initiated by the nurse conducting the round (21%). This pattern contradicts the subjective impressions of nurses in previous questionnaire studies, but it was notable that the longest individual interruptions were from conversations with patients (mean 249 seconds) and phone calls (mean 212 seconds). The data confirm the frequency of interruptions, and their potential as a safety hazard. Objective information from direct observation will prove valuable in designing possible solutions to the problem. These will require local knowledge and frontline staff involvement to be sustainable.
Contemporaneous nursing: a conclusion to the 2008 series
Authors: Fullbrook Suzanne
Published: May 2014

This 2008 series has sought to identify, discuss and analyse two issues that confront nurses in the 21st century. First, the legal duty of care that all healthcare professionals and other workers owe has been reflected on in the context of ‘standards’. The question asked was that of how differently the legal principle, from the political expectation, is identified and applied in practice by nurses and other healthcare providers. The second issue was professional regulation. By considering the political expectations placed on nurses and others it has been possible to trace the ways in which the Government has sought to assert increasing direct control on nursing as an aspect of healthcare provision, and on the behaviour of nurses as providers. This article explores how while the law directly influences nursing behaviours, its influence is not always obvious or clear. The emergence of a clear political direction, set by those who are not necessarily members of the nursing profession, has consequences, consequences that this series has sought to identify and analyse. In juxtaposition to the contents of government literature, experiences of nurses as the people most likely to have been affected by the changes have been recognized. A polarization of expectation has been identified between those in positions of control over change, and those who cannot separate themselves from other elements of their lives (e.g. domestic responsibilities). This last article seeks to reassure nurses that their professionalism is not in doubt. The changes are in the clinical domain of care provision, in the ways in which practice is applied and the needs of patients measured and assured.
Ensuring a holistic catchphrase of reform
Authors: Black Peter
Published: May 2014

The catchphrase the Government has been using to epitomize their aspirations for the NHS is ‘personalized care’. Perhaps this catchphrase will finally start to gain weight as the Government moves into phase III of its public service reform strategy. Phase I was ‘targets and minimum standards’; phase II added the extra criteria of ‘expanded user choice and diversity of supply’; and phase III centres on personalized services
Nursing care and management of patients with sarcoidosis
Authors: Page Martin
Published: May 2014

Sarcoidosis is a rare genetic autoimmune disease that can attack any organ and tissue type in the body. Although it has been recognized for over 100 years the aetiology remains unknown. The group most at risk is black females under the age of 40, but no group is immune to it. The disease is commonly asymptomatic at diagnosis and often resolves without medication; however, where it does manifest it can become chronic and can be fatal. Corticosteroids are the preferred treatment although there are alternative approaches. The disease can develop in different systems simultaneously, and sarcoidosis of the lungs, skin, eyes, heart, the central nervous and musculoskeletal systems are explored in this article. The practicalities of nursing are discussed, and the work of the nurse Imogene King (1981) is shown as a useful strategy to address chronic sarcoidosis.
Managing the job lottery
Authors: Castledine SirGeorge
Published: May 2014

One of the biggest decisions a newly qualified nurse has to make is: ‘which area of nursing should I choose to work in?’ It is not an easy decision to make, especially these days when job opportunities are very tight and competition for certain popular specialities is high
Current clinical overview of cutaneous melanoma
Authors: Lens Marko
Published: May 2014

This article reviews current evidence on epidemiology, diagnosis and management of cutaneous melanoma. Incidence of cutaneous melanoma is rising in all Caucasian populations across the world; thus, melanoma represents a significant public health burden. Although, incidence of melanoma is in continuous increase, a decrease of mortality and improved survival has been observed in most western European populations. Clinical characteristics of four major types of melanoma (superficial spreading, nodular, lentigo maligna melanoma and acral lentiginous melanoma) have been described. Surgical removal of melanoma remains the standard care in all primary melanomas. Current evidence suggests use of 1–2 cm excision margins. Wider margins may be necessary in patients with thicker melanomas with higher risk for local recurrence. In the treatment of regional lymph nodes elective lymphadenectomy has been surpassed by the sentinel lymph node biopsy (SLNB). However, although prognostic value of SLNB has been confirmed, it’s therapeutical benefit still need to be evaluated. Currently there is no standard adjuvant therapy for melanoma although interferon-alpha has been the most widely used treatment in the adjuvant setting. The role of metastasectomy (removal of distant metastases) is still controversial. Chemotherapeutic agents have a limited activity in patients with metastatic melanoma with response rates up to 25%. Although different vaccines have been tested in melanoma patients their role still remain to be established in phase III trials. Progresses in molecular biology and genetics of melanoma may lead to the development of novel melanoma therapies.
Patients’ experiences of privacy and dignity. Part 1: a literature review
Authors: Whitehead Juliet , Wheeler Herman
Published: May 2014

This article reviews the literature on patients’ privacy and dignity and concludes that interest in the topic goes back to psychiatric patients in the 1960s, with the 1990s seeing a shift to all hospitals. A number of databases were used to obtain information for the literature review. Findings revealed United Kingdom (UK) government policies designed to raise the profile of patients’ privacy and dignity. UK research on patients’ privacy/dignity is limited, although there is universal interest. While a variety of methodologies have been used in previous research, and there is consistency in findings, more research is indicated. Previous research spanned topics such as elderly patients, medical and surgical patients, palliative care, rehabilitative settings and child-bearing women. A conceptual framework and definitions of privacy and dignity were examined. Although healthcare professionals and patients attach importance to patients’ privacy, there is insufficient understanding of the problem. Limitations of previous research have been discussed.
Exploring strategies for promoting the use of research findings in practice
Authors: Veeramah Ven
Published: May 2014

Following the integration of nurse and midwifery education into institutions of higher education in the United Kingdom, a number of studies have shown that a defined clinical framework for nursing and midwifery lecturers in practice areas is lacking. The aim of this study was to explore strategies that nurse and midwifery lecturers from one higher education institution in south east England can use to work collaboratively with nurses and midwives to promote the utilization of research findings in practice. A cross-sectional survey using a structured questionnaire was sent to a sample of 60 nurse and midwifery lecturers and 90 clinical managers. Response rates of 67% (40) and 69% (62) respectively were obtained. The main strategies suggested were to make clinical staff more aware of what research exist in their specialties; to help them to access research information from research databases; and to critically appraise this information. Other strategies were for teachers to run research workshops on site; to undertake joint research projects with clinical staff; to set up journal clubs or research interest groups; and to help formulate clinical guidelines and protocols which are explicitly research-based.
Contemporary codes of behaviour
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 tenth column, Lyn Karstadt discusses the updated ‘Standards of Conduct’, and questions whether it is time for a single set of standards covering the ethical and moral principles underpinning practice.
The role of percutaneous endoscopic gastrostomy in patients with dementia
Authors: Sanders David S , Leeds John S , Drew Kaye
Published: May 2014

Percutaneous endoscopic gastrostomy (PEG) is an accepted technique for long-term enteral feeding. Its use has increased because of its relative technical simplicity and low complication rate. As a result, the demands for gastrostomy insertion have risen and now encompass indications where the long-term outcomes are uncertain. One example of this, are patients with end-stage dementia who may be unable or unwilling to eat. For this reason, dementia has become one of the most common indications for gastrostomy feeding. This article reviews the current evidence relating to PEG feeding in dementia as well as work from the authors’ own group. The purpose of this review is to provide the reader with an overview of the published literature and suggest a practical approach for this difficult clinical situation. The changes which the authors have implemented and described (including audit data), may be something which any practicing healthcare professional in this field may choose to incorporate into their own clinical practice.
Parastomal hernia: incidence, prevention and treatment strategies
Authors: Jo Thompson Mary
Published: May 2014

Parastomal hernia continues to be a common and distressing problem for patients with stomas, and research investigating prevention strategies is scant. In March 2005 Thompson and Trainor reported that the introduction of a prevention programme for 1-year post-stoma surgery formation had significantly reduced the incidence of development of parastomal hernia. This was further supported by a follow-up study in 2007, strengthening the reliability and validity of the first findings by confirming a statistically significant reduction in the incidence of parastomal hernias through the introduction of a simple non-invasive prevention programme. This article reviews the current literature on incidence, prevention and treatment, together with a step-by-step guide for stoma care nurses to implement the prevention programme and/or study within their area.
Wound odour: principles of management and the use of CliniSorb
Authors: Morris Clare
Published: May 2014

The management of malodour in fungating wounds and chronic ulcers presents a number of challenges. This article examines the sense of smell and the development of fungating malignant wounds. It describes the psychological and physical aspects of managing malodorous wounds and how they impact on quality of life for the patient. It concludes with a focus on CliniSorb® – an activated charcoal dressing from CliniMed – and how the dressing impacts on the psychological and physical needs of a patient with a malodorous wound.
Older people, continence care and catheters: dilemmas and resolutions
Authors: Godfrey Helen
Published: May 2014

Urinary incontinence (UI) is a common problem and has a profound impact on quality of life among older people. There are various nursing interventions and treatments which can improve UI for the majority of people. Catheterization should be considered for specific clinical indications only when other options have been ruled out. Many complications are associated with catheterization, including catheter-associated urinary tract infections (CAUTIs), which are the most common cause of hospital-acquired infections. It is important for nurses and other healthcare professionals to appreciate how catheters produce infection so that appropriate catheter care is used. The best way to avoid CAUTI is to avoid catheterization, whenever possible, and to remove indwelling catheters when they are no longer required. There is a need to raise public awareness about UI and the interventions and treatments available so that more older people seek help. The challenge for nurses is to avoid using catheters and develop alternative approaches to the care of older people with incontinence.
Back to basics in IV therapy: an unfortunate necessity
Authors: Dougherty Lisa
Published: May 2014

In 1992 I wrote my fi rst article on intravenous (IV) therapy at a time when literature on the subject was sparse. It covered the basic principles of caring for a patient receiving IV therapy and listed some undesirable practices (still performed by some nurses) which could result in complications (Dougherty, 1992). One of these was related to managing an infusion that had slowed or stopped, which was often resolved by winding the infusion tubing round a pair of scissors or pinching the tubing and then releasing it; both have the same effect of causing acute pain and an increase in pressure which enlarges the venepuncture site resulting in infi ltration a few hours later. Best practice is to ascertain the cause and, where necessary, disconnect the infusion and to gently try to aspirate the clot and flush the cannula, or if it is venous spasm apply heat to the limb.
Improving patient safety using clinical needs assessments in IV therapy
Authors: Scroggs Jacqueline
Published: May 2014

A clinical needs assessment (CNA) consulting programme was initiated with the NHS Healthcare Purchasing Consortium to improve safety and reduce risk in intravenous (IV) therapy through standardization, best practice guideline adherence and ensuring adequate training. The results of CNAs conducted at two acute NHS Trusts (A and B) are summarized. Fifteen-minute ‘pump needs assessment’ and ‘clinical practice review’ interviews were conducted with junior and senior staff members, and recommendations were made to a multidisciplinary Trust-steering committee. Post-assessment recommendations included: standardizing to one pump type with activated medication error reduction software, purchasing optimal numbers of IV pumps, implementing best practice guidelines and protocols to minimize unnecessary IV set tear-down (removing and replacing IV set), the use of standardized accessories and ensuring adequate training. Both assessments showed that streamlining, best practice adherence and training could result in pronounced cost savings and improve patient safety. Importantly, the cost savings could facilitate implementation of CNA recommendations. The Trusts have since prioritized standardizing IV pumps and accessories and future implementation of medication error software. The CNA is a valuable tool for Trusts that positively impacts on patient safety.
Patient satisfaction with colorectal cancer follow-up system: an audit
Authors: Wilkinson Susan , Sloan Katie
Published: May 2014

Although there have been studies into intensive follow-up versus non-intensive follow-up of patients following colorectal surgery, the evidence has not demonstrated sufficient benefit in the intensive follow-up regimen to warrant change in practice nationally, and there are no national guidelines for this. Currently at the authors’ hospital the follow-up is non-intensive, and consists of an initial nurse-led surgical follow-up, dedicated patient hotline telephone number, surveillance, symptom list and open access to the nurseled clinic as required. An audit was carried out to determine patient satisfaction with the current method of follow-up and to identify areas for improvement. The majority of patients (95%) were ‘very or fairly’ happy with the current service. Areas for improvement were identified. The key point from the survey was that patients would like a follow-up phone call post-diagnosis and 48 hours post-discharge from hospital. This has been implemented since the audit.
Understanding the nurse’s role in smoking cessation
Authors: Carlebach Sarit , Hamilton Sharon
Published: May 2014

Guidelines from the National Institute for Health and Clinical Excellence (NICE) recommend that every nurse should consult their patients about giving up smoking. This is an important public health role but in order to fulfil it, nurses need to have an understanding of the motivations and barriers that underpin smoking cessation. Furthermore, nurses need to know the options available to support the patient. This review provides an overview of the stages and motivations behind smokers’ intentions. It aims to increase the knowledge of nurses and provide them with a greater understanding of the issues which smokers face. This review identified smoking cessation as a continuum. Nurses play an important role in raising the issue of smoking cessation with patients and they can offer a balanced perspective on the challenges they might face. They can then sign-post patients to the most appropriate smoking cessation options.
Percutaneous endoscopic gastrostomy feeding in the adult patient
Authors: Best Carolyn
Published: May 2014

Percutaneous endoscopic gastrostomy (PEG) is a procedure in which a feeding tube is passed through the abdominal wall directly into the stomach under endoscopic guidance, enabling nutrients, medication and fluids to be delivered directly into the stomach. PEG feeding is the most common form of enteral feeding in people requiring artificial nutritional support for longer than 4–6 weeks. However, the procedure is not without risk, and although most patients experience few problems with their PEG tube, complications do occur. It is important that nurses are able to recognize the risks and problems associated with PEG feeding, and know what actions can be taken to minimize the risks and how to treat the complications when they occur. This article details insertion of the PEG tube and its subsequent care, highlighting possible early and late complications associated with PEG feeding and the steps that can be taken to minimize their occurrence
Evidence-based care for patients undergoing coronary angiography
Authors: Bowden Tracey
Published: May 2014

Coronary heart disease is the most common cause of death in the United Kingdom, accounting for approximately 94,000 deaths per year (Allender et al, 2008). Coronary angiography is currently regarded as the gold standard technique for evaluation of patients with suspected coronary heart disease and for defining coronary anatomy (Di Mario and Sutaria, 2005; Edmond et al, 2008). When caring for patients undergoing coronary angiography, it is essential to ensure that all aspects of nursing care are evidence-based so that the nurse can perform safe and accountable practice (NMC, 2008). The aim of this article is to update the nurse’s knowledge and skills on caring for a patient undergoing coronary angiography. The indications, contra-indications and complications will be reviewed. All aspects of nursing care and patient education will be discussed and a rationale for nursing actions will be provided.
Principles of mechanical ventilation – a critical review
Authors: Pertab Dhanishwar
Published: May 2014

This article is the first of a two-part review focusing on mechanical ventilation, with particular emphasis on non-invasive ventilation when managing patients suffering from respiratory failure. This article explores the principles underpinning artificial ventilation, explains the difference between positive and negative pressure ventilation, and differentiates between invasive and non-invasive modes of ventilation. Finally it examines the various operational features, flexibily in use and limitations that artificial ventilation therapy presents. Optimum ventilatory practice requires knowledge to ensure the choosing of the ‘right’ ventilator. It ensures informed practice and maintains optimum patient safety.
Lower urinary tract symptoms in women with multiple sclerosis: 2
Authors: Rantell Angie
Published: May 2014

Bladder dysfunction in women with multiple sclerosis (MS) is a common and distressing problem affecting up to 75% of patients (Das Gupta and Fowler, 2003). It can seriously affect their quality of life and in some cases cause deterioration of MS symptoms. The first part of this article (Rantell, 2009) set out how to perform a full assessment of these patients and how to diagnose their lower urinary tract symptoms (LUTS). This second article aims to provide an overview of the conservative, pharmacological and surgical management of lower urinary tract symptoms. Often women will need a combination of therapies to achieve optimum benefit from treatment. Management and interventions should be regularly re-assessed as women’s symptoms and their severity may change over time as the disease progresses.
Moral judgements in nursing
Authors: Castledine George
Published: May 2014

On the 25 July, 2009, The Times claimed that nurses were dropping their opposition to assisted suicide. The story was that the RCN has recently carried out a consultation with members on assisted suicide and, as a result, adopted a ‘neutral’ position on the subject. This statement was reinforced by a poll carried out by The Times, which claimed that almost three quarters (74%) of people want doctors to be allowed to help terminally ill patients to end their lives.
Percutaneous endoscopic gastrostomy feeding: indications and management
Authors: Slater Rebecca
Published: May 2014

Percutaneous endoscopic gastrostomy (PEG) has become one of the most useful and established enteral nutrition techniques available to patients requiring nutritional support worldwide. Good nutrition and the receiving of essential nutrients and electrolytes are vital for growth, healing, repair and delivery of essential energy to carry out daily tasks. The article looks specifically at PEG as a form of enteral nutrition delivery, how it is undertaken, and the care needs of the patient post-insertion of a PEG tube.
Effective consulting and historytaking skills for prescribing practice
Authors: Young Kim , Franklin Penny
Published: May 2014

There is increasing emphasis on the need for nurses to develop history-taking and consultation skills for prescribing and advanced clinical practice roles. This article discusses both theoretical and practical aspects that could facilitate the development of these skills using safe and structured approaches. It explores some of the origins of consultation theory, and the challenge that nurses face in integrating new consultation skills with existing nursing assessment practice. This article outlines practical generic approaches to history taking in the clinical consultation and considers the main areas that need to be covered to support safe prescribing decisions.
Applying ethical principles in healthcare practice
Authors: Wheat Kay
Published: May 2014

This article outlines general ethical principles that can be applied in all healthcare contexts. It examines some general principles in the context of healthcare decisions and highlights some inadequacies in their application. The article concludes that there are lessons to be drawn from displaying an awareness of the different principles that can be applied and an awareness of their interplay.
Importance of accurate risk assessment and appropriate intervention in tissue viability
Authors: Benbow Maureen
Published: May 2014

The recent article written by Maureen Benbow has caused me some concern. I agree wholeheartedly with the conclusion, but disagree with several statements within the article.
A critical review of auscultating bowel sounds
Authors: Baid Heather
Published: May 2014

Auscultation (listening for bowel sounds) is part of an abdominal physical assessment and is performed to determine whether normal bowel sounds are present. This article evaluates the technique involved in listening for bowel sounds and the significance of both normal and abnormal auscultation findings. Review of the relevant literature reveals conflicting information and a lack of available research on the topic of auscultating bowel sounds. The clinical significance of auscultation findings when there is no evidence base to support the practice of listening for bowel sounds is explored by further analysis of the literature and reflection by the author on the teaching she received and her own personal practice.
Developing a breath-stacking system to achieve lung volume recruitment
Authors: Armstrong Alison
Published: May 2014

Patients with neuromuscular disease often experience respiratory problems. It is recognized that lung volume recruitment is an effective way of managing and often avoiding respiratory problems associated with muscle weakness. There are a number of methods that may be employed to provide this client group with lung volume recruitment, but some can be quite costly or difficult to manage. This article describes the local development of a breath-stacking system based on an existing respiratory therapy product designed to achieve lung volume recruitment. The system was developed through consultation with The National Home Ventilation Benchmarking Group and adapted as a procedure; practice guidelines were also drawn up. Initial local informal feedback provides an insight into the success of its use for patients with neuromuscular diseases.
Blasé about drug administration
Authors: Castledine George
Published: May 2014

The trouble with some tasks and procedures in nursing is that you get too used to them, and errors inevitably set in. No other area is as vulnerable to this as drug administration. A recent report from the National Patient Safety Agency highlighted that dozens of patients are killed every year by drug errors. In 2007, the watchdog received reports from NHS staff of 86 000 mistakes in prescribing or administering medicines, compared with 36 335 errors in 2005. In England and Wales, in 96% of cases the incidents caused low or no harm, but 37 patients died during 2007, and another 63 suffered severe harm.
Hospital versus community-based phase III cardiac rehabilitation
Authors: Blake Elise , Tsakirides Costas , Ingle Lee
Published: May 2014

Aim: to compare patient and staff perceptions of phase III cardiac rehabilitation delivered in a hospital versus community setting. Method: data were collected by semi-structured interviews with staff and patients. Patients and staff members were interviewed in one of two local leisure centres and in the cardiac unit at Leeds General Infirmary. Five patients who had previously attended a hospital-based phase III programme, four patients who attended a communitybased programme, and four hospital and community staff members participated. Data were analysed using a content analysis technique based on the ‘framework’ approach. Results: three patients admitted having negative expectations of the community-based phase III programme. Maintaining attendance is more challenging in the community; however, progression rates to phase IV were better. Differences between programmes were identified in adherence to sessions, type and number of staff present, and number of sessions provided each week. All patients found the sessions helped with their rehabilitation and all stated that they would recommend their programme to others. Conclusion: both community- and hospital-based rehabilitation programmes were seen as successful by both patients and staff. The emergence of the community programme has proven to be a valuable additional service for cardiac patients. However, if the future of phase III cardiac rehabilitation in Leeds is to be community-based, then specific issues such as exercise adherence will need to be addressed.
Education mentoring for teenagers and young adults with cancer
Authors: Pini Simon
Published: May 2014

This article provides a review of the unique learning mentor role developed in the Leeds Hospital Teaching Trust since 2004. The role provides educational support to teenage and young adult cancer patients aged 13–25 years. During the period September 2004– December 2008 the learning mentor worked with 234 teenage and young adult patients. A questionnaire was administered in the summer of 2008 to gather reflections of patients and professionals, to evaluate the impact of this post. The questionnaire findings support the success of the role and the positive impact it has had for patients and professionals. There is potential for the role to be extended to national teenage and young adult cancer services, and to wider clinical areas where young people are living with chronic illness.
Consent and refusal for adolescents: the law
Authors: Carey Brian
Published: May 2014

The media reported last year that a 13-year-old girl had ‘won the right’ to refuse a heart transplant, which highlighted the issues of the rights of adolescents to consent to and refuse medical treatment. However, the perception that the right of adolescents to refuse health care has changed is a false one. Healthcare decision making for adolescents is an area of particular concern for paediatric nurses, who should attempt to make some sense of the complex legal issues concerning competence, consent and refusal. This article outlines the legal status of adolescents regarding consent to and refusal of treatment, and highlights rulings that have affected them greatly. Nurses must understand and believe in their patients’ rights if they are to promote them and act as their advocate.
The impact of European Union law on the work of nurses
Authors: Hodgson John
Published: May 2014

The EU has a significant impact in shaping the legal rules which regulate the professional environment of nurses and other healthcare professionals. One such aspect is in relation to conditions of employment – health and safety, equal opportunities, free movement within the EU and mutual recognition of qualifications. EU Directives are also deployed as the chosen method to ensure harmonious development of law in all Member States on the basis of EU-wide standards. This article is the first of three focusing on EU law, and looks at the impact of EU law on the nurse as an employee.
Nutrition through the life span. Part 3: adults aged 65 years and over
Authors: Shepherd Alison
Published: May 2014

The UK has an ageing population, but this is not being matched by a similar increase in healthy life expectancy. The greatest challenge in the 21st century will be to improve the quality of life as ageing occurs. Health is the most important prerequisite for people to enjoy life in their older years (Brundtland, 1988). Diet is one factor that is believed to play a key role in the prevention and treatment of chronic diseases associated with ageing. The third and final part of this series addressing the concept of nutrition through the lifespan seeks to educate health-care professionals as to what constitutes a healthy diet for the elderly population, and gives practical guidance as to how to try and prevent the ever-growing problem of malnutrition within this age group. It is suggested that when the older adult is hospitalized their risk of malnutrition increases. Therefore, some guidance for the use of oral nutritional supplements in this population is given. Good nutrition and physical exercise are essential for healthy ageing from both a physical and psychological perspective (NICE, 2008). Therefore a multidisciplinary life course approach to ageing is vital to minimizing its complications for quality of life and subsequent public health (Denny, 2008).
The impact of European Union law on individuals as patients
Authors: Hodgson John
Published: May 2014

This article considers how the EU affects individuals as patients. This can arise in several separate situations – where the person concerned is living in a host state, where treatment becomes necessary during a temporary visit or where a patient wishes to travel to another country for planned treatment. The situation is complicated by the fact that each member state has its own system of health-care and social security, which operate on very different principles and which have not been harmonized, as this is not within the remit of the EU. For example, in many systems the health-care provider will charge the patient a fee covering the whole or part of the cost of treatment and medication, which is then recovered from the patient’s health insurance provider. A ‘monolithic’ national health service offering a comprehensive service ‘free at the point of delivery’, as in the UK, is the exception rather than the rule.
Taking drug administration seriously
Authors: Castledine George
Published: May 2014

In the last edition of the BJN there was a short historical piece about a nurse who administered medications by the colour of the medicine. Even 100 years ago, this procedure was frowned upon, and nurses were expected to be more intelligent and safe in their practical work. Just how good nurses have become at drug administration is open to debate, with some critics arguing that nurses lack the overall knowledge and skills to be as effective as they could be. Others argue that drug administration, and other responsibilities associated with it, takes a long time and nurses are often under unnecessary pressure to complete it swiftly, resulting in errors. These criticisms may seem rather harsh, especially as there are more nurses effectively prescribing drugs than ever before. But have we become complacent and not as effective as we could be in this vital area of patient care?
Making a donation – should nurses lead the way?
Authors: Beckford-Ball Jason
Published: May 2014

Is it me or does it seem like there is a ‘dedicated’ awareness day for everything – there is a National Non-smoking Day; a World Day for Cultural Diversity (very snappy); a Suicide Prevention Day – there’s even a day dedicated to the protection of the ozone layer.
Nursing education – is it time to go back to the future?
Authors: Sally Glen Professor
Published: May 2014

This article attempts to project the future of nursing education by learning the lessons of the past. Since 1989, a constant discourse has evolved: pre-registration nurses are emerging from nursing education programmes without essential clinical skills. It is argued that, if the profession is to heed the lessons from the past, a focus on this constant discourse is inevitable. This is because, in the UK, nursing practice-based learning has long been valued and considered to be of equal importance to institution-based learning. The article thus draws on lessons that can be learnt from the evolution of models of nursing education over the past two decades. Having identified and outlined three models of nursing education, the article predicts the demise of pre-registration nursing and the development of practice-based assistant practitioner programmes and practice-based postgraduate nursing programmes owned and managed by primary care trusts and NHS foundation trusts.