bluuebunny/crossref_metadata_2025 huggingface dataset:
Understanding bipolar disorder and the role of support workers
Authors: Puri Ramneesh , Gilmore Michelle
Published: May 2014

Bipolar disorder is a chronic mental illness that has a lifelong impact on patients and their carers. The severity of the illness will fluctuate throughout patients' lifetimes, ensuring they have variable needs. Support workers can play an important role in implementing an effective management plan. This article provides an overview of bipolar disorder, focusing on the common clinical presentations, available treatments and prognosis as well as discussing the role that support workers can play in providing high standards of care.
Learning disabilities and valuing informal carers
Authors: Barber Chris
Published: May 2014

Informal carers are not always recognized for the role they play in supporting those with a disability, including learning disabilities. However, their inclusion in the way in which health services are provided can be crucial in ensuring that the best possible standards of care are offered. This article looks at the definition of formal and informal care and discusses how support workers and health professionals more broadly can improve the experiences of informal carers and those with learning disabilities.
Action learning: maximizing learning in the workplace
Authors: Jackson Carolyn , Thurgate Claire
Published: May 2014

Action learning is gaining in popularity as a way to improve performance, promote learning and develop the capabilities of individuals, teams and organizations. Harnessing the connection between reflection and action, it is a key mechanism to help practitioners learn from practice to solve complex decisions and issues. It has the potential to create a sense of collective action and empowers practitioners to understand their role in transforming the workplace to manage change and improve standards. This article defines action learning and its application to practice. It also provides guidance for practitioners who wish to use it to develop themselves, their workplace and quality of care.
Skin assessment: a vital skill for HCAs and APs
Authors: Andrews Hilary
Published: May 2014

Wherever healthcare assistants (HCAs) and assistant practitioners (APs) work, they will inevitably come across people with existing skin conditions or new skin changes. Patients in their care may also be at risk of developing skin problems and pressure ulcers. This article explores the HCA/AP role in relation to skin assessment and what is involved in a comprehensive skin assessment.

The article also explores when and why skin assessment is important, how to describe skin changes and what steps to take after assessing the skin.
Telecare: supporting independence at home
Authors: Dewsbury Guy , Ballard Debbie
Published: May 2014

This article introduces the notion of telecare technology and its use within the community to enable older people to live independently. It identifies the essential things that healthcare assistants (HCAs) should be aware of when working with telecare.
Hospital accommodation for transgender people
Authors: Peate Ian
Published: May 2014

Healthcare assistants and assistant practitioners (HCAs and APs) are privileged to care for a wide range of people. The care HCAs and APs provide is of a high quality, safe and effective. Care also takes into account the unique individual needs of each person, placing the person at the centre of care provision. Transgender people expect and should be offered the same high-quality, safe and effective care as the rest of the population is entitled to. This article considers appropriate hospital accommodation for adult transgender people and offers the HCA and AP insight into how they can be accorded patient-centred, respectful, sensitive and flexible responses to their unique gender needs. The terminology used in this sphere of care is discussed and the impact of the law is considered.
Embracing all areas of the work
Authors: Tatiana Rodrigues
Published: May 2014

Tatiana Rodrigues was nominated by her line manager, Jackie Tardivel, Senior Sister, at Jersey General Hospital: ‘Tatiana has worked in outpatients for three years. During this time she has shown great courage and commitment in her work. The excellent skills and competencies which she had gained through her NVQ award enable her to work within all specialities in Outpatients.

‘Tatiana tirelessly works in the paediatric clinics, where her calm and reassuring presence means she is able to act as a sensitive support to both child and family. In an extreme emergency, Tatiana used her bilingual skills to support a family to make a terrible situation more bearable, for which they are forever indebted.’
Audit in improving dementia care on the inpatients wards
Authors: Mawaka Tiritega Perfect
Published: May 2014

Dementia care is generally often overlooked on the acute inpatient hospital wards (Leung and Todd, 2010). Up to 70% of acute hospital beds are occupied by older people (Department of Health, 2001; Alzheimer's Society, 2009 ) and it is estimated that up to a half of these patients, in general acute care at any one time may have cognitive impairment including delirium and dementia ( Royal College of Psychiatrists, 2005 ). This paper presents some of the findings and implications for practice from a service improvement audit exploring the educational and the training needs of nursing and therapy staff working within a community rehabilitation hospital in meeting the needs of dementia patients.
The support worker's guide to ethical practice
Authors: Stonehouse David
Published: May 2014

Within this article the author will be examining what ethics and ethical practice actually means for the support worker. What an ethical dilemma actually is. The four main ethical principles as identified by Beauchamp and Childress (2009) will be discussed and how these relate to our everyday practice. Veracity and fidelity will also be examined as important ethical principles.
Wound cleansing: is it necessary, or just a ritual?
Authors: Jones Menna Lloyd
Published: May 2014

Wound cleansing is considered to be an integral part of wound care. Nevertheless, it is often said to be a ritualistic procedure that is undertaken with little thought or rationale ( Magson-Roberts, 2006 ). Is wound cleansing therefore a procedure that needs to be performed?

The aim of this article is to consider the need for wound cleansing, the solutions used and the preferred method of cleansing wounds.
Clinical observations 2/6: assessing the pulse rate
Authors: Wild Karen , Peate Ian
Published: May 2014

This is the second article in a series of 6 that focuses upon clinical observations. The healthcare assistant (HCA) and assistant practitioner (AP) must ensure they employ effective practices and have the ability to record and report findings in line with local policy. This article details the why, when, how, what and where of pulse rate measurement. A discussion concerning pulse rate measurement is offered, providing the HCA and AP with an understanding of how the pulse is maintained. Factors that impact on the pulse rate are discussed and a conclusion is offered

Measurement of the pulse is an indirect measurement of the heart beat.
Spirituality in healthcare: an introduction for HCAs and APs
Authors: Barber Chris
Published: May 2014

Spirituality is a much misunderstood term, concept and phenomenon and at best is frequently confused with religion. It is paid ‘lip service’ and at worst side-lined or even ignored by many healthcare professionals, including nurses and healthcare assistants (HCAs). This series of nine articles sets out to briefly explore the meaning of spirituality and apply this meaning to a number of service user or patient groups within a number of healthcare and clinical settings. This first article sets out the reasons for this series and a brief indication as to its content.
Making Principles of Nursing Practice a reality at work
Authors: Watterson Linda , Coley Maive , Jobling Stephen
Published: May 2014

The Royal College of Nursing's Principles of Nursing Practice tell us what everyone can expect from nursing practice. They apply to all nursing staff, including healthcare assistants (HCAs) and assistant practitioners (APs). Using the principles to think about your own practice is a simple and effective way of making sure you are living up to these expectations. In this article, reflection on practice using the principles in this way is explored.
Role of the physiotherapy AP in postoperative cardiothoracic care
Authors: Eden Allaina
Published: May 2014

This article will outline the role of the physiotherapy assistant practitioner (AP) in respiratory care, specifically treating patients following cardiothoracic surgery. It is an innovative new role for both the Papworth Hospital NHS Foundation Trust and the physiotherapy profession, with few pre-existing posts in this field. The role is relevant to other disciplines, as the key features can be transferred into nursing and other therapies. This article will provide a greater understanding of the scope the AP role can fulfil.
Clinical observations 5/6: breathing/respiratory rate
Authors: Wild Karen , Peate Ian
Published: May 2014

This is the fifth article in a series of 6 that focuses upon clinical observations. The healthcare assistant (HCA) and assistant practitioner (AP) must ensure they employ effective practices and have the ability to record and report findings in line with local policy. This article details the why, when, how, what and where of respiratory rate measurement. A discussion concerning respiratory rate measurement is offered, providing the HCA and AP with an understanding of how respiration is maintained. Factors that impact on respiration rate are discussed.
Building capacity: leadership and HCAs (2/2)
Authors: Megson Denise
Published: May 2014

The article describes the processes of a business project that was carried out in 2010. It is the personal leadership journey of a nurse managing a change process for an organisation and the principles in the article are applicable to any health and social care sector organisations. It uses the characteristics from Factor 8 Diverse Leaders and demonstrates how a project such as this can address the challenges, be aligned to the organisation's strategic vision and produce outcomes. The report will illustrate the inter-relatedness of the characteristics of good leadership. It concludes with a series of questions and an example to help those who may be interested in starting a project that could challenge and develop their capacity as leaders.
Integrated care–a way forward for APs
Authors: Norman Kay , Roche Kairen , Jukes Sherron
Published: May 2014

This article will explore the concept of integrated care and how the assistant practitioner (AP) role will be key in delivering the components required to improve patient and service outcomes. The educational and learning components necessary to embrace this role are discussed, in particular the collaborative learning approach within a foundation degree programme at Staffordshire University.
Support workers: key members of the multidisciplinary team
Authors: Stonehouse David
Published: May 2014

Multidisciplinary team working is key to patients receiving the right care at the right time, delivered by appropriately qualified and experienced staff. Support workers are a vital part of this team and their contribution needs to be recognised, both by other professional groups, but also importantly by themselves. This article will examine why the multidisciplinary team is so important to delivering quality patient care. It will also highlight potential barriers and how these can be broken down.
Continence series 3: holistic continence care
Authors: Nazarko Linda
Published: May 2014

Incontinence and continence do not occur in a vacuum. They occur in a context. That context includes the environment where the person lives, the person's abilities and the quality of care that the person receives. This article aims to enable readers to understand the context in which incontinence occurs and to provide holistic continence care.
Fundamentals of infection prevention and control
Authors: Nazarko Linda
Published: May 2014

At the beginning of the 21st century, the UK had one of the highest rates of healthcare–associated infection (HCAI) in Europe ( National Audit Office (NAO), 2000 ; 2004 ).

Changes in healthcare practice, including an increased emphasis on handwashing, have led to a major decline in healthcare–associated infections, from 9.2% of patients in 1980 to between 6.7–6.4% in 2011 ( Walker et al, 2011:69 ; Health Protection Agency (HPA), 2012 ). Health Protection Agency data (2012) shows the rate of HCAI fell from 8.2% to 6.4% in five years. There has been a 69% reduction in MRSA bacteraemia rates and a 59% reduction in clostridium difficile infections over the past five years (Public Health England, 2013). Although much has been achieved, recent rising levels of antibiotic resistance mean ‘we could be close to reaching a point where we may not be able to prevent or treat everyday infections or diseases’ ( Department of Health (DH), 2013 ).

Every healthcare worker has an important part to play in helping to prevent infection and to stem the tide of antibiotic (also known as antimicrobial) resistance. This article, the first in a series, aims to enable readers to understand the fundamentals of infection prevention and control. It explains how the body attempts to defend itself against infection, who is most vulnerable to infection and how infection affects older people and other vulnerable groups. The article explains how to assess and reduce risk and sets the scene for the series.
Ambulation in older people—mobility explained
Authors: Hayes Catherine
Published: May 2014

The way older adults move is significantly different and progressively changing as part of an overall decline in physiological and mechanical function in the normal ageing process. The aim of the article is to provide an insight into how positioning of the skeleton and the musculoskeletal system contribute to an older person's capacity to remain independent and mobile, two key factors in their overall health and wellbeing.

Certain medical conditions can greatly influence the capacity people have to move; and they can become identifiable not as individuals but as the diseases they have been characterised by in their outward physical appearance.

Many HCAs will have no previous knowledge of the terminology of human walking and this article offers a basic introduction to how the gait cycle works and how this changes in ageing. Posture and stability are two pivotal elements to successful ambulation and these are considered alongside the overall concept of movement in older people. From a practical perspective, it offers a means of HCAs being compassionate and understanding about the ease of movement older people live with on a day-to-day basis.
Support workers have a vital role to play in play
Authors: Stonehouse David
Published: May 2014

Within this article, the author will be examining the importance of play for children and young people, especially when they are in hospital. Play will be defined; however, this is a concept which is difficult to grasp, as play means different things to different people. The article will highlight the benefits that play brings for healthy children, before discussing the important role it has for children and young people in hospital.

The fact that play is everybody's business and should not just be left to the play specialist alone, will be asserted and demonstrated. Support workers are closest to patient care and are therefore ideally placed to support children and young people to play within the healthcare settings where they are being cared for.
Why the Government is so down on doctors
Authors: Baker Mark
Published: May 2014

‘Setting up the medical establishment as a high-profile whipping boy creates an alternative source of blame and helps to deflect public anger away from the government’
Maersk Medical: cost-effective wound care
Authors: Madden Vicky
Published: May 2014

Our new series of cost-benefit analyses continues. As budgetary constraints, evidence-based medicine and health economics have come to the fore in managing health care, the importance of examining cost-effective solutions to common health care problems has grown. We move on to ways of making clinically-effective and cost-effective progress in management of wound dressings.
Models of pressure ulcer care: costs and outcomes
Authors: Clark Michael
Published: May 2014

Pressure ulcer prevention and treatment are expensive with these costs generally believed to be largely avoidable. The consequences for cost-effective treatment are evident.

This paper describes the use of a decision model that predicts both the occurrence and cost of pressure ulcer care within UK hospital populations.

The data upon which the model was based was drawn from a large multi-centre cohort study and illustrates the translation of research data into a relevant management tool.
Modernising dental education
Authors: Elkind Andrea , Blinkhorn Anthony
Published: May 2014

The goal of wider access to dentistry has exercised the minds of managers, politicians and civil servants for some time. We consider a working pilot scheme doing just this.
Reforming public sector dentistry in the UK
Authors: Oliver Adam
Published: May 2014

The way in which NHS dentistry is financed generates inappropriate incentives for dentists. Partly as a consequence, the Government has pledged to increase investment in this sector. However, what is really required is a fundamental reform of the way in which dentists are remunerated.
Managers’ and secretaries’ views of job satisfaction
Authors: Atakli Aylanur , Kmeta Elif D
Published: May 2014

All good managers understand the organisational value of secretaries. This paper explores original research into both parties’ attitudes towards their job satisfaction.
SEA for GP practice managers: lever or lemon?
Authors: Boxall Matthew , Wallace Louise M
Published: May 2014

GP practice managers recognise their pivotal role in solving problems, and that teamwork is essential. Significant Event Audit (SEA) is a structured approach to help practice teams learn from everyday events. We interviewed seven practice managers who shared their early experience of using SEA, and draw out lessons for those embarking on SEA.
Advocacy - the real voice for change
Authors: Bell Andy
Published: May 2014

Amid the festive cheer occasioned by the continuing saga of Bradford's foundation trust, a little-noticed report emerged from the King's Fund last month on the role of advocacy in the health sector.
Dr John Reid's two replacement pleasures
Authors: Roth Andrew
Published: May 2014

Having given up smoking and also the Scottish males' prime indulgence of heavy drinking, Health Secretary Dr John Reid currently most enjoys two other indulgences: shredding his political opponents' health policies and glorifying the enhanced results of the new, refinanced and remanned NHS.
Should Alan Maynard be next for the furnace?
Authors: Kernick David
Published: May 2014

In a recent BJHCM article, Alan Maynard (2004) likened the NHS to a crematorium - lots going in but little coming out. This choice and use of metaphor is illuminating, offering new insights as it asks us to consider one thing in terms of another.
Hello, goodbye
Authors: Cowper Andy
Published: May 2014

We don't yet know the exact financial out-turn of the year. We do know that there's a net surplus of a couple of billion pounds, and that activity continues positively towards the 18-week referral to treatment target.
Effective quality improvement: recognising the challenges
Authors: Powell Alison , Rushme Rosemary , Davies Huw
Published: May 2014

Quality improvement in health care is highly topical, but definitions of quality are contested and many healthcare organisations struggle to achieve lasting changes in routine practice. This article, the first in a series on quality improvement, considers some of the factors that make health care a particularly challenging environment for managers introducing quality improvement interventions.
Limitations of the HRG tariff: efficiency comparison
Authors: Jones Rod
Published: May 2014

The method that the Department of Health (DH) uses to assess operational efficiency is the reference cost index (RCI). The DH (2008) states that
Effective quality improvement: some necessary conditions
Authors: Powell Alison , Rushmer Rosemary , Davies Huw
Published: May 2014

In the previous article in this series, the authors discussed the growing importance of quality improvement in healthcare organisations, outlined some of the approaches that have been used, and considered some of the factors that make healthcare organisations a particularly challenging setting for managers introducing quality improvement interventions. This article considers some of the core conditions that are necessary for successful quality improvement in health care, regardless of the approach used.
Modernising nursing careers
Authors: Doherty Carole
Published: May 2014

Dissatisfaction with career prospects and development opportunities has been shown to be highly significant in explaining nurses' job satisfaction, organisational commitment and intention to leave (Collins et al, 2000; Shields and Ward, 2001; Fochsen et al, 2005). The purpose of this article is to identify nurses' job aspirations and examine the underlying factors that influence their ambitions. The findings add to understanding of the factors influencing career satisfaction among nurses and therefore identify implications for managers responsible for providing opportunities for staff to progress in their careers.
Achieving the 48-hour week for junior doctors
Authors: Kendall Deborah , Ahmed-Little Yasmin , Cousins Darren , Sunderland Howard , Johnston Mark , Najim Omar
Published: May 2014

In August 2007 NHS North West committed to delivering the European Working Time Directive (EWTD) 48-hour working week across the 38 trusts in the region, for all junior doctors in training, one year ahead of the national August 2009 deadline by recruiting a team of junior doctors to implement the project. This article will describe the management tools and techniques used in achieving this unique and ambitious task.
The NICE decade
Authors: Rawlins Michael
Published: May 2014

NICE was formally launched, 10 years ago, on 1 April. When it began, there was a suspicion, among many commentators, that we were to be tools of the government and Department of Health (DH); and that our independence was in name only. I believe this perception is now dead and buried. NICE guidance is developed by the external members of our advisory bodies, drawn from the NHS, public health professions and universities, as well as professional and patient organisations. Asking them to reach particular conclusions that might be convenient to the government would be impossible. Indeed, no government minister or civil servant has ever attempted to put pressure on us to reach specific conclusions.
Involving local people to improve services
Authors: Nicholson-Banks Kathy
Published: May 2014

Not only is patient and public engagement a legislative requirement for NHS organisations (NHS Act 2006; Local Government and Public Involvement in Health Act 2007), as well as an essentialcompetency in achieving world class commissioning standards (Department of Health, 2007a), but it is also a strong and widely held belief that involving patients and carers in decisions about health care is fundamental to the improvement of health and social care services. In order to ensure that patient's needs and preferences are met and continue to do so, NHS organisations must ensure that they are involved in all aspects of redesigning care. This article presents amodel being launched by NHS Bournemouth and Poole, who are keen to ensure that local people havethe chance to become engaged at a variety of different levels, and in ways and at times that suit them. The model aims to create more opportunities for people, which will then encourage peopleto take a shared responsibility in their own health, the health of others, and in the provision of improved, more efficient and effective, value-for-money health services.
Appreciative inquiry in health care
Authors: Richer Marie-Claire , Ritchie Judith , Marchionni Caroline
Published: May 2014

Organisational change in health care is a complex, non-linear process that must evolve in response to shifts in social, economic and political environments. Given this constant flux, current organisational models fail to address the needs of the patients and healthcare workers, who are becoming increasingly dissatisfied. The radical changes required must influence work design and workforce management, while focusing on the interactions between actors within the systems. This article presents an approach to organisational change: appreciative inquiry. By building on positive ideas and images emerging from individuals or groups, this approach fosters learning andpromotes the emergence of innovative ideas. A review of the literature from 1990 to 2009 was undertaken to describe the application of appreciative inquiry in health care. After a brief description of the theoretical foundations and the process of appreciative inquiry, the studies and projects uncovered in the review are presented. The limits and advantages of using appreciative inquiry to promote organisational change in health care are discussed.
Health care costs and the HRG tariff
Authors: Jones Rod
Published: May 2014

In this month's BJHCM, an article on the nature of health care costs explores the possibility that a group of medical and mental health diagnoses may show a three to eight year cyclein admissions (Jones, 2010d). There will be additional knock-on effects against wider primary care and other costs.
Goodbye Audit Commission
Authors: Timmins Nick
Published: May 2014

August is the silly season, even for a government acting with unprecedented speed and haste. One of its sillier decisions may well prove to be the abolition of the Audit Commission.
Clinical coding in ear, nose and throat (ENT) operations
Authors: Mirza Showkat , Arhsad Faisal , Watson Andrea
Published: May 2014

Clinical coding of a surgical operation produces a health resource group (HRG) code with a specific payment tariff that the hospital receives. Our aim was to review the clinical coding in our ENT department and discover whether there was scope for improving the accuracy of coding and the income tariffs. We retrospectively reviewed the clinical coding of operations over a four month period. Using a system that groups operation codes according to anatomical regions and types of procedure, we analysed each case to see if the actual code attributed to the procedure could be improved. Such a system aids the accuracy and optimisation of income tariffs. It can be used during the coding process and subsequently as a quality assurance tool as well as in the auditing of clinical coding.
Inclusive communication: a tool for service innovation
Authors: Shute Rebecca , Davies Gavin , Clee Shaun , Coupland Tim , Melton Jane , Forsyth Kirsty
Published: May 2014

There is global acknowledgement of the need to improve services for those experiencing mental illness, with learning disabilities or those who abuse substances (WHO, 2010). Government policy in the UK also outlines the importance of using resources efficiently, improving access to services and driving up quality (Darzi, 2009). Organisational transformation of this nature can create uncertainty, not only for those working within the service but those accessing services and wider stakeholder. This paper proposes that effective communication is a crucial ingredient of successful change and a tool that can be used in to support transitional change and those that may be affected but it. The paper describes the underpinning communication theories used by an NHS Foundation Trust in the United Kingdom to develop an effective, inclusive communication strategy to support a service delivery innovation.
Avoidable acute hospital admissions in older people
Authors: Mytton Oliver T , Oliver David , Mirza Nabil , Lippett Janet , Chatterjee Apurba , Ramcharitar Kriel , Maxwell Janet
Published: May 2014

Understanding avoidable admissions in older people is a pressing issue, with budget restraint, an ageing population and demand for care close to home. To inform local efforts to reduce avoidable admissions in older people we audited a series of acutely ill older people admitted under the local elderly care team. Those admissions that appeared ‘avoidable’ on the ward round were scrutinised in more depth: review of medical notes, patient/carer interview, and primary care provider (GP or community nurse) interview. The information from this process was presented to a GP-consultant panel to judge whether the admission was avoidable. Admissions considered avoidable were classified into one of seven themes. Between 20.6% (27/131) and 32.0% (42/131) of admissions to elderly care were considered potentially avoidable. The findings suggest that avoidable admissions do not just represent a simple failure to manage long-term conditions, but depend on high quality clinical decision making around the time of admission as well as having sufficient capacity in alternative community services.
Can leadership behaviour affect quality and safety?
Authors: Bohan Peter , Laing Michelle
Published: May 2014

Leadership behaviours of executives in healthcare are considered to be of prime importance ( Burke, 2006 ), with strategy, structure and process being key elements of team and organisational effectiveness ( Yammarino et al, 2008 ). This research identified that executives were clear on what type of leadership behaviour is expected of them; seeing themselves as transformational, setting clear goals and expecting the best from their teams. They also identified elements of autocratic and transactional leadership were required frequently in the achievement of targets. There was acute recognition of the tensions between quality and safety and the target-driven approach required by commissioners and the current financial climate. External drivers for quality and safety included losing foundation trust status and the resultant financial penalties. It was acknowledged the commissioners have huge power and influence over the direction of where the organisation concentrates effort to influence policy which could also provide tension with the quality and safety strategy. Finance and ‘doing more for less’ are constant themes, with competition to keep quality and safety on the agenda. Quality and safety has a reputation for being problematic, many executives believed changing the organisational culture requires evaluation.
Creating an environment of shared leadership
Authors: Hawken James , Lee-Wright Richard , Walsh Stephen
Published: May 2014

Junior doctors and management trainees have been paired to run service improvement projects as part of an exciting new scheme set up by the Kent Surrey Sussex School of Clinical Leadership. By pairing junior doctors and management trainees, the scheme aims to improve doctor-manager understanding and create an environment of shared leadership.
High risk categories and risk pooling in healthcare costs
Authors: Jones Rod
Published: May 2014

In England the totality of healthcare costs are aggregated at local area using 23 programme budgeting cost categories. These 23 categories have been analysed to determine the extent of year-to-year volatility in costs for each local area. After adjustment to bring all categories and locations to the same size the 23 categories are ranked according to volatility in costs. Six high-volatility categories were identified and excluding these from the base budget resulted in a three-times reduction in volatility (financial risk). Strategies around risk pooling are discussed.
Managing mobile medical devices using radiofrequency identification
Authors: Jarritt Peter
Published: May 2014

As healthcare services are relying more on sophisticated medical devices to make and record measurements and to monitor therapy, there is a challenge in managing these numerous devices. This article describes how mobile devices can be monitored and managed. The article explores the implementation of radiofrequency identification (RFID) at Cambridge University Hospitals NHS Foundation Trust (CUHNHSFT) in particular through a case study, highlighting the benefits of the system, and its impact upon services at the trust.
A continuous quality improvement project
Authors: Ka-yee Jasperine Ho , Lee Quinnie , Lam Ka-chi , Lam Kwok-key , Leung Siu-kee , Man Chi-wai , Tang Kam-shing , Lo Chi-yuen
Published: May 2014

Hospital Authority (HA), a statutory body responsible for managing public healthcare in Hong Kong, provides 90% of inpatient hospital services. The Surgical Outcomes Monitoring and Improvement Program was launched to monitor and improve the surgical outcomes of patients managed under HA. Tuen Mun Hospital, the largest acute hospital in Hong Kong, was committed to implement quality improvement projects to improve patients' outcomes after reviewing the first report in 2010. Other than the possibility of surgical technique failure, there were multiple cultural and managerial problems recognised, which could have contributed to the suboptimal outcome. The Surgical Quality and Safety Circle was formed, and was composed of hospital administrators and consultants from departments of surgery, anaesthesia and intensive care, and aimed to create a patient-centered culture. It also aimed to improve the fundamental standards of services provided, promote inter-departmental co-ordination and communication, ensure continuous medical education, and discuss policies and strategies regarding patient service management. Members attended meetings every four-to-six weeks, in which complicated cases were discussed. The four main areas focused on during case discussion were: interdisciplinary communication; logistics, workflow and policy making; continuous professional education; and improving communication between hospital management and clinicians. As a strategy for change, the ‘Speak up culture’, which was under-developed in the locality, was promoted. 400 comments and suggestions had been arrived at during group discussion across 25 meetings since February 2011. There were more than 10 inter-departmental and hospital based improvement programmes successfully implemented based on the clinical and system weakness identified in the meetings.
Recruitment challenges facing elderly care service providers in Hong Kong
Authors: Wong Wai Ning Kris , Kwok Sing Tung , Lee Tse Yan Alexander
Published: May 2014

The present survey study was conducted to examine the challenges facing the elderly care service industry in Hong Kong. The survey was designed based on a qualitative study conducted earlier and was aiming to examine the recruitment challenges facing Hong Kong's elderly care service providers and their perceptions of the latest elderly policy, ‘Ageing in Place’. The results resonated with an earlier qualitative study, strengthening the findings that recruitment of frontline care workers remained the major difficulty facing many elderly care service providers, and that maintaining a stable frontline care workforce can be done only with an effective preparation of the workforce through adequate education and training, along with a well-structured career prospect and reasonable competitive remuneration. Nevertheless, many elderly service providers supported the concept of ‘Ageing in Place’ and it can only be facilitated with an aged-friendly environment and by promoting the culture of intergenerational harmony in Hong Kong.
A triple whammy for offenders with mental health problems
Authors: Illingworth Paul
Published: May 2014

This article focuses on offenders with mental health problems and how they can be stigmatised in several ways due to the multifaceted nature of their situation. It attempts to show that despite being offenders or ex-offenders, they still need health and social care providers to care for their mental health needs in the same way any other mental health service user does. The author attempts to explore some of the issues, acknowledging that due to their criminal behaviour they are likely to be negatively labelled, but that they often suffer from several other factors which are not always necessarily their own making. Examples of how labelling can be viewed differently and how health professionals can contribute to stigmatising not only offenders with mental health problems, but mental health services users generally.
Clinical supervision in psychological therapists
Authors: Nellaney Julie , Sloan Graham
Published: May 2014

The aim of this study was to audit recommendations contained within the clinical supervision (CS) of psychological therapies guideline and specifically, whether psychological therapists have appropriate training and competencies in generic CS. Results showed that the majority of supervisors perceived themselves to be competent in CS and a positive relationship was found between perceived competencies and years as a supervisor.
The role of research in the mental health nurse consultant
Authors: Barron Derek , Snowden Austyn , Martin Colin R
Published: May 2014

Using a facilitated discussion forum, a group of mental health nurse consultants in Scotland, along with senior clinical nurse leaders, sought to better understand their collective research contribution along with potential barriers that may exist. The underlying belief was that research is important and an essential aspect of the nurse consultant role, whereas evidence presented suggests the reality is research is infrequently prioritised within the role. Additionally, this article suggests that nurse consultants play down their research credentials under the guise of audit or service improvement, which may unnecessarily perpetuate the perception that they do not undertake research.
Slow methadone reduction as a way towards recovery
Authors: Fernandez Jeff , Jones Mark Medjesi
Published: May 2014

The latest national policy intends to move drug treatment from maintenance on substitution medication, such as methadone towards recovery. However, a primary care drug services in Islington, London, has used methadone reduction pathways as a way to recovery for several years. A negotiated and planned slow reduction off methadone introduces patients to the idea of recovery and detoxification. Maintaining patients on substitute medication benefits their overall wellbeing and helps them work towards recovery. This period of stability—where a patient is taking substitute medication and no illegal drugs—is the key to moving to reduction. The detoxification period can be flexible and slow but it results in abstinence. The final stages of reduction are usually completed as an inpatient in a detoxification centre; this appears to be effective for patients who have struggled on community detoxification. The reduction pathway has four planned stages: titration of substitute medication; stabilisation; planned reduction of substitute medication; and an aftercare plan. The evidence from an audit and a typical case study shows that a slow reduction plan can move a patient towards abstinence. Slow reduction is a useful concept to consider when planning drug service treatment.
Developing an effective care package for adults with ADHD
Authors: Gilbert Emma , Padmore Jane
Published: May 2014

Attention deficit hyperactivity disorder (ADHD) is a commonly diagnosed disorder in childhood that often persists into adulthood. Although those with ADHD are classified as having a disability, there has historically been little recognition of ADHD in adults, both in terms of diagnosis and service developments. ADHD can cause significant impairments in a number of aspects of a patient's life, including: an inability to function in academic or work environments, problems sustaining relationships, antisocial behaviour and substance misuse. Effective and comprehensive care plans need to be developed for adults with ADHD that reduce the symptoms, or the impact of symptoms.
Assessment and management of sexual dysfunction in women with multiple sclerosis
Authors: Ward Nicki
Published: May 2014

Multiple sclerosis (MS) is a complex, incurable and unpredictable disease of the central nervous system diagnosed in young adults. The progression of the disease can result in significant sexual dysfunction for some, and can cause great distress and severely impair quality of life for both the individual and his/her partner(s). Much of the research into sexual dysfunction in MS has studied the male experience, partly because pharmacological treatments have become available to treat erectile dysfunction in men. However, women's sexual difficulties do not respond well to available drug therapies.

This paper looks at the definition and categories of sexual dysfunction and at the assessment of sexual dysfunction in women with MS. Practical suggestions are made for the management of the symptoms of sexual dysfunction in women with MS, and it is argued that the specialist nurse has an important role in providing education and support for such women. A nurse sensitively raising the topic of sexual difficulties allows MS patients to relax and discuss this vitally important area; without this, patients may wish to initiate such a discussion but find it too embarrassing to do so.
What′s in a name? Transfer of skills across the Cinderella services
Authors: Clark Louise L
Published: May 2014

Louise Clark argues that it is time to find new terminology for nursing in learning disability, elderly care and rehabilitation, if the aim of providing more highly skilled care for these patient groups is to succeed.
The importance of early consideration of palliative care in Parkinson's disease
Authors: Rudkins Helen , Aird Thomas
Published: May 2014

The topic of palliative care is a complex paradigm. However, there is limited literature considering its component in Parkinson's disease and other neurodegenerative conditions. The aim of this paper is not to discuss the nursing care of palliative-stage Parkinson's disease, but rather the wider issues pertaining to palliation and the role played by the nurse specialist. Initially the definition of palliative is discussed and whether the criteria for reaching the palliative stage of Parkinson's disease match the definition.

The palliative stage will be considered alongside the other three stages in the ‘pathways paradigm’ as identified by MacMahon and Thomas (1998). The direct impact of the diagnostic stage is discussed alongside the differential diagnosis of Parkinson's disease. How this may affect when the palliative stage begins and how the role of the nurse affects patient outcomes will be outlined. Additional psychosocial issues will be examined, regarding the impact on family members and carers encountered during the palliative stage. Finally, the provision of services in relation to palliative care of patients with neurodegenerative conditions will be discussed, alongside the National Service Framework for Long-Term Conditions and how it impacts on nursing practice.
Fatigue in multiple sclerosis: A common, hidden symptom requiring regular assessment
Authors: MacLean Rhona
Published: May 2014

Fatigue is an under-recognized common symptom in multiple sclerosis (MS). Multidisciplinary assessment and management are necessary to ensure that all aspects of the person's life style are addressed. This can be time-consuming and challenging to all involved, but can be shown to reduce the level of fatigue experienced and improve the person's quality of life. The principles involved in the management of fatigue in MS can help address the recommendations made in the guidelines for MS from the National Institute for Health and Clinical Excellence (NICE) (2003) and meet many of the quality requirements in the National Service Framework for Long-Term Conditions (Department of Health, 2005). The principles of assessment and management of MS-related fatigue should also be applicable across many other neurological conditions.
The impact of depression on life for people with Parkinson's disease
Authors: Mayor Susan
Published: May 2014

Depression may affect up to half of people with Parkinson's disease but it is easy to overlook the signs. Susan Mayor considers its impact and national recommendations for diagnosis and management
Bactiseal: A system to prevent catheter infections in shunts and external ventricular drains
Authors: Bayston Roger
Published: May 2014

It is important to accept that, while shunt infection rates can be reduced by adherence to rigorous surgical protocols, prophylactic antibiotics have little impact and skin bacteria will continue to gain access to the shunt. The Bactiseal catheter is intended to reduce infection in hydrocephalus shunts and external ventricular drainage by preventing bacterial colonization of the catheters. This article outlines the causes of such infections and discusses a number of strategies for prevention. The principle of the Bactiseal system is presented, along with in-vitro evaluation. Finally, clinical studies of its effi cacy are discussed. While Bactiseal has limitations, clinical trials have shown signifi cant reductions in shunt infection rate. Fewer data on the use of Bactiseal external ventricular drainage catheters are available, and clinical trial results are awaited.
Renewed vigour in the northwest
Authors: Gray Olivia , Arnott Lynn
Published: May 2014

The Northwest Benchmarking Group Meeting was held in Belfast last month. Olivia Gray and Lynn Arnott report on the successes and achievements that the region has experienced
The BioDerm external continence device: Evidence and assessment for use
Authors: Woodward Sue
Published: May 2014

Urinary incontinence is a common problem experienced by many people with neurological conditions such as Parkinson's disease, multiple sclerosis, stroke and spinal cord injury and has a signifi cant impact on quality of life. Such patients may benefi t from using products designed to contain the urine that is voided involuntarily, often used in conjunction with medication or behavioural methods to promote continence. Until recently patients have had to rely on body worn pads and pants and male patients have also had to option of wearing a condom catheter or urinary (penile) sheath. This article will review the problems encountered when using urinary sheaths and will consider BioDerm as a possible alternative to this external condom catheter based system of urinary drainage for male patients.
Assessment and treatment of pain in traumatic brain injury: Clinicians' views
Authors: Islam Nargis , Russell Louise , Gauntlett-Gilbert Jeremy
Published: May 2014

Acute and chronic pain are common after brain injury, but under-researched. Anecdotal reports from clinicians suggest that pain can be difficult to manage and can inhibit rehabilitation. Expert clinicians' views on the management of pain after brain injury and the relevant literature were investigated. Participants were 17 experienced clinicians drawn from three specialist UK centres for brain injury rehabilitation. Three focus groups were conducted on different sites using a semi-structured schedule. Recordings were transcribed and subjected to thematic analysis. Analysis revealed that clinicians considered pain to be prevalent, important and difficult to assess. Generic pain assessment tools are inappropriate for this group, and some research findings were viewed sceptically. Self-report of pain was often either impossible or viewed with scepticism; observational tools from other fields (such as dementia or intensive care) might have relevance in brain injury.