bluuebunny/crossref_metadata_2025 huggingface dataset:
Human Tissue Act 2004 comes into force
Authors: Musson Ruth , Burnapp Lisa
Published: May 2014

Nurses have a key role to play in implementing the requirements of the Human Tissue Act 2004 (HT Act), which comes into force on 1 September 2006. From that date, the Human Tissue Authority (HTA) will be responsible for licensing a number of activities and will also be responsible for approving transplantation of organs, bone marrow and stem cells from living donors. This article aims to inform nurses of what the changes will mean for their practice.
Chronic obstructive pulmonary disease: clinical signs and infections
Authors: Banning Maggi
Published: May 2014

Chronic obstructive pulmonary disease (COPD) is a pathological condition that involves excessive production of mucus, chronic cough and inflammatory changes leading to airway limitation. The most common cause of COPD is cigarette smoking. COPD can be categorized into either chronic bronchitis or emphysema; both conditions can be differentiated by age and the production of copious, tenacious sputum. Patients with COPD are susceptible to pulmonary infections of bacterial or viral origin. Nurses should be aware of the subtle differences in conditions and the usefulness of antibiotics in the treatment of acute bacterial exacerbations of chronic bronchitis.
Post-exposure prophylaxis:access and fairness
Authors: Peate Ian
Published: May 2014

Post-exposure prophylaxis (PEP) is the provision of treatment after a person has been exposed to human immunodeficiency virus (HIV). The use of PEP has been around for many years and has come to the fore since the arrival of antiretroviral medication in 1987.
What is the law if a patient refuses treatment based on the nurse's race?
Authors: Dimond Bridgit
Published: May 2014

This article considers the legal implications of racism within health care where a patient makes it clear that he or she is not prepared to be attended to by a nurse of a specific ethnic group. It looks at the rights available to the victim of the racism, the action which should be taken by management and the provisions of the Equality Act 2006.
Storage, destruction and retention of records
Authors: Dimond Bridget
Published: May 2014

The storage of records is a significant cost to many NHS organizations and therefore a clear policy over retention and destruction is essential as part of any record management strategy. This article considers the legal time limits within which a court action must be commenced from the cause of action giving rise to claim in negligence for personal injuries and then discusses the guidance provided by the Department of Health.
Pressure ulcer care: making and handling a complaint in the NHS
Authors: Dimond Bridgit
Published: May 2014

This article considers a case where a patient is suffering from a pressure ulcer and there is a dispute between hospital and care home as to its cause. It looks at the handling of a complaint under the new NHS Regulations and in a care home.
The provision of nursing care for gay men with GI issues
Authors: Peate Ian
Published: May 2014

The holistic nursing care of the individual is a hallmark of high-quality care; this holistic approach means that the nurse will also have to take the sexuality of the person being cared for into account. This article promotes the notion of holism and, in particular, the care of one group of patients – homosexual men. In this article the needs of the gay patient who has undergone GI surgery are discussed in respect to their sexuality. Key terms and concepts are considered. A therapeutic nurse–patient relationship can only be achieved if the needs of the patient are taken into account; the term that the patient chooses to use when identifying his individual sexuality must be respected. Stigma, discrimination and prejudice are unwanted results of a failure to respect an individual and should be avoided. There are several instances where stereotyping and myth may occur concerning the gay patient who has undergone GI surgery, and erroneous assumptions made about the patient can thwart the unique nurse–patient bond.
Nurse's poor moving and handling technique put patients at risk
Authors: Castledine George
Published: May 2014

Moving and handling patients in nursing is now taken very seriously compared with 20–30 years ago. In those days nurses used to hump and lug patients up the bed or transfer them into a chair or commode without the equipment and techniques used today. The implementation of a number of European Directives in 1992 led to important changes in health and safety requirements in relation to manual handling and moving. These directives stipulated that employers have a duty to ensure the safety of all employees involved in manual handling and moving activities. This legislation also laid down the principles which employers should follow with regard to assessing risk in their areas and implementing measures to avoid unnecessary injuries. It was also responsible for encouraging all employers to provide appropriate handling equipment and train their staff to use such apparatus and perform correct handling and moving techniques.
A voice from a children's charity
Authors: Storey Margaret
Published: May 2014

I've worked with families who have a child with a life threatening or terminal condition for many years now and I've seen tremendous development in paediatric community nursing services. These changes include: complex nursing procedures carried out in children's homes rather than hospitals and an increase in home-based palliative care with parents fully involved in the care of their children.
Development of catheter care guidelines for Guy's and St Thomas'
Authors: Stewart Ellie
Published: May 2014

The need for an up-to-date, evidence-based guideline for urethral catheter care became apparent after the author started working as continence advisor in the urology, gynaecology and elderly care directorates at Guy's and St Thomas' NHS Foundation Trust in 2003. This article details the processes and difficulties the guideline group went through when developing and passing the guidelines through the Trust's clinical governance committee. It details the aims and objectives of the new guidelines and the areas of debate pursued following the consultation period.
Knowing why patient safety incidents occur in the NHS
Authors: Tingle John
Published: May 2014

Nurses as key members of the healthcare team need to know about the National Reporting and Learning System (NRLS) of the National Patient Safety Agency (NPSA) and its analysis of reported patient safety incidents. Nobody wants adverse patient safety incidents to occur and when they do we need to learn the lessons to stop them or at least to minimize the likelihood of them occurring again, so far as we reasonably can. To get to know where you are going you have got to know where you have been. The NPSA report (NPSA, 2006) tells us exactly this in the context of patient safety incidents in the NHS – the summary provides an update on incidents reported to the NRLS from all sectors of the NHS. A pattern of incident types and severity is shown
The duty of care 1: compliance with directives and protocols
Authors: Fullbrook Suzanne
Published: May 2014

The first three articles in this series will concentrate on the issue the legal ‘duty of care’ – the terms of which we as nurses have to understand. The first article examines a recent decision of the High Court of England and Wales that discusses and examines directives and protocols. I have begun with a discussion of the fact that a duty of care not only extends from healthcare providers to patients (clients) but also from employers to employees, and between healthcare providers themselves.
Developing the role of a ward housekeeper within a multidisciplinary team
Authors: Richmond Jo
Published: May 2014

The implementation of a housekeeper induction competency programme demonstrates the innovative way that the clinical standards facilitator has led the development of the housekeeping service at one NHS Trust. This service has been developed to ensure that there is sufficient training, support and opportunity to share best practice for the housekeepers. A Trust-wide approach using the multidisciplinary team (including dietitians, catering and facilities managers) has contributed to the raising of standards in meeting the patients’ nutritional needs, as well as improving the ward environment. NHS Estates guidance (DH, 2001b) relating to the housekeeping service and the Essence of Carebenchmarks for nutrition (DH, 2001a) were used to provide this framework for continuous quality improvement
Review 2006. NHS key issues: finance, care, continuity
Authors: Castledine George
Published: May 2014

Keeping with tradition the Castledine column reviews 2006 and highlights issues for 2007. The health agenda has become dominated by two key factors: finance and infection control. From a clinical point of view the biggest factor to emerge has been the problem of delivering the fundamental aspects of nursing care. This was particularly highlighted by the television programme, which showed how older people were particularly at risk in general hospital wards
Abuse – a day in the life of a student nurse
Authors: Bailey Asa
Published: May 2014

Unbelievably (to me at least), according to new research presented at the Royal College of Nursing’s 2007 International research Conference on 1st of May, nearly half of student nurses surveyed by a London University have been verbally abused while on their work experience placements.
Some mothers do ‘ave ‘em…
Authors: Peate Ian
Published: May 2014

Liverpool came third in the premiership league and they could have won the premiership, if only … Many male deaths could be prevented, if only … If only men took more responsibility for their health, if only healthcare provision was geared towards meeting the needs of men and if only it adopted a more gender sensitive approach.
New challenges and new thinking in sickle screening
Authors: Anglin Sandra
Published: May 2014

Last Month saw the second annual ‘Sickle Cell Awareness Month’. As local centres and support groups reach out to their communities to improve knowledge about the disease and encourage people to get screened, there is a great deal to celebrate in the achievements of the last 12 months.
Challenging the blueprints of the NHS
Authors: Karstadt Lyn
Published: May 2014

Nursing and midwifery education has evolved over the past few decades, making many in the profession — as well as education — slightly confused as to what is going on. In this third column, Lyn Karstadt continues to shed light on these issues and discusses whether the ongoing changes occurring in the shape of health services and nurse education are really to the benefit of all nurses.
Nutritional support via enteral tube feeding in hospital patients
Authors: Roberts Elizabeth
Published: May 2014

Patients receiving enteral tube feeding are often encountered in the ward environment of an acute care setting. Patients may receive enteral tube feed through tubes intended for short-term feeding, or they may have a long-term feeding tube in situ. This article aims to provide a practical overview of feeding solutions and administration to enable nursing staff to understand prescribed regimens and provide patients with optimum care.
Which do you want first: the good news or the bad?
Authors: Bailey Asa , Black Peter
Published: May 2014

The bad news it is then – which isn’t difficult considering that a daily perusal through the news these past 2 weeks reveales more bad than good. For once the sport section seems glowing amidst heroics on the field (well, in the rugby anyway); however, casting eyes on the latest events in health care seem poor to say the least.
Researching the management of constipation in long-term care. Part 2
Authors: Grainger Michelle , Castledine George , Wood Neil , Dilley Carol
Published: May 2014

The management of constipation is a problem in any healthcare setting. Constipation can affect all individuals; older people and those suffering from disabilities and long-term chronic conditions, such as Parkinson’s disease and rheumatoid arthritis, are particularly vulnerable. This two-part article is based on a research study carried out in nine care homes, among patients of various ages with a variety of chronic conditions. The aim of the study was to investigate and improve bowel care in long-term care settings. The background to the study, including the definition, causes, risk assessment and management of constipation, were discussed in part 1 (Castledine et al, 2007). Part 2 presents the main part of the study. Results show that appropriate education of staff improves their knowledge and practice in dealing with constipation. The importance of educating and training all members of the care team, especially healthcare assistants, in the management of bowel care is highlighted. An evidence-based approach using a constipation risk assessment, management of constipation flow chart and an interventions tool are identified as key factors in the ongoing care of patients in long-term settings.
Becoming more proactive!
Authors: Castledine George
Published: May 2014

Headlines in the newspapers and the stories in the media have been shocking lately as much has been made of the recent report by the Healthcare Commission (2007) into the Maidstone and Tunbridge Wells NHS Trust outbreak of Clostridium difficile. Ninety patients died and more than 1100 became infected as the hospital failed to control the worst outbreaks ever recorded in the UK. The commission found some horrific failings in the way that infection control was managed, i.e. failing to contain the situation at all levels in the three hospitals within the Trust.
Purchasing for safety: standardization in intravenous equipment
Authors: Rodkin Sharon
Published: May 2014

In 2005 the National Audit Office published figures that revealed nearly a million (974 000) ‘incidents’ or ‘near misses’ regarding patient safety had been recorded in England over the previous year. A total of 2181 later proved fatal. These incidents included errors in drug dose calculations, administering drugs at the wrong rate or to the wrong patient. The nursing profession, along with doctors, surgeons and every other member of the healthcare team must understand their role in these mistakes. This article considers how standardizing equipment used by clinical staff and enhancing best practice with evidence can significantly reduce medical errors and allow clinical staff more time with their patients.
Women’s health equality: more studies, better care
Authors: Foss Tara D
Published: May 2014

I would first like to wish everyone a happy and healthy New Year and just like you I’m ready to charge forward and see what 2007 holds. BJN has had some special issues recently and I think this one is no exception
Innovative computer-based learning for breast cancer surgery
Authors: Wingfield Karen Louise
Published: May 2014

Discussions with student nurses when they have been on placement on the breast cancer surgery ward highlighted their lack of knowledge about breast cancer surgery. This lack of knowledge by student nurses necessitated the development of a computer-based learning tool. A distance learning tool was found to be an effective way of providing education, due to lack of facilities and workload on the ward. The student nurses using this tool will have better understanding of the treatments their patients are undergoing, leading to improved patient care
Part 3: Nurses’ guide to alcohol and promoting healthy lifestyle changes
Authors: Harrington-Dobinson Anne , Blows William
Published: May 2014

In this the third and final part, the focus is on the support and care of patients who are working towards a solution for their drink problem. While a number of treatment regimens exist for the management of alcohol abuse and there are well established groups to assist patients and their families, this article concentrates on three critical themes. The first concerns the promotion of insight. Only when the drink problem is understood by patients, carers and professionals alike, and shared in common terms, can rehabilitation begin to work. The second concerns communication channels. The propensity of some patients to deny their problem, or to lapse from therapy, makes communication especially challenging. While some patients are helped to overcome the risk of lapsing by being segregated from their usual community for some time (the clinic approach), many less well resourced patients must tackle this problem from home and with the help of community-based practitioners. Finally, the interplay of treatment (detoxification) and psychological support is discussed, arguing that the nurse has an important part to play in motivating patients and helping them to solve problems as they arise
An audit of nutritional care in a health board in Scotland
Authors: Beech Chris , Hill Rachel , Morrison Mirian , Moss Margaret , McInnes Louise
Published: May 2014

This article’s aim is to describe the processes used and results found when conducting an audit of nutritional care within a health board area in Scotland. Nutritional standards and an audit tool were developed by a multidisciplinary team and all in-patient clinical areas took part. The results demonstrate that there is still a considerable amount of work that needs to be undertaken to ensure that patients are getting the most effective and efficient nutritional care and this article denotes some of the initiatives instilled to address areas of identified challenges.
Assessment is the key!
Authors: Castledine George
Published: May 2014

The care of the patient’s bowels has always been one of the key aspects of nursing care down the centuries. Therefore, it probably comes as no surprise to learn that both doctors and nurses have become obsessed at times with the patient’s bowels and the examination of their faeces. Purgatives were considered a valuable class of medicines and were used in both the cure and prevention of disease. Even in patients with severe mental health problems, purgatives were tried and believed to have some beneficial effects. In fact, Andrew (1842) mentions, with regard to dealing with the problem of constipation, the effects of sedentary and studious lifestyles are blamed as the causes for the problem. Advice is given that if someone was to suffer from constipation then they should change their diet to one full of vegetables and various kinds of fruit that may produce the desired effect. A special ‘pease brose or peas-pudding’ made out of fine pease flour quickly mixed with boiling water, was recommended. If this failed then medicines, such as senna or an infusion of roses with epson salts, were prescribed.
Getting us to work together
Authors: Castledine George
Published: May 2014

The relationship between nurses and doctors is now expected to be much more cordial and conducive to effective patient care, but is it? There are many nurses who feel that if it was not for the superior attitude and arrogant behaviour of some doctors then many of the key communication problems in the health service today would not exist.
Controlling transmission: are nurses passing the test?
Authors: Peate Ian
Published: May 2014

The publication of the Health Protection Agency’s most recent report on the United Kingdom’s (UK) sexual health, Testing Times (The UK Collaborative Group for HIV and STI Surveillance, 2007), launched ahead of World AIDS Day provides sober reading for all nurses and specialist community public health nurses. Despite some promising developments being carried out in human immunodeficiency virus (HIV) and sexually transmitted infection (STI) prevalence, HIV has increased, syphilis still remains high and there has been an increase in genital herpes and genital warts. However, it must be noted that there has been a marked improvement in clinical services associated with genitourinary medicine (GUM) with the objective of curbing transmission, providing more screening opportunities to take place and reducing waiting times.
Letters to the Editor
Authors: Harper Phil
Published: May 2014

There must be few nurses working in surgical environments who are not familiar with the well-known phrase by Margo McCaffery that ‘All pain is real regardless of its cause, pain is whatever the person experiencing it says it is and exists where he says it does’ (McCaffery, 1968, p95). This quote is frequently used to indicate the uniqueness of an individual’s pain experience and nurses are taught that it is important to always believe what patients say about their pain. However, this is not always the case and many studies have shown that nurses frequently disagree with patients’ self-reports of pain (McCaffery and Pasero, 1999). This was apparent recently when a relative was admitted to hospital for a total hip replacement. The surgery was uneventful and postoperative analgesia was given via an epidural infusion. However, within 2 hours of returning to the ward, the analgesia began to wear off (later to be confirmed that the epidural line was incorrectly positioned). My relative informed the nursing staff who offered two paracetamol tablets and said they would ask a doctor to visit later. Subsequently, the pain worsened and my relative, who is normally very stoic, ended up in tears and was reduced to pleading for some stronger analgesia, a situation my relative found extremely humiliating. The response from the nurses was that oral analgesia had been given and the pain would be better in the morning.
The Mental Capacity Act 2005 and decision-making: advocacy
Authors: Dimond Bridgit
Published: May 2014

This article continues the series into the content and implications of the Mental Capacity Act 2005, which looks at the requirement to provide an independent mental capacity advocacy service in specified situations. The Act requires NHS organizations and local authorities to arrange for the appointment of an independent mental capacity advocate in the following situations: where serious medical treatment is being considered for a person who is incapable of making his or her own decisions, and where accommodation is being arranged by an NHS organization, or by a local authority, for a person who lacks the requisite mental capacity to give consent. Additional situations have been added by regulations and these include where there is a review of the accommodation arrangements (Reg. 3) or where an NHS body or local authority propose to take protective measures in relation to a person who lacks the requisite mental capacity (Reg. 4). The statutory duty does not apply if there is a person whom it would be appropriate to consult on a person’s best interests, except in the case of protective measures being taken. The article considers the powers and the duties of the independent mental capacity advocate and applies the legal provisions to a practical situation.
Stop having surgery. Stop working for your salary.
Authors: Foss Tara D
Published: May 2014

Sometimes we all just need a big laugh when it seems that all around us, our lives are not what we need them to be. Stories on NHS job cuts and discussions on the effects of privatization on the NHS abound in the news. There are times when we want to put our hands over our ears and yell, just so we don’t have to hear any more about it.
Risk, responsibility and regulation: whose risk is it?
Authors: Tingle John
Published: May 2014

It is increasingly difficult these days to find the time to stand back and think about the fundamental concepts which underpin what we are doing in our daily work. In the area of clinical risk and health quality management, we need to ask such questions as: what is risk management in nursing and medicine? Why regulate for health quality? Do patients maintain unrealistic expectations of what can be achieved in their treatment? As nurses, do we protect them too much? Do patients know that there is no such thing as zero risk? Reflection is useful as it can help us develop new perspectives or even reaffirm old ones in our minds.
Professional behaviour: professional indemnity insurance
Authors: Fullbrook Suzanne
Published: May 2014

As registered nurses, we are aware that we msut behave in a ‘professional’ way. We know that we must achieve certain standards of behaviour and that our conduct as registered nurses is constrained by regulation. The Nursing and Midwifery Council (NMC) have the statutory power to decide how we must act and how we must not. Certain types of behaviour can and will attract sanctions from the NMC professional committees. Registered nurses are removed from the register in ever-increasing numbers, and one of the reasons given by the professional committees for a removal from the register, is that there was failure to act to protect patients by providing a safe environment. Examples of negligent behaviour include misadministration of drugs, a failure to properly manage dietary needs or failures to protect the integrity of the person from pressure sores and damage to the skin.
Diabetes mellitus, part 1: physiology and complications
Authors: Nair Muralitharan
Published: May 2014

In part 1 of this 2-part article the author discusses the physiology and complications of diabetes mellitus (DM), a chronic and progressive disorder which affects all ages of the population. The number of people diagnosed with diabetes is approximately 1.8 million and an estimated further 1 million are undiagnosed (Department of Health, 2005). In the UK, 1–2% of the population have diabetes and among school children this is approximately 2 in 1000 (Watkins, 1996). There are two main types of diabetes - type 1 and type 2 (Porth, 2005). The aetiology of DM is unknown; however, genetic and environmental factors have been linked to its development. Type 1 results from the loss of insulin production in the beta cells of the pancreas, and type 2 from a lack of serum insulin or poor uptake of glucose into the cells. Diabetes causes disease in many organs in the body, which may be life-threatening if untreated. Complications such as heart disease, vascular diseases, renal failure and blindness (Roberts, 2005) have all been reported. The increased prevalence may be caused by factors such as environmental aspects, diet, an ageing population and low levels of physical exercise.
Autonomy and care: acting in a person’s best interets
Authors: Fullbrook Suzanne
Published: May 2014

In previous articles, I have examined certain principles of human behaviour that inform the common law, and thus our nursing practice. We have determined that we do in fact owe those we care for, a duty of care. This duty in its widest sense is a duty not to cause harm. In the second article I reviewed the concept of risk assessment; how we act so as to avoid causing harms or allowing harms to occur, by undertaking an assessment of risk, prior to any events that could occur. And lastly, I examined how we as professionals need to indemnify our practice so as to ensure that should things go wrong, those harmed can, at the very least, obtain funds to assist with recovery of health.
Recurring themes in NHS complaints
Authors: Tingle John
Published: May 2014

The Healthcare Commission (HC) has recently published a report of its work in reviewing complaints made by patients or their representatives about NHS care and treatment (HC, 2007). Recurring themes in some 16000 complaints sent to the HC for independent review between July 2004 and July 2006 are identified and areas of concern most frequently raised by patients are highlighted. The top ten issues raised in complaints reviewed by the HC were
Pathophysiology and management of hepatic encephalopathy
Authors: Sargent Suzanne
Published: May 2014

Hepatic encephalopathy is a common complication of liver cirrhosis occurring in up to 80% of patients and is characterized by neuropsychiatric complications ranging from slight altered mental status to coma. While the underlying mechanisms remain poorly understood with several proposed hypothesized theories, the mainstay of treatments are aimed at identifying and treating the precipitating causes or reducing intestinal ammonia production. Despite the increasing incidence of liver disease and liver cirrhosis within the UK, there have been few major advances in treatments of hepatic encephalopathy over the last decade. This article provides an overview of the pathogenesis, and medical and surgical management of this major clinical problem.
A qualitative study to determine the restratification of nursing
Authors: Wilkinson Carol
Published: May 2014

The theory of occupational closure is a neglected area in the field of nursing. This article attempts to determine its relevance to nursing within the current political and economic climate where skills shortages within the field of medicine and the introduction of the European Working Time Directive in Britain, has presented new opportunities for nursing on several fronts. The study attempted to identify the impact of this policy upon the working relationships of doctors and nurses. It also attempted to determine how doctors and nurses classify the work of nursing in current context and the reasons for so doing. A series of semi-structured interviews were conducted with a group of doctors and nurses working in a large teaching hospital in the English Midlands. The study showed that a restratification of nursing has occurred whereby a three-tier classification system has emerged within the hierarchy of nursing. The findings have opened up a debate concerning issues of power, territorialism and new directions for the future of nursing.
Don’t use the term ‘health promotion’ to promote health
Authors: Castledine George
Published: May 2014

Someone from the World Health Organization once told me that if nurses want to help people with their health, they should never use the term health promotion. I have never forgotten this piece of advice and have seen many nurses fail to get their message across. I suppose the main problem has been that many health promoters have seen their task as ‘getting their message across’ rather than enabling or stimulating people to make their own informed choices and improve their habits.
Consent and capacity: principles of the Mental Capacity Act 2005
Authors: Fullbrook Suzanne
Published: May 2014

In this series we have seen that competent adult patients have the legal right to withhold their consent to treatment offered to them. This rule applies to all areas of treatment and care, even where treatment offered is for a serious or severe condition. It applies equally where in the extreme situation, a refusal is likely to result in the person’s death (House of Lords, 1994; Re MB, 1997; Re JT, 1998; Re AK, 2001). However, many people do not meet the strict criteria that enables them to consider themselves ‘competent’. Where a person cannot be considered competent, another set of legal principles are effected, by the common law, and now by statute.
Evaluating a framework for the development of joint appointments
Authors: Fowler John , Richardson Marylyn , Ashton Mandy , North-Rose Angela
Published: May 2014

This article evaluates an evidenced-based framework for the development of joint appointment posts by reflecting on the lived experience. It uses an action science philosophy that acknowledges the development of actionable knowledge from the integration of theory and practice. At the same time the lived experience of setting up a joint appointment post is evaluated using the same evidenced-based framework. The actionable knowledge generated confirms the importance of articulating vision at strategic levels and of empowering people who are solution focused at operational levels.
Letters to the Editor
Authors: Anderson Irene , Charles Hildegard , Gannon Robert
Published: May 2014

An article in our last Tissue Viability Supplement in June caused quite a stir. Shortly after publication of ‘A review of the four layer vs the short stretch bandage system’ (BJN, 2007, 16(11): S18–S21) we received letters discussing it. Here are two of those letters, along with a response by the author himself.
The waiting game we cannot afford to lose
Authors: Bailey Asa
Published: May 2014

Christmas came, the goose got fat, and if the World Health Organization’s (WHO) predictions are correct, so will 27% of the population of the UK by the year 2015 (WHO, 2006a). And by that, the WHO do not just mean ‘overweight’, they mean ‘obese’, i.e. a body mass index equal to or more than 30, which presents a major risk factor for chronic diseases such as cardiovascular disease, diabetes, musculoskeletal disorders and some cancers (WHO, 2007b)
The Mental Capacity Act 2005 and decision-making: advance decisions
Authors: Dimond Bridgit
Published: May 2014

One of the crucial features of the Mental Capacity Act (MCA) 2005 was recognizing in a statute the ability of a person to refuse treatment at a subsequent time when he or she lacked the mental capacity to decide on treatment. This refusal, known as an advance decision or living will or advance refusal had been recognized at common law, i.e. judge-made law. This article, continuing the series on the MCA explains the statutory provisions, the specific requirements which must be satisfied if life-sustaining treatment is refused in advance and looks at a practical situation to illustrate the statutory provisions. The link between advance decisions are lasting powers of attorney is also discussed
Postmortem tissue donation for research: a positive opportunity?
Authors: Millar Tracey , Lerpiniere Chrys , Walker Robert , Smith Colin , Bell Jeanne E
Published: May 2014

Previous research using human brain tissue has increased the understanding of many brain disorders, such as Alzheimer’s disease and Creutzfeldt Jakob disease. However, there are other conditions, such as multiple sclerosis, which remain poorly understood and which require further investigation. The ongoing decline in the consented postmortem rate poses a threat to tissue collections and, consequently, future research. In the setting of the new Human Tissue legislation the authors set out to ascertain whether families recently and suddenly bereaved were willing to grant authorization for tissue samples and/or organs to be retained for research purposes at the time of medicolegal postmortem examination in adequate numbers to support the establishment of a brain and tissue bank. During the 2-year pilot phase of the project, 96% of families authorized retention of tissue samples for research and 17% agreed to whole brain donation. Respondents to a short questionnaire indicated that they were not further distressed by the approach and the majority were of the opinion that research donation should be offered to all bereaved families. This research concludes that the overwhelming majority of families who are recently and suddenly bereaved are willing to authorize research use of tissue taken at the time of postmortem examination.
Choosing the right surgical glove: an overview and update
Authors: Tanner Judith
Published: May 2014

Sterile surgical gloves are routinely worn during all invasive procedures to prevent the two-way transmission of pathogens between the surgical team and the patient. This reduces the risk of surgical-site infections and blood-borne diseases. Since their introduction to the operating room over 100 years ago, surgical gloves, and the materials used to make them, have continued to evolve in line with ever changing healthcare demands. Following recent developments in surgical glove technologies, including de-proteinized natural rubber latex and newer gloving methods such as triple gloving, it is timely that an overview and update of surgical gloves is given. By providing information on latex-associated allergies, glove materials, gloving methods and glove protection, this article will enable practitioners to choose the most appropriate surgical glove.
The pursuit of happiness in end-of-life care
Authors: Bailey Asa
Published: May 2014

Oh, the joys of Government hype … After a gruelling and ruthless assault in recent months on party policy, direction, results and above all, leadership, it is no surprise that the Government are almost frothing at the mouth on publication of their new End of Life Care Strategy (Department of Health [DH], 2008) – at last they have something to shout about. I admit, that sounds rather negative and maybe a bit harsh, but it is not the strategy I have quarrel with – I challenge anyone to oppose a £286 million injection of any sort into the NHS – it is more the song and dance over a plan that is so simple and so obviously going to help thousands of people as they near their end of life, yet one that is so late, and which could and should have been implemented years go.
Historical development of psychiatric classification and mental illness
Authors: Collier Elizabeth
Published: May 2014

Psychiatric classification has been developing for over 100 years and there are now over 400 diagnoses available. Dementia and adjustment disorder were the only diagnosis available for older adults until a number of papers published between 1944 and 1955 demonstrated the relevance of functional mental illness for older adults. It was not until 1987 that the Diagnostic and Statistical Manual published by the American Psychiatric Association included an option to diagnose schizophrenia in the over 45s. This paper describes the historical development of psychiatric classification and discusses how this has potentially influenced ageist attitudes to older people, with particular reference to schizophrenia and dementia. Nurses are encouraged to reflect on their own attitudes in light of this discussion as to how medical frameworks for understanding mental illness may have influenced personal beliefs, particularly ageist beliefs about older adults.
Healthcare for all?
Authors: Fearns Debra
Published: May 2014

Further evidence (if needed) of the unequal and discriminatory treatment of people with learning disabilities within the NHS emerged last week: publication of Healthcare for All(Michael, 2008) follows on from Mencap’s (2007) Death by Indifference, and confirms that adults and children with learning disabilities ‘find it much harder than other people to access assessment and treatment for general health problems that have nothing directly to do with their disability’ (Michael, 2008, p 7). This is supported by the Disability Rights Commission (2006), who carried out a formal investigation outlining physical health inequalities that are still experienced by people with learning disabilities.
‘Like waiting for a bus that never comes’
Authors: Bailey Asa
Published: May 2014

These were the words of 41-year-old Rod Lenette in a report on BBC Breakfast News this morning (4 September). Rod, a father of three, has spent more than 4 years on dialysis, every day making a 1-hour trip each way to the unit at Addenbrooke’s hospital. Physiologically speaking, yes, dialysis is keeping Rod alive, but from his stark words and emotional responses, it is clear that Rod’s quality of life is severely lacking, affecting not only himself, but also his wife and children.
Freeing students caught between pillar and post
Authors: Castledine George
Published: May 2014

There is increasing concern that many nursing students are getting caught up between academic pillars and NHS posts. The root cause may be the different cultures which have developed between the health service and current nursing education. At present there is an NHS which has changed from its philanthropic style of caring for its staff and sees people as a resource, rather than human beings. Nursing students at one time were viewed as essential individuals to be moulded and shaped into the type of staff the institution wanted to extol their virtues. Many nurses at the end of their hospital training were proud to be known by the hospital which had nurtured them.
High-flow humidified oxygen therapy used to alleviate respiratory distress
Authors: Turnbull Betty
Published: May 2014

This article describes the utilization of humidified high-flow oxygen therapy systems, which can comfortably deliver optimal humidified high-flow oxygen therapy, via nasal cannulae, at flow rates of up to 40 litres per minute to adult patients, in hospital or at home. The oxygen is saturated with water vapour at body temperature allowing flow to be well tolerated. First, to set the scene, three clinical scenarios are presented of patients nursed in intensive care, who suffered severe respiratory distress. Respiratory failure is explained, and the need for oxygen therapy set out. Alternative oxygen delivery devices and systems are then outlined, and an example of a high-flow system introduced. Set-up of the system is explained and the need for decontamination propounded. Finally, the benefits of the humidified high-flow oxygen system are exemplified, with particular reference to the critically ill patients presented here.
Bladder cancer and smoking. Part 2: diagnosis and management
Authors: Anderson Beverley , Naish Wendy
Published: May 2014

This is the second article in a series of four on bladder cancer and smoking. The link between bladder cancer and smoking was discussed in part 1, and part 2 looks at diagnosis and management. The authors conducted a survey within their own workplace to identify whether patients had been given information about the role of smoking in the development of bladder cancer and drew on the results of this to identify areas where clinical practice needs to change. This article seeks to provide an overview of the management of bladder cancer: how the disease is manifested, and subsequent treatments to reduce the risk of recurrence and progression. Superficial bladder cancer is managed by surgery: transurethral resection. Additional treatment includes cytotoxic therapy with intravesical chemotherapy and immunotherapy agents. However, while treatments may be effective in reducing tumour recurrence, the chance of tumour progression from superficial to invasive disease remains high. Further risks are incurred from the side-effects of treatments on the individual’s quality of life.
Management of end-stage chronic obstructive pulmonary disease
Authors: Barnett Margaret
Published: May 2014

Chronic obstructive pulmonary disease (COPD) is a potentially fatal, slowly progressive condition of the airways. It is a chronic disease which, although preventable, is not curable. COPD is one of the chronic conditions projected to increase over the next decade, and as a consequence causing increased morbidity and mortality. As the disease progresses the symptoms become more severe and, frequently, regular medication alone becomes less effective. It is essential that healthcare professionals are able to recognize, which is not always easy, when patients have reached this stage of the illness, to ensure appropriate care and management. This article provides an outline for healthcare professionals of clinical markers to help distinguish end-stage disease and pharmacological and non-pharmacological interventions that may assist in achieving optimal symptom control and provide some quality to the patient’s final stage of their life.
Dementia care. Part 1: guidance and the assessment process
Authors: Ouldred Emma , Bryant Catherine
Published: May 2014

This article outlines recent guidance on dementia care and provides information on dementia, its different subtypes, the assessment process and the utility of cognitive screening tools. As dementia progresses a person may gradually lose their ability to make decisions for themselves. The Mental Capacity Act 2005 (MCA) is one of the most significant Acts to be passed in the United Kingdom, which protects people with dementia and stresses the need to advocate on behalf of this vulnerable group. The MCA is described in detail as practitioners working in the field of dementia care need to be aware of its clauses, as they are likely to require knowledge of it on a frequent basis. Dementia, delirium and depression are often mistaken for one another and useful ways to differentiate between the different conditions are given in addition to comprehensive advice about the management of people with dementia admitted to hospital with delirium.
Paradigms of nursing: which will it be?
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 this eighth column, Lyn Karstadt explores increased computer usage in nursing, and discusses what this shift in education holds for the future.
Casting parallels to overseas shores
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 this nineth column, Lyn Karstadt reflects on her recent trip to Malaysia, and believes that we may be leading the way, but their system is snapping at our heals.
Acute coronary syndrome: social support and coping ability on admittance
Authors: Almerud S , Baigi A , Hildingh C , Jogre J , Lyrström L , Fridlund B
Published: May 2014

Aim: To compare social support and coping ability in acute coronary syndrome patients at the time of the cardiac event with a healthy community-based sample, with regard to age, sex, education and marital status.

Method: The study comprised 241 patients and 316 healthy controls. The participants answered a self-administered questionnaire that included three well-established scales. Multiple logistic regression was used in the analysis to compare the health situation between the patients and controls.

Results: Persons suffering from acute coronary syndrome rated emotional support significantly lower than the healthy controls. However, there were no differences between the two groups in terms of socio-demographic variables.

Conclusion: This study indicates that social support may be a predictor of acute coronary syndrome.
Duty of care and political expectations. Part 4: standards as a political promise
Authors: Fullbrook Suzanne
Published: May 2014

The last article was concerned to identify connections that exist between principles elucidated at common law that affect the behaviour of nurses - and the exposition of principles contained in the literature produced by the Nursing and Midwifery Council (NMC). This was in order to identify a level of expectation directed at nurse’s practice in terms of health care provided. Although there was not a great difference, and clarity was seen in both areas, the issue of political expectation was introduced.
Barriers to gathering evidence in tissue viability
Authors: Palfreyman Simon
Published: May 2014

Aclinician trying to examine the evidence about a particular treatment or intervention can be frustrated by phrases such as: ‘more evidence needed’ or ‘insufficient evidence of effectiveness’ or ‘the current evidence was of poor quality’. It can sometimes seem that researchers are not answering questions that have any relevance or use to clinical staff. As a nurse researcher within the area of tissue viability I would like to plead some extenuating circumstances. In conducting research you can encounter problems with money, bureaucracy, recruitment and dissemination.
Join the lobby: pushing for NICE guidelines in oedema
Authors: Anderson Irene
Published: May 2014

Some days you wish you had stayed in bed with a book rather than face the world. I arrived at work this morning feeling quite emotional and could not decide whether I wanted to shout at the radio (again) or weep at another example of bad press for nurses. Radio 4 is running a campaign looking at care provision for elderly people. Give them their due, there was a couple of positive points but there was an horrific narration of a daughter watching her elderly mother being hoisted and a soiled, disintegrating pad on which she had been sitting for 12 hours, falling from her bottom. Hoists are very necessary to ensure safety of staff and patients but I am sure we can all picture the scene and appreciate that not everyone takes account of patient position, understanding and comfort. The indignity and misery was hard to bear as a listener and a million times worse for the woman and her family. What must the public think?