bluuebunny/crossref_metadata_2025 huggingface dataset:
Honey in wound care: effects, clinical application and patient benefit
Authors: Lay-flurrie Karen
Published: May 2014

The use of honey in wound management has enjoyed a resurgence. This is largely due to the growing clinical problem of antibioticresistant bacteria and the combined difficulties for the practitioner in managing chronic wound types, such as burns, leg ulcers or surgical wounds, that may become infected, for example, with methicillinresistant Staphylococcus aureus or Pseudomonas. The associated costs of treating such wounds are escalating as a result. While the use of honey as a wound dressing has been recognized, at least since Egyptian times circa 2000 BC, it is only more recently, due to the development and licensing of modern honey wound dressings, that such dressings have become more widely available and used in wound management. This article focuses on the use of honey in the treatment of infected wounds and burns. It will examine the effects of honey at the wound bed and its clinical applications, along with the current dressings available. Also discussed are the practical considerations, if, like any wound dressing, honey is to be used safely, appropriately and for the benefit of the patient.
Honey: a guide for healthcare professionals
Authors: Evans Julie , Flavin Susan
Published: May 2014

There is a growing body of literature promoting the use of honeybased products in wound care, demonstrating their efficacy, costeffectiveness and excellent record of safety. Thus, there has been a sizeable renaissance in the use of honey as a topical treatment for a wide range of wounds. This resurgence has brought an array of new honey-based wound products into the market place. Honey for the purposes of wound management has to be ‘medical grade’, which ensures that it has been sterilized by gamma irradiation and has a standardized antibacterial activity – only these honeys can be registered as medical devices. Hence, practitioners should exercise caution before using any unregulated unlicensed honey product as a treatment for wounds. This article provides healthcare practitioners with the information they need to make a considered decision when choosing between honey-based products. It highlights the importance of established clinical evidence in demonstrating the therapeutic properties of honey and supporting the use of honey-based products in the management of wounds. The practitioner needs to consider the written information provided by manufacturers as to the clinical evidence base of the product, indications and contraindications for use and safety of the product.
Exploring mental health students’ perceptions of role models
Authors: Illingworth Paul
Published: May 2014

This article describes and reflects on a qualitative study that attempted to develop further understanding of the concept of role models, using the experiences of third-year students undertaking mental health nurse education. Although there is a wealth of literature regarding role models, little exists that acknowledges what, in this case, students want of a role model, or how the students identify the positive attributes of a significant role model. The researcher used a qualitative approached based on phenomenological methods. The research question used, was: ‘From the viewpoint of a third-year student undertaking mental health nurse education, what is the phenomenon referred to as role model?’
The pathophysiology and causes of raised intracranial pressure
Authors: May Kathryn
Published: May 2014

This article explains the pathophysiology and causes of raised intracranial pressure (ICP), and the significance of assessing and recording vital observations for all patients when admitted to hospital. It discusses the nursing care, treatment and management required in order to minimize the risk of further increases in ICP.
The role of the health-care assistant in general practice
Authors: Brant Catherine , Leydon Geraldine M
Published: May 2014

The role of the health-care assistant (HCA) has developed rapidly in general practice and has occurred on an ad hoc basis across the UK, with the precise role shaped by the requirements and culture of individual practices. Currently, there is no regulation of HCAs and little published material about the remit of the role. This study aimed to describe general practice colleagues’ perceptions of the HCA role; identify key areas of inter-professional agreement and disagreement about the role; and describe the likely impact of these on the direction and development of HCAs. The study used a multiple-method qualitative study, using focus groups and semi-structured interviews and was set in general practices across one primary care trust. It featured uni-professional focus groups of practice nurses, HCAs and practice managers and interviews with GPs and practice managers. Transcribed material was analysed using constant comparison to derive robust themes. Participants focused on issues surrounding communication and teamwork and the fact that the individual nature of practices will affect the development of the HCA role. Questions regarding the development and structure of the HCA role were also broadly debated. The study concluded that the development of the HCA role in general practice is variable and the success of the role within a practice depends on good preparation for its future direction as well as the broad inclusion of team members in discussion and decision-making about the role.
Effectiveness of two opioid antagonistsin treating opioid-induced constipation
Authors: Healy Richard
Published: May 2014

Aim: This literature review reports the effectiveness of two peripheral opioid antagonists to relieve constipation caused by prolonged use of opioids, primarily in patients with advanced cancer. Background: Opioid-induced constipation can cause great discomfort to patients who use opioids for prolonged periods and on occasion decline painrelief in an effort to help aid laxation. The use of peripheral opioid antagonists can help reverse the slowing of the gut caused by the opioids, but the correct one must be used in order not to reverse the important analgesic effects the opioids provide. Data sources: Information was obtained by searching the databases British Nursing Index, CINAHL and Medline. Review methods: Selection criteria were as follows: original research in the form of randomized controlled trials; articles had to be written in English; articles had to focus on the effectiveness of naloxone and methylnaltrexone in the treatment of opioid-induced constipation; the search was limited to the period 1990–2008. Results: Nineteen articles were included in the study. The results from the studies indicate that due to fewer withdrawal effects and less reversal of analgesia experienced, methylnaltrexone is more effective at relieving opioid-induced constipation. Conclusion: The recent development of methylnaltrexone into a commercially-viable drug indicates its effectiveness. It may help patients suffering from the intense discomfort that constipation can cause.
Obesity and diabetes: time to act
Authors: Black Peter
Published: May 2014

Half of all adults will be obese by 2050 (Foresight, 2007). Globally, there are more than 1 billion overweight adults, at least 300 million of them clinically obese.
Classification of schizophrenia. Part one: the enduring existence of madness
Authors: Snowden Austyn
Published: May 2014

The classification of schizophrenia is currently under review in a coordinated worldwide consultation for the Diagnostic and Statistical Manual of Mental Disorders (DSM V) and the International Classification of Diseases (ICD 11) – the standard manuals for psychiatric classification. To understand the issues under consideration, the underpinning foundations of the concept need to be understood. This article, the first of two parts, analyses the theoretical input of Kraepelin, Bleuler, Jaspers, Schneider and Crow in order to delineate the boundaries of current discussions. The second part will analyze the importance of nursing engagement with classification by contrasting it with the harm of not doing so.
Right to receive treatment in accordance with the Human Rights Act 1998
Authors: Wicks Elizabeth
Published: May 2014

The question of whether a patient can rely upon a right to treatment in the courts is a topical and controversial one. This article provides a short summary of the current law on this issue and concludes that, while there is no substantive right to treatment as such, the courts are increasingly willing to enforce procedural requirements onto those bodies that make funding decisions. These procedural requirements seek to ensure that each patient is assessed on the basis of his or her individual clinical needs. Blanket policies against funding particular treatments are not permitted, but neither are funding decisions based on exceptional personal (non-clinical) circumstances. Individual clinical needs are always relevant and must be taken into account. Provided that the body making funding decisions satisfies this requirement, the courts will be reluctant to intervene with decisions about the provision of medical treatment.
Improving peripheral IV cannula care: implementing high-impact interventions
Authors: Aziz Ann-Marie
Published: May 2014

Infection prevention and control measures have been recognized as effective in minimizing the risk of infection from peripheral intravenous (IV) cannulas. However, this relies on health professionals’ compliance with guidelines for the care of patients with IV catheters and at times it may be that practice is inconsistent with guidelines. This article discusses the care required for peripheral cannulas and shows how implementing the high-impact interventions can improve peripheral IV catheter care on insertion and its management afterwards.
Prison health care: it’s time to ‘water the flowers’
Authors: Walsh Elizabeth
Published: May 2014

During the last three weeks, there have been two notable reports published which concern prison health care. Her Majesty’s Inspectorate of Prisons (HMIP) launched their annual report at the end of January (HMIP, 2009), and more recently the joint Health Care Commission (HCC) and HMIP report for 2007/2008 (HMIP and HCC, 2009) has been published. The HMIP report relates to all aspects of the prison inspection agenda, including health, whilst the joint HMIP and HCC report concentrates on the commissioning of health care services in prison.
Adverse events in bevacizumab and chemotherapy: patient management
Authors: Blowers Elaine , Hall Kate
Published: May 2014

Bevacizumab (Avastin®) is an anti-angiogenic agent recently approved for the treatment of metastatic breast cancer in combination with paclitaxel. It is important that nurses are familiar with the side-effects associated with this agent – several of which differ from those seen with traditional chemotherapy agents – and how these can be optimally identified, monitored and managed. Side-effects associated with bevacizumab include hypertension, proteinuria, thromboembolic events, bleeding, cardiac toxicity, wound-healing complications and gastrointestinal perforations. Many of these are easily manageable, often without the need to discontinue bevacizumab therapy. This article, the second in a series, provides nurses with management recommendations for these toxicities in order to deliver optimal patient care and improve patients’ quality of life.
A comparative study of two-piece ostomy appliances
Authors: Welser Marion , Riedlinger Inge , Prause Ulla
Published: May 2014

The quality of life of people with a stoma may be affected by peristomal skin disorders and by frequent unplanned changes of ostomy appliances due to problems with those appliances. The aim of this study was to evaluate two new, two-piece ostomy appliances with mechanical couplings (both from the SenSura range by Coloplast) and their ability to address areas that may be important to the quality of life of people with stomas, including appliance changes, stool seepage and overfilling. The study design featured two comparative, crossover, randomized multi-centre studies that were conducted in Germany. The SenSura appliances were evaluated against established reference appliances. Seventy-three individuals with a colostomy (closed-end appliances) and 75 individuals with an ileostomy (drainable appliances) participated in the studies. The participants tested 4–6 flanges of each type within a maximum period of two weeks. The results demonstrated that there was less seepage of stool observed under the SenSura flange when it was removed (p<0.05). Also, there were fewer unplanned changes (p<0.0005) seen with SenSura than with the reference appliances.The SenSura flanges had better adhesion and flexibility and were easier to remove than the references (p<0.0005), and they had greater resistance to erosion (p<0.05). In conclusion, SenSura performed better than the reference appliances on quality of life indicators – there were fewer unplanned changes and less seepage of stool was observed in patients using the SenSura products.
The effective management of squamous cell carcinoma
Authors: Davies Ann
Published: May 2014

In recent years, the various types of skin cancer have been on the increase, with over-exposure to sunlight in people with sensitive skin being the main epidemiological risk factor (National Institute of Health and Clinical Excellence (NICE), 2006). This article discusses the second most common of the non-melanoma skin cancers, squamous cell carcinoma, and looks at epedimiology, assessment and treatment. The article also examines other skin lesions that may have the potential to develop into squamous cell carcinomas if left untreated. As these types of skin cancer are on the increase, the article will conclude with health promotion advice on how to avoid skin cancers and how nurses can play a role in their prevention.
Building the evidence base – the Zassi Bowel Management System
Authors: Norton Christine
Published: May 2014

Uncontrolled faecal incontinence (FI) secondary to diarrhoea represents a major risk to perianal skin integrity and the healing of perineal wounds or burns. In an era of heightened awareness of the morbidity and the costs associated with hospital-acquired infection, there are obvious concerns about the risks of crossinfection associated with diarrhoea or FI. This article evaluates the Zassi Bowel Management System (ZBMS, Hollister®>), a product that has been designed to manage diarrhoea, faecal incontinence and defaecation in situations where a patient is either completely dependent, has overwhelming uncontrolled diarrhoea that poses a threat to skin integrity and is a cross-infection risk, or where normal defaecation poses a risk to wound integrity and sterility.
Undergoing enucleation of the eye. Part 2: postoperative care
Authors: Cooper John
Published: May 2014

In this, the second of a 2-part article, the author discusses the postoperative care of patients who undergo enucleation of the eye. Part one explored aspects of preoperative care of enucleated patients. In the immediate period following surgery, patients require support and advice regarding pain, nausea and simple care of the eye socket. Apart from the intrinsic postoperative demands of the surgery, there are also the difficulties and challenges associated with providing psychological support and helping patients cope with the loss of an eye. Ultimately, the patient can overcome any initial problems and eventually be able to wear a custom-made prosthesis, which will hopefully allow the patient to move on with their lives. As in the first part, the author will use both referenced material and anecdotal references (upon personal reflection) to analyze the ongoing postoperative care and support of these patients.
What the staff think about the NHS
Authors: Tingle John
Published: May 2014

John Tingle discusses the 2009 NHS Staff survey which provides trusts with information about the views and experiences of employees that can help to improve the working lives of staff and the quality of care for patients.
Type 2 diabetes and obesity in adults
Authors: Whitmore Catherine
Published: May 2014

There are approximately 2.5 million people in the UK with diabetes; 85–95% of whom have type 2 diabetes. Type 2 diabetes mellitus is characterized by insulin resistance and impaired insulin secretion. As approximately 90% of people with type 2 diabetes are overweight or obese, obesity is seen as a significant contributory factor in its development. This article aims to examine some of the physiological mechanisms by which overweight and obesity contribute to the development of type 2 diabetes, and review some of the approaches to managing overweight and obesity in the person with established type 2 diabetes, including dietary management, the use of reduced carbohydrate diets on glycamic control, anti-diabetes and anti-obesity drugs both in use and in development, and bariatric surgery
Airway management for nurses: emergency assessment and care
Authors: Higginson Ray , Jones Bridie , Davies Kevin
Published: May 2014

Within the hospital environment patients can deteriorate rapidly and for many different reasons. Maintaining a patient’s breathing is the main priority in any emergency situation—although achieving airway control can be difficult. All health professionals need to be able to safely undertake airway management and the key to the management of an airway is through a thorough assessment, to firstly ensure whether the airway is patent or not. This article will discuss airway management— both acute and chronic—as well as associated nursing care
Advance care planning: the role of the nurse
Authors: Samanta Ash , Samanta Mrs Jo
Published: May 2014

Advance care planning is a process designed to enable patients to discuss and record their values and treatment preferences to inform future care in the event that they lose decision-making capacity. Current law provides for the appointment of a proxy decisionmaker under a Lasting Power of Attorney, or advance decisions for treatment refusal. A further option is a statement of wishes to record the values and views to be used to inform the determination of best interests. Nurses can play an invaluable role in facilitating open and frank discussion
Is self-management a better option for skin conditions?
Authors: Onselen Julie Van
Published: May 2014

In 2009, a Self Care Campaign was launched with advocates from key primary care organizations. Self Care: an Ethical Imperative (Self Care Campaign Group, 2010) is a manifesto calling for all political parties to support a campaign for self-care for minor ailments. The top minor ailments, listed in the manifesto as accounting for 75% of a GP’s time, include two dermatology conditions, dermatitis (eczema/dermatitis are synonymous terms) and acne. Acne and dermatitis are long-term conditions, which may be acute and chronic, often causing significant psychological distress. They require prescribed treatments, often with complex regimens requiring support and monitoring from health professionals
NHS trusts put patients’ lives at risk by ignoring safety guidelines
Authors: Tingle John
Published: May 2014

John Tingle discusses the recent Action Against Medical Accidents (AvMA) report on the implementation of patient safety alerts in the NHS, which is critical of widespread failure to follow-up trusts and Ensure compliance with patient safety alerts.
The bonfire of the regulators: a phoenix from the ashes?
Authors: McHale Jean
Published: May 2014

Jean McHale considers the implications of the Government’s recent report, Liberating the NHS: Report of the arm’s-length bodies review. The report proposes to abolish a number of regulatory and other arm’s-length bodies: does this restructuring offer an opportunity to rationalize the regulation of medical research in the UK?
The changing patient
Authors: Castledine George
Published: May 2014

It is interesting to see how the person behind the ‘patient’ has changed with the development of the modern health service. Many textbooks paid little attention to the individuality and sensitivity of the patient who was the focus of many nursing procedures and functions. Even the Handbook for Ward Sisters(Scales, 1952), which devoted 16 pages to the subject, refers to ‘The Patient’ like an object that is passed around and cared for by nurses who should know what to do at various stages or steps in the busy routine of hospital life
The role of the nurse in the management of acute kidney injury
Authors: Murphy Fiona , Byrne Gobnait
Published: May 2014

Acute kidney injury can occur with patients within the hospital and within the community setting. The term acute kidney injury replaces the previous recognized term acute renal failure in the literature and uses two internationally recognized classification systems. The causes of acute kidney injury remain the same, pre renal failure, intra renal (intrinsic), or post renal failure. The nursing care of acute kidney injury is challenging and multifaceted as the patient can be critically ill and requires constant monitoring. It is therefore vital that nurses understand what acute kidney injury is, and the management of it in order to deliver holistic care to the patient concerned.
IV training is important for community nurses
Authors: Kayley Jill
Published: May 2014

Intravenous (IV) therapy in the community is not new, but over the last few years has become more routine, accepted and expected practice. The provision of short and long term IV antibiotic therapy for a wide range of infections is without doubt the biggest demand. The delivery of any IV therapy requires suitably trained healthcare professionals to be involved, and I have always advocated that community nurses are ideally placed to do this as well as support patients and carers. However, in order to provide this care and support they do need access to community focused theoretical, and skills-based IV training
Hypergranulation: exploring possible management options
Authors: Vuolo Julie
Published: May 2014

Hypergranulation (or overgranulation) is an excess of granulation tissue beyond the amount required to replace the tissue deficit incurred as a result of skin injury or wounding. An infrequent but not rare consequence of wounding, the dearth of reliable evidence on the subject of hypergranulation has led to widely varying practices over time, including some which cause pain or discomfort and some which may further impair healing. However, despite a relatively poor evidence base, it is possible to ascertain that clinicians recognize different types of hypergranulation tissue in practice and that a variety of factors contribute to their development. Coupled with an understanding of normal healing processes, this differentiation of types and identification of contributory factors goes some way toward identifying effective treatment pathways and justifying treatment decisions, one of which includes adopting a wait and see approach
Managing highly exuding wounds with Eclypse®dressings
Authors: Godar Susan , Guy Heidi
Published: May 2014

Wounds naturally produce exudate containing nutrients, blood cells, enzymes, cytokines and growth factors, which are all essential to the healing process. When this balance is altered by local or systemic conditions then exudate can become problematic. Wound healing is delayed, quality of life is detrimentally affected and nursing staff are faced with time-consuming dressings. The wound product market has always contained absorbent dressings, yet there is a need for further absorbent dressings to be made available to us. This has seen the introduction of super-absorbent dressings onto the market. One of these dressings, Eclypse®, is discussed in this article. Eclypse uses highly absorbent crystal technology to increase its fluid handling capacity. The functionality of this product and the benefit for patients derived from its use are described in this article.
Supporting self and others: from staff nurse to nurse consultant. Part 3: Preceptorship
Authors: Fowler John
Published: May 2014

This series of articles explores different ways of supporting staff who work in the fast-moving and ever-changing health service. In the first two articles, John Fowler, an experienced nursing lecturer, author and consultant, examined the importance of developing a supportive working culture and how learning from experience can result in both positive and negative consequences. This article examines the importance of preceptorship for all staff taking on new roles.
Rheumatology helpline: challenges in the biologic therapy era
Authors: Palmer Deborah , El Miedany Yasser
Published: May 2014

For rheumatology patients, telephone helplines can provide rapid access to management, advice, information and support. In many cases, the provision of a telephone helpline reflects an attempt to make care more flexible and patient-based. The ‘direct’ mode advice delivery can only be informally compared with the traditional route of patient access to advice, which often travelled a complex route via overworked medical secretaries or receptionists toward the final destination of medical staff, sometimes engaged in other activities. This article will discuss the challenges facing the rheumatology helpline and how these can be tackled.
NHS resource allocation: a question of funding?
Authors: McHale Jean
Published: May 2014

The article explores the implications of using human rights principles as a basis to challenging a resource allocation decision by a primary care trust in the courts. It explores the implications of the recent decision in R (Condliff) v North Staffordshire NHS Trust [2011] and the prospects for development of future litigation.
Rheumatoid arthritis: treating to target with disease-modifying drugs
Authors: Firth Jill
Published: May 2014

Treating to target is an established concept in a number of long-term conditions, which aims to improve outcomes and prevent disease progression. Treatment targets in rheumatoid arthritis (RA) are to control the signs and symptoms of significant inflammatory disease activity, with the ultimate goal of remission from disease. Assessment of patients' disease activity includes clinical examination of the number of swollen and tender joints, combined with measurement of inflammatory markers and visual analogue scales of patients' overall wellbeing and symptoms. Early initiation and rapid dose escalation of disease-modifying anti-rheumatic drugs (DMARDs) has been shown to be crucial to optimizing disease control, protecting joints from destruction and preserving health-related quality of life. Corticosteroids can be prescribed for oral use but are often given by intra-muscular or joint injection in times of flare to minimize the risks of side effects. The rational use of non-steroidal anti-inflammatory drugs and analgesia remains important to symptom management throughout the patient journey. In part two of this three-part series, the concept of treating to target in rheumatoid arthritis is outlined, including the role of the nurse in optimizing outcomes and an overview of treatment options using conventional DMARDs. Part three will cover the use of biologic agents, which have increased treatment options for RA, but their use is reserved for patients with severe disease activity who have failed to respond to adequate trials of DMARDs.
Treating to target in rheumatoid arthritis: biologic therapies
Authors: Firth Jill , Critchley Sarah
Published: May 2014

Treating to target is an established concept in the management of a number of long-term conditions to improve outcomes and prevent disease progression. Treatment targets in rheumatoid arthritis (RA) are to control the signs and symptoms of significant inflammatory disease activity, with the ultimate goal of remission from disease. The previous article in this series ( Firth, 2011 ) outlined treating RA to target with conventional disease modifying drugs (DMARDs), including the role of the nurse in assessing disease activity, promoting shared clinical-decision making and monitoring treatment. In recent years, biologic agents have increased the treatment options for RA, but their use is reserved for patients with severe disease activity who fail to respond to treatment with two or more DMARDs. This article outlines the role of biologic therapies in treating RA to target, including eligibility criteria and the role of the nurse in optimizing outcomes.
Intravenous practice: improving patient safety
Authors: Lavery Irene
Published: May 2014

The aim of this article is to explore factors leading to risks and to offer suggestions that improve practice and patient safety. Patient safety has gained prominence in the past decade ( Department of Health (DH), 2000 ; McCannon and Berwick, 2011 ), while awareness of managing risk and learning from adverse events has also increased ( Ingram and Lavery, 2005 ). The DH (2006) estimated that 1 in 10 patients admitted to hospital will unintentionally be the victim of an error, and around 50% of these are avoidable errors. The NPSA (2007a) received 800 reports a month relating to injectable medicines and these represented 24% of the total reported medication-related incidents. The cost to the NHS ranges from £88 000 to £400 000 per annum for patient safety incidents ( DH, 2006 ). However, any risk reduction must focus on the system and not just the individual, and this recognizes complexity of the care and the NHS, and that human factors can be supported by robust organizational systems ( Vincent et al 2000 ).
To the point: needlestick injuries, risks, prevention and the law
Authors: Adams Debra
Published: May 2014

Healthcare staff are at risk of infections if they are exposed to bloodborne pathogens from needlestick injuries (NSIs). In 2010, the European Union adopted a directive to prevent injuries and infections to healthcare workers from sharp objects, including NSIs. It recommended an integrated approach to preventing these injuries; this includes risk assessment, training and the provision of safety needle devices (SNDs). This directive has to be enshrined in UK legislation by May 2013. NSIs are under reported, but nearly half of nurses may have had such an injury. NSIs occur in many clinical areas, often when nurses are busy or tired, and most are caused by conventional hollow-bore needles. SNDs, if implemented and used correctly, reduce the risk of NSI. This article examines: the legislation; the prevalence of NSI; the risk of infection transmission; devices and procedures associated with NSI; SNDs; and costs of NSIs and SNDs.
Chemotherapy-induced alopecia: advice and support for hair loss
Authors: Roe Helen
Published: May 2014

This article provides insight into the growth cycle of a hair follicle and the potential impact chemotherapy agents can have on this process, which often results in hair loss (alopecia). It explores the psychological consequences of chemotherapy-induced alopecia for an individual as a result of the perceptions of others as well as an individual's perception of his or her self-image. Despite the development of various forms of scalp cooling, chemotherapy-induced alopecia remains a major side effect for patients receiving chemotherapy; however, there have been improvements in wig provision and changing public opinion relating to baldness. Although chemotherapy-induced alopecia affects both males and females and all age groups, this article focuses on the potential impact for patients receiving chemotherapy as a form of treatment for breast cancer. As professionals we need to understand the social significance of hair in relation to a person's outward presentation and social interactions, along with the possible psychological implications of a person losing his or her bodily hair, and not just the head hair. We must aim to minimize the distress alopecia can cause by: ensuring we provide patients with up-to-date verbal and written information to enable them to prepare for losing their hair; helping them to preserve their self-image and minimize the psychological consequences of hair loss while receiving chemotherapy; and preparing them for their hair re-growth following completion of chemotherapy.
Effect of nutrition on wound healing in older people: a case study
Authors: Timms Lorna
Published: May 2014

Wound healing requires an increase in the energy intake of the patient due to an increase in metabolic demand. Nutrition plays a vital role in the wound healing process, as various nutrients have specific functions related to wound healing. Adequate nutrition is required to maintain healthy skin integrity, and malnourished patients often experience delayed wound healing as a result of this. Additionally, older people may have difficulty meeting their nutritional requirements owing to a diminished dietary intake. Effective management of malnourished patients with wounds depends on accurate early diagnosis and treatment. This short case study critically analyses the care that was provided in one NHS trust to a malnourished older patient with a wound. Recommendations for improving practice include early identification of malnourished patients, early referral for dietetic assessment and tissue viability intervention, and education for health professionals.
Using a superabsorbent dressing and antimicrobial for a venous ulcer
Authors: Hampton Sylvie , Coulborn Anna , Tadej Martin , Bree-Aslan Cathie
Published: May 2014

In chronic wounds, exudate is believed to prolong the inflammatory phase and is detrimental to healing ( Trengove et al, 1999 ; Vowden and Vowden, 2004 ). Poor exudate management can have important management cost implications, and may result in increased patient morbidity ( White and Cutting, 2006 ). Accurate assessment of wound exudate is a key component of wound healing and management is achieved through different methods depending on the cause of the excessive exudate production. Superabsorbent dressings have been designed to treat highly exuding wounds; they have a greater fluid-handling capacity than traditional dressings and require changing less frequently (Tadej, 2009). This case study reports on the combined use of a superabsorbent dressing with an antibacterial dressing in a 102-year-old patient who presented with a painful infected venous ulcer complicated by some arterial disease. The combination of the superabsorbent KerraMax® (Crawford Healthcare) with the antibacterial honey Algivon® (Advancis Medical) created the ideal dressing for the treatment of this infected mixed aetiology ulcer, as manuka honey has a strong antibacterial effect ( Molan, 1992 ), and the dressing absorbs the excessive exudate. The dressings worked together to reduce the bacterial load on the wound bed surface, with the honey selectively destroying the bacteria ( Molan, 1992 ), and KerraMax absorbed and locked away the bacteria-containing exudate, which helped to reduce further exudate production, prevent maceration and reduce the potential for a wound to become malodorous ( Hampton, 2011 ).
Using anonymized NHS data without consent: a step too far?
Authors: McHale Jean V
Published: May 2014

On 5 December 2011, the Government announced that NHS data will be made more widely available to researchers ( BBC News, 2011 ). David Cameron suggested that ‘everyone was to be a research patient’ ( BBC News, 2011 ) with anonymized NHS patient data being opened up to researchers in the private sector as well as the NHS. The proposals envisaged that all such data is opened up to researchers unless patients opt out. This article explores the relationship between patient privacy, confidentiality and the public interest, and asks whether anonymization is simply enough or whether we need a broader debate as to what constitutes disclosure in the public interest and its boundaries.
Physical activity and learning disability
Authors: Hallawell Bob , Stephens Jacqueline , Charnock David
Published: May 2014

The inclusion of people with learning disabilities in sporting activities promotes a number of positive outcomes. These may include opportunities for social inclusion, the creation of positive role models for other people with learning disabilities, the opportunity to present people with learning disabilities in valued social roles to a global community, sharing of common interests and experiences, and social and competitive rewards. There is also the potential for positive physical and mental health outcomes. Current data suggests that people with learning disabilities are physically less active than the rest of the population, more likely to lead sedentary lifestyles and more prone to obesity and associated health conditions. However, there are a number of ways in which nurses may support both individuals and their carers to engage with and promote programmes of physical activity. These may include the design of individual activity plans incorporated within health action planning aligned with suitable rewards systems. Action might also be taken in terms of health promotion advice and information to carers and those providing facilities for physical activity.
A tormented death: end-of-life care for people with dementia
Authors: Bracegirdle Lorna-Rose
Published: May 2014

District nurses are often faced with difficulties when patients with dementia lack the capacity to express how they feel and the family has to make end-of-life decisions for the sufferer. Although 25% of palliative care is concerned with controlling physical symptoms, health professionals are sometimes faced with challenges when one comorbidity masks another. The GP-patient relationship is central to improving overall care for these vulnerable patients and there is a continual need for a workforce to be trained and empowered to provide care with precision. This article discusses the importance of correct diagnosis during end-of-life care and makes recommendations on how this can be achieved.
A mistaken case of peroneal dislocation
Authors: Concannon Michael , Davidson Annabel
Published: May 2014

This article is centred around the similarities and highlights some differences between a sports injury compared with any other injury profile. The authors use a musculoskeletal assessment, diagnosis and management of an injury based on a particular case study. The intention is to highlight how problems may be masqueraded in the history and perception of the injured athlete and how this perception may have complicated the injury and the rehabilitation process. This issue generates a renewed awareness for all primary care nurses and health practitioners who may be involved in treatment pathways for associated injuries related to sports medicine problems. The article gives an insight into peroneal dislocation/subluxation, but primarily focuses on peroneal tendonitis/tendonosis. The management of the injury briefly touches on the associated benefits (and risks) of barefoot running and its role in the prevention of sporting injuries. This article illustrates how the frustration of a chronic injury can lead to the athlete making ill-informed decisions and highlights the need for a thorough assessment and an evidence-based management plan that is negotiated with the athlete.
Transition from child and adolescent to adult mental health services
Authors: McGrandles Amanda , McMahon Karen
Published: May 2014

This article explores key issues in relation to adolescence and the transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS). A national review of services revealed some concern and dissatisfaction regarding existing service provision. Nurses are employed in both of these services and are well placed to play a significant role during transition. The challenges and opportunities for services are explored with reference to key policy documents. Several factors contribute to better outcomes, including collaboration between CAMHS and AMHS, the young person and the family, aligning services with the young person's development and maturity, and approaching transition in a flexible way. These factors are highlighted with the use of a case study and with reference to the nurses' role.
A compassionate vision for nursing and midwifery
Authors: Glasper Alan
Published: May 2014

Professor Alan Glasper discusses the Department of Health's latest initiative to promote a culture of compassionate care within the nursing and midwifery professions
Telephone triage assessment for musculoskeletal disorders: part 2
Authors: Chetty Laran
Published: May 2014

This paper explores the results of a diagnostic analysis that was undertaken before the implementation of a nursing telephone triage assessment for musculoskeletal disorders in an occupational health and wellbeing service. Mixed methods were used to gather the relevant information. Authentic organisational documents provided support for several themes including evidence-based change. Several barriers and facilitators to change were identified and their implications are highlighted. Overall the organisation was classified as ready for change. Following the results of this diagnostic analysis, specific recommendations are suggested for implementation.
Assisted suicide: a right to professionally-aided death?
Authors: McHale Jean V
Published: May 2014

The article examines the recent decision in the case of Re AM (2012), in which a man in a locked in state seeks assistance in dying. The preliminary hearing in this case decided in January 2012 concerns whether AM's lawyers can provide professional assistance in relation to providing information about assisted suicide. The article explores the issue of professional assistance in the suicide process; something which is particularly controversial following the recent guidelines ( The Crown Prosecution Service, 2010 ) on prosecution in the case of assisted suicide.
Attrition rates: the student perspective
Authors: Airey Jo
Published: May 2014

Jo Airey, a mature student nurse, wife and mother of two, is a regular contributor to the BJN Student Column. In this issue, Jo shares her views about how to tackle the issue of student attrition based on the success she has witnessed at the University of Sheffield, where is currently completing a postgraduate nursing diploma.
Applying research to practice:exploring the barriers
Authors: Hewitt-Taylor Jaqui , Heaslip Vanessa , Rowe Nicholas E
Published: May 2014

Nurses are not averse to applying research findings to their clinical practice; however, there appears to be a number of barriers to achieving this. Generally, barriers include lack of time and the need to provide more education surrounding the use of research. While these are both valid points, the authors suggest that perhaps the solution to the problem is looking at how research is ‘sold’ to practitioners. For example, the use of jargon in research is off-putting to many practitioners, which creates an impression that research is associated with academia, rather than a tool for practitioners. Also, there may be an unrealistic expectation of what ‘using research’ might mean. Research is seen as the pinnacle of evidence, and not a part of evidence-based practice. In this article, the authors propose that teaching and expectations of research should focus on the application of research to practice. Reviewing and critiquing of research should serve the purpose of helping to make decisions about its practical applications, rather than for academic use.
Chrysalis to butterfly: improving access to psychological therapies
Authors: Glasper Alan
Published: May 2014

Professor Alan Glasper explores the implications of No Health without Mental Health, and outlines the importance of prioritising young people's access to psychological therapies
Care homes: quality and patient safety challenges
Authors: Tingle John
Published: May 2014

John Tingle discusses two reports on health care in care homes that raise important patient safety and health quality issues.
Nurses and mental health: breaking down the barriers
Authors: Daylan Agyness
Published: May 2014

Agyness Daylan is approaching the end of her nursing diploma, and is about to start a new job on an intensive care unit. She discusses the relationship between mental health disorders and student nurses following a recent publication by The Royal College of Psychiatrists, and explores the stigma surrounding mental health disorders in NHS staff.
Negotiating the unofficial hierarchy of placements
Authors: Airey Jo
Published: May 2014

Jo Airey is a mature student nurse at University of Sheffield and a regular contributor to the BJN Student Column. In this issue, she shares some of her lessons learned in manoeuvering the minefield of clinical placements and how to avoid the trap of placing them in stereotypical categories of best and worst
Pressure ulcer incidence among high-risk inpatients in Nigeria
Authors: TeslimOnigbinde Ayodele , Ogunsanya Gbolade Isaac , Oniyangi Shuaib Olanrewaju
Published: May 2014

This main aim of this study was to determine the incidence of pressure ulcers among inpatients in selected hospitals in South West Nigeria. It also aimed to determine the body parts most susceptible to pressure ulcers. The study used a questionnaire completed by health workers in five hospitals, and 318 patients took part. Statistical methods used included descriptive statistics and non-parametric inferential statistics. Within the 12–week follow-up period, 44 patients developed nosocomial pressure ulcer(s). Inpatients with spinal cord injury (50%), orthopaedic (38.6%) and head injury (11.4%) related diagnoses were the most prone to developing pressure ulcers. The commonest areas where pressure ulcers developed were the sacrum, heel, greater trochanter and lateral and medial malleoli. The median time for the skin to develop an ulcer was 25 days after admission. There was a significant association between diagnosis and the number of days taken to develop pressure ulcers (χ2=3.76, p=0.05). This study concluded that: the incidence rate was 13.84%; spinal cord injury was the clinical condition most likely to be associated with pressure ulcer development; and pressure ulcers occurred most frequently on the sacrum.
Assessing the patient experience while attending A&E
Authors: Tingle John
Published: May 2014

John Tingle discusses the results of a national survey of NHS accident and emergency departments carried out by the Care Quality Commission.
Sexuality and stroke: the effects and holistic management
Authors: Hall Joy
Published: May 2014

Since the days of the early pioneering work of authors such as Glover (1985) and Woods (1987) , there has been a proliferation of research and practice guidelines related to the effects of ill health on individuals’ and couples’ sexuality and sexual health ( Reis et al, 2010 ; Sadovsky et al, 2010 ; Royal College of Nursing, 2000 ). This article reviews the common difficulties experienced by individuals and couples affected by stroke regarding to their sexuality and sexual health. Furthermore, it presents and explores a possible model of care that can be used in practice to address these difficulties with people affected by stroke.
How in situ simulation affects paediatric nurses' clinical confidence
Authors: Dowson Anne , Russ Stephanie , Sevdalis Nick , Cooper Mehrengise , De Munter Claudine
Published: May 2014

Considering the emphasis on safety in health care, new methods for training qualified nurses are being considered. The use of simulation technologies to provide regular and repeated training for qualified nurses in the management of paediatric emergencies has yet to be investigated. This paper presents the results of a study designed to determine if and how a period of regular simulation training in the management of paediatric emergencies improves qualified nurses' clinical confidence. A mixed methods design was employed using a group of qualified paediatric nurses (n=20) who were matched into two groups. The intervention group (n=10) received three simulation-based training sessions and the control group (n=10) had no training. Each nurse completed a pre- and post-clinical confidence questionnaire and were interviewed. Results demonstrated a statistically significant improvement in confidence following simulation training, which was explained by the provision of insight and preparation for real life. Further research should aim to replicate these findings using larger sample sizes and direct assessments of nurses' clinical performance.