bluuebunny/crossref_metadata_2025 huggingface dataset:
People with learning disabilities need control
Authors: Carlile Guy , Crowhurst Mike
Published: May 2014

The Government's first strategy for learning disabilities in 30 years Valuing People is designed to tackle social exclusion and discrimination (Department of Health (DoH), 2001). It is bold and challenging, but will it work? It is built upon four key principles: civil rights, independence, choice and inclusion.
It is possible to recognize higher level nurses
Authors: Castledine George
Published: May 2014

It may have taken some time but at long last the final report of the UKCC's higher level practice (HLP) project has been accepted by the UKCC and will be published shortly.
The Tielle family of dressings: overview of the product range
Authors: Ballard Kate
Published: May 2014

The Tielle family (Johnson & Johnson Medical) is a range of dressings that come in a variety of shapes and sizes, designed to fit the different types and locations of wounds that occur in practice. There are three types — Tielle, Tielle Lite and Tielle Plus — and the choice of dressing should be based on the degree of exudate that the wound is producing. This product focus aims to give an overview of the range and provides research-based evidence for application in clinical practice.
Large patients must be treated with respect
Authors: Weafer Karen
Published: May 2014

Caring for obese and very tall patients in an acute hospital can cause a variety of problems for the entire healthcare team. These problems are exacerbated because many health carers, including nurses, adopt negative attitudes towards patients whose size makes them difficult to manage. The larger patient is, in fact, an individual person who, in most cases, is able to lead a normal, active lifestyle. Being overweight (body mass index (BMI) exceeding 30; Green and Gillett, 1998) only presents as a complex problem during an episode of acute illness.
Pain management 1: psychological and social aspects of pain
Authors: Adams Nicola , Field Linda
Published: May 2014

This two-part article presents psychological and social factors which affect pain perception and response and the implications of these for nursing practice. In this article, the complex interactions between neurophysiological and psychological factors are outlined and theories of pain perception and ways in which the pain experience can be modulated are presented. The role of psychological factors, attitudes, beliefs and expectations of both patient and practitioner, pain behaviours and ability to cope are discussed. In the second part, these are further elaborated with particular reference to the nurse'spatient interaction. The use of psychological approaches to augment clinical practice, such as education, reduction of anxiety and improving coping ability, are suggested. Finally, the importance of communication skills in pain management is addressed.
Legal aspects of consent 10: determining ‘best interests’
Authors: Dimond Bridgit
Published: May 2014

The claimant, aged 36 years, sought a declaration from the court that two preliminary blood tests and a conventional bone marrow harvesting operation under general anaesthetic could be lawfully taken from and performed upon her sister Y. The facts were that the applicant was suffering from a pre-leukaemic bone marrow disorder. She had undergone extensive chemotherapy and a blood stem cell transplant. She had started to deteriorate and was likely to progress to acute myeloid leukaemia over the next 3 months. Her only realistic prospect of recovery was a bone marrow transplant operation from a health compatible donor. Preliminary investigations suggested that Y her sister would be a suitable donor. Y was 25 years and severely mentally and physically handicapped. She had lived in a community home for 8 years. She was incapable of giving consent to the donation of bone marrow. The court had to decide whether it was in the best interests of Y for a declaration to be made for the blood tests and the bone marrow harvesting to take place (Re Y (adult patient) (transplant: bone marrow) [1997]).
Network For Psychiatric Nursing Research Journal Club
Authors: Cutcliffe John R , Jones Julia , Jackson Ann
Published: May 2014

Fletcher RF (1999) The process of constant observation: perspectives of staff and suicidal patients. J Psychiatric and Mental Health Nursing 6: 9–14
Accurate selection of compression and antiembolic hosiery
Authors: Maylor Miles E
Published: May 2014

The use of compression and antiembolic hosiery is widespread in hospital and community settings, but there is wide variation in almost every aspect of selection and prescribing practice. In some localities pharmacists or appliance officers are responsible for selecting a suitable stocking for patients, whereas in others it may be left to medical staff. Anecdotally, there is a lack of knowledge about when and what is safe to prescribe relative to the underlying disorder. This is compounded by discrepancy between the level of compression provided by stockings made according to the European method, and that prescribable under the UK Drug Tariff in primary care. This can result in clinically serious variation in what the patient is given and what his/her condition needs. A particular problem arises when the patient's care is continued following discharge from hospital. In this case not only may an inferior quality product be supplied (meeting the Drug Tariff specifications), but also the compression ‘strength’ can be unintentionally lower than expected or prescribed. A simple method of prescribing according to condition and pressure has been developed and is outlined here.
Health needs assessment in intermediate care of elderly people
Authors: Clegg Angie , Doherty Bridget
Published: May 2014

The National Service Framework for older people (Department of Health (DoH), 2001a) identifies health promotion as one of the eight standards for improving the health and wellbeing of older people. Population health needs assessment is the first stage in any public health promotion cycle. This article critiques health needs assessment methodology, investigates the origins of health needs assessment and discusses the application of health needs assessment theory in a community hospital setting.
Child health nurses' perceptions of enquiry-based learning
Authors: Glasper Edward Alan
Published: May 2014

Since the publication of Fitness for Practice (UKCC, 1999), most preregistration nursing curriculae embrace the principles of enquiry-based learning (EBL) as a method of educating students. EBL uses genuine real-life client scenarios which provide the students with an opportunity to explore a range of issues directly pertaining to client care in a variety of contemporary nursing settings (Long et al, 1999). This evaluative study of one group (n = 12) of child branch students conducted during the last EBL session of the course reflects the students' experiences of this method of teaching over a 3-year period. Nominal group technique (Delbecq and Van de Ven, 1971) was utilized to give a quantitative dimension to the reporting and recording of individual student reflections of EBL. The results demonstrate overall satisfaction with this method of student learning. A number of concerns raised by students reflect some of the pitfalls associated with EBL and these have important ramifications for nurse educators and clinical placement mentors. However, the small size limitations of this study do not allow for generalizability.
Record keeping should be a key skill not a chore
Authors: Tingle John H
Published: May 2014

The Health Service Ombudsman (HSO) reports always provide an excellent teaching aid for staff in relation to legal issues, nursing, health quality and complaints. Sadly, many of the reported errors could have been easily avoided if basic clinical risk management steps such as good record keeping policies and effective communication strategies had been adopted. The latest reports cover investigations carried out during April and July 2001 (HSO, 2001a,b).
Oasis®: an innovative alternative dressing for chronic wounds
Authors: Benbow Maureen
Published: May 2014

Chronic wounds in patients with multiple systemic factors present a significant clinical challenge for clinicians. Oasis® Wound Dressing is derived from porcine small intestine which, when placed in a non-infected wound, stimulates new tissue and an absorbable, natural template for the growth of new tissue. Emerging evidence suggests that it is beneficial for patients with chronic, non-healing wounds complicated by multiple systemic factors.
Understanding and listening to people with autism
Authors: Aylott Jill
Published: May 2014

This article continues the learning disability supplement's examination of autism (see Aylott, 2000a,b) by exploring how a lack of knowledge and understanding of positive aspects of autism among non-autistic people (neuro typicals) has led to many adults with autism having negative life experiences. It calls for all staff working with people with autism to find ways to ‘think’ and ‘feel’ in autism. It is only when this has been achieved that any of us will be able to listen effectively to people with autism; this hopefully may result in life experiences for people with autism being more of a positive than a negative encounter.
A student nurse's learning in a leg ulcer outpatient department
Authors: Cooper Jean M
Published: May 2014

A descriptive case study was used to examine a student nurse's learning experience during her clinical placement in an outpatient department at a general hospital in the South of England. A specific leg ulcer clinic in the outpatient department was selected. Research questions were formulated to consider the learning outcomes achieved, the patient's experience of participation, the use of evidence-based practice and the learning environment. The results indicated that the staff nurse teacher was able to facilitate learning for the student within this clinic, despite constraints of time, environment and the patient's presence. The research questions were addressed, areas for further research arising from the outcomes of the study were identified, and recommendations were made for future practice.
Mental illness and substance misuse: a nursing challenge
Authors: Jackson-Koku Gordon
Published: May 2014

The treatment of patients diagnosed with a coexisting psychiatric and psychoactive substance misuse disorder remains an important clinical challenge in mental health nursing. This is not only because of the complexity of the disorder, but also because an increasing number of patients are presenting both disorders (i.e. coexisting psychiatric and psychoactive substance disorder). This article will review the literature on the subject of severe mental illness and substance misuse by examining various issues, including the phenomenon of dual diagnosis and its prevalence, the nature of the relationship between substance misuse and severe mental illness, the extent of the problem of illicit substance use among the psychiatric population, treatment trends and management models.
Relieving the pressure in the radiology department
Authors: Howatson-Jones Isis Lioba
Published: May 2014

Interventional radiological procedures can be complex, requiring patients, many of whom already have compromised arterial circulation, to lie immobile for significant periods. X-ray table mattresses are designed to avoid radiation attenuation, which could degrade image quality or increase patient dose. Consequently, most mattresses do not have pressure redistribution properties. Skin changes, noted after lengthy radiological procedures, would appear to indicate that this unrelieved pressure places vulnerable patients at risk of sustaining pressure damage that could potentially initiate pressure ulcer development. This article examines the biomedical basis of pressure ulcer development, and discusses the suitability of alternative support devices for radiological examinations in an apparently under-researched environment.
A new cohesive short-stretch bandage and its application
Authors: Hawkins Jackie
Published: May 2014

The undisputed optimum treatment for venous leg ulcers is compression therapy, where an external appliance (multilayer, short-stretch bandaging and compression hosiery) promotes venous return through graduated compression of the tissues and capillaries. However, this is not always acceptable to the patient, particularly when the patient’s social life is affected with malodour and pain associated with venous leg ulcers, thereby reducing quality of life. There is a psychosocial consideration when the bandaging system is bulky, hot and difficulty is found with the fitting of shoes. An alternative and clinically effective solution is essential if the wound is to heal. In this case study, the patient was provided with a cohesive and short-stretch compression bandage (Actico), which allowed her to continue her social life while effectively treating her ulcer.
Expectations and experiences of newly recruited Filipino nurses
Authors: Daniel Patricia , Chamberlain Angela , Gordon Frances
Published: May 2014

This article reports the preliminary results of a small study into the changing expectations of newly migrated Filipino nurses at a London hospital. The aim was to identify initial expectations and experiences. Focus group interviews were conducted with two groups of nurses shortly after their arrival. Career prospects and salaries were key factors influencing the decision to come to the UK. Differences emerged between the nurses' expectations of the nursing role and their actual experience on the wards. Adjusting to the new system of health care proved stressful but was helped by the provision of support services. Factors that may promote successful adaptation and retention included equal opportunities with respect to training and promotion and the use of culturally sensitive orientation programmes. Strategies to reduce social isolation may also be important. The results will be used to inform the trust's retention strategy and will also be of interest to other NHS trusts recruiting Filipino nurses and nurses from other countries.
Infection surveillance scheme: collaborative working practices
Authors: Greatrex Brenda
Published: May 2014

This article describes the development of the Nosocomial Infection National Surveillance Scheme. Doctors and nurses are expected to collaborate and work together in order to improve patient care. Guidelines on infection control in hospitals include the need for infection control teams to carry out surveillance and feed back the results to doctors so that they can make the necessary changes. The relationship between doctors and nurses has long been debated, and this could hinder the success of doctors cooperating and sharing ownership of the scheme. Interpersonal skills, group dynamics, organizational controls and professional standards are discussed.
Eldery patients caught in a political argument
Authors: Scott Helen
Published: May 2014

New national care home standards have just been announced as part of Government reforms designed to modernize the current regulatory system for social services and nursing homes (Department of Health (DoH), 2001).
Legal aspects of consent 3: the duty of care to inform
Authors: Dimond Bridgit
Published: May 2014

Mrs Pearce was expecting her sixth child. The expected date of delivery was 13 November 1991. On 27 November when she saw the consultant the baby had still not arrived. She begged the doctor to induce her or to carry out a caesarean. He preferred to let nature take its course, and explained to her the risks of induction and a caesarean section. The baby died in utero sometime between 2 and 3 December. The delivery of a stillborn baby was induced on 4 December. She brought an action alleging that the consultant should have advised her of the increased risk of stillbirth as a result of the delay in delivery between 13 November and 27 November (Pearce v. United Bristol Healthcare NHS Trust, 1998).
Comparison of two skin care regimes for incontinence
Authors: Cooper Pam , Gray David
Published: May 2014

It is estimated that 30% of nursing home residents may be faecally incontinent, with those figures rising to 60% for patients in long-stay hospitals (Royal College of Physicians, 1995). Maintaining skin integrity for these patients can be complex. With little clinical information to support carers, choosing a skin care regime that maintains skin integrity for this high-risk group can be difficult. This study aims to compare two recognized skin care regimes, used in the cleansing of patients' skin following an episode of incontinence, and their impact on patients' skin integrity. A total of 93 patients were recruited to the trial from five care of the elderly or dependent service providers. The subjects were randomly allocated to either group A (soap and water; n = 49), or group B (Clinisan (Vernacare); n = 44). Initially, 33 patients in both groups started with healthy skin. However, the results of the final assessment identified only 17 subjects in group A remaining healthy, compared with 27 in group B.
Venous disease treatment and compliance: the nursing role
Authors: Furlong Winnie
Published: May 2014

This article explores the numerous factors that influence compliance in the management of venous disease. The nurse's/health practitioner's role is highlighted as being pivotal in promoting compliance or non-compliance. The literature suggests there are many components that influence compliance, varying from impersonal relationships, treatment regimes and psychosocial influences. This implies that compliance is a shared responsibility between the healthcare practitioner/nurse and the patient. Holistic assessment incorporating negotiated care plans will provide the foundation of a partnership in care. Nurses have a responsibility to empower the patients with the necessary knowledge and skills to enable them to be an active participant in their own treatment/life regimes. Nurse education is key to effective, tolerable treatments that are acceptable to patients.
Factors influencing community nurses’ treatment of leg ulcers
Authors: Ruston Annmarie
Published: May 2014

Clinical effectiveness and evidence-based practice are a central feature of the clinical governance framework. Few studies have examined factors that motivate nurses to change practice in line with evidence-based guidelines. The overall aim of this exploratory study was to examine community nurses’ experience of taking part in a clinical effectiveness programme for the management of leg ulcers in the community and to identify factors most likely to ensure a change in practice. The implementation programme was conducted in the general practices within one district of a primary care audit group. Face-to-face interviews were conducted with all practice nurses and district nurses involved in the care of patients with leg ulcers from the participating practices. Nurses identified the presence of a credible facilitator, visible benefits for patients and a desire to carry out their work in an evidence-based way as factors likely to influence change. However, the degree of change achieved was not uniform across all participants and three typologies of nurses were identified according to their attitudes and level of involvement.
The concept of hope in nursing 1: its origins, background and nature
Authors: Cutcliffe John R , Kaye Herth
Published: May 2014

Hope has been described in theoretical terms for many years but the recognition of the importance of hope within the practice of nursing is a more recent phenomenon. Despite the recent growth of references to hope within contemporary nursing literature, it is reasonable to suggest that there remain gaps in the substantive knowledge base and that there appears to be room for both additional research and further discursive literature. Accordingly, this series of six articles will explore the nature of hope, review the existing theoretical and empirical work in several discrete areas of nursing, and provide case studies to illustrate the role that hope plays in clinical situations. This article focuses on the origins, background and definitions of hope. The next article will examine hope within mental health nursing, and further articles will focus on hope within palliative care nursing, hope in gerontological nursing and hope in critical and acute care nursing.
Spirituality and learning disabilities: a qualitative study
Authors: Narayanasamy Aru , Gates Bob , Swinton John
Published: May 2014

This article describes a unique empirical study where critical incidents were obtained from learning disability nurses to understand how they attempt to meet the spiritual needs of the people for whom they care. Following analysis, the nurses' approaches to meeting spiritual needs were categorized as ‘personal’ and ‘procedural’, and each of these is described in turn. There then follows a discussion on the effects of these nurses' interventions on both clients and their families, and nurses themselves. The findings of the study illuminate how these learning disability nurses attempted to meet the spiritual needs of people with learning disabilities in their care. The findings may help nurses ensure that spiritual needs are identified in the construction of the personal care plans of people with learning disabilities.
A review of amputation, phantom pain and nursing responsibilities
Authors: Ellis Kirsteen
Published: May 2014

Phantom pain is a common phenomenon among amputee patients. It is usually reported during the immediate postoperative period but can persist for up to 2 years. Sixty per cent of patients can still experience phantom pain 7 years postamputation and it has even been reported 30 years postamputation. Pain of any type, which persists for more than 6 months, is difficult to treat and is often unresponsive to analgesia, including opioids. A large percentage of patients undergoing amputation have experienced chronic pain before their operation. Chronic pain is known to affect adversely patients’ quality of life, and ability to function and achieve quality sleep. Nurses, therefore, need to address not only the physical aspects of amputation and phantom pain but also the psychological aspects.
Pulse oximetry: an audit of nursing and medical staff understanding
Authors: Howell Mandy
Published: May 2014

Pulse oximetry provides continuous, non-invasive monitoring of the oxygen saturation of haemoglobin in arterial blood, which is updated with each pulse wave. The primary advantage is that it detects immediately deviations to a patient’s baseline. Care givers can therefore detect changes before the patient becomes hypoxaemic. However, staff are reported to have limited education, if any, in the correct use of the pulse oximeter and what may affect the readings. In order to test this theory, an audit was conducted on 50 staff within a large general hospital, comprising trained and untrained nurses and medical staff. Participants’ responses to a questionnaire and to six clinical scenarios were analysed. Overall, there was a deficit in participants’ knowledge on pulse oximetry. The answers given by the medical staff to the clinical scenarios showed no greater level of knowledge than many of the trained nurses. The recommendations made following this audit were to improve the education and training of all staff in the understanding of this technique.
Avance: silver hydropolymer dressing for critically colonized wounds
Authors: Ballard Kate , McGregor Fiona
Published: May 2014

Avance is a hydropolymer dressing that has a silver compound bonded into it. The silver acts as a bacterial shield to prevent bacterial invasion, and as a bacterial barrier to impede cross-infection. This article aims to give an overview of the use of silver in eradicating surface bacteria, and provides case study evidence of the use of Avance on the leg ulcers of two patients. Both patients had complex medical histories and underlying aetiologies that delayed the wound-healing process.
Lymphoedema 2: classification, signs, symptoms and diagnosis
Authors: Board Jane , Harlow Wendy
Published: May 2014

The second article in this series describes the different types of Iymphoedema and the signs and symptoms associated with the condition. In the preceding article (Vol 11(5): 304–9) we examined the anatomy, physiology and functions of the Iymphatic system in relation to the condition of lymphoedema, and demonstrated how, by acting as a one-way drainage system, the Iymphatics maintain tissue homeostasis through the removal of excess fluid from the interstitial spaces. Failure or dysfunction of the system can result in Iymphoedema, a condition characterized by the accumulation of fluid in the soft tissues. Lymphoedema is classified into two main groups — primary and secondary. Defining the causative factors and pathogenesis of both conditions and other forms of chronic oedema will assist the reader in the clarification of the condition. The article concludes with an overview of assessment criteria for diagnosis, which should assist all healthcare professionals in appropriate referral. The third article in this series will look at the treatment of lymphoedema.
Sixty-five years of nursing: selected recollections
Authors: Roper Nancy
Published: May 2014

From 1936–1939, I was in training to become a registered sick children's nurse (RSCN). The training began with a period in the preliminary training school. One vivid recollection I have is of a jar labelled ‘Leech’. Each week the water surrounding this blood-sucking worm had to be changed. I did not hear anything more about these worms until several decades later when they were being applied to wounds created by delicate plastic surgery.
Topical negative pressure for pressure ulcer management
Authors: Coggrave Maureen , West Hester , Leonard Bridget
Published: May 2014

The use of negative pressure therapy has been reported previously in a variety of care settings, but not in spinal cord-injured (SCI) patients. These individuals are at greatly increased risk of pressure ulcer development because of many factors associated with their neurological deficit and the incidence of pressure ulcers is high among them. This small case series employed objective measures to evaluate the effectiveness of negative pressure therapy when used to prepare pressure ulcers for surgical closure. The treated wounds demonstrated increased granulation tissue development and reduced wound colonization, and the reduced frequency of dressing changes compared with other treatment options may reduce the nursing workload. These case studies highlight the benefits of negative pressure therapy to SCI patients and emphasize the need for further work to compare the technique with other treatment options and determine the optimal application parameters of negative therapy in this patient group.
Risk factors for nosocomial bloodstream infections
Authors: Apostolopoulou Eleni , Katsaris Georgios , Katostaras Theophanis
Published: May 2014

A retrospective study of 205 patients was performed to identify the risk factors associated with nosocomial bloodstream infection (BSI). The study occurred during a 5-month period in four medical–surgical intensive care units (ICUs) in Athens, Greece. Risk factors were determined using single and multivariate analyses. Thirty-five patients developed nosocomial BSI (17.1%). The incidence density (defined as the number of new cases of BSI divided by the total of patient-days in the population studied; Jarvis, 1997) of BSI was 14.3 per 1000 patient-days (total number of days that patients are in the ICU during the selected time period). A multivariate model showed that only three factors were significantly and independently responsible for nosocomial BSI: the length of ICU stay (adjusted odds ratios (AOR) 1.052, 95% confidence interval (CI) 1.018–1.087, P=0.002); the presence of trauma at admission (AOR 2.622, 95% CI 1.074–6.404, P=0.034); and nosocomial ventilator-associated pneumonia (AOR 6.153, 95% CI 2.305–16.422, P=0.000). These results show that the factors that had most influence on the development of nosocomial BSI were those factors associated with the treatment received by patients during ICU stay.
Using the Roper-Logan-Tierney model in neonatal transport
Authors: Healy Patricia , Timmins Fiona
Published: May 2014

In recent years approaches to nursing practice have changed. Nursing theorists have advocated the need for nursing practice to be carried out using a systematic rather than an intuitive approach. A process of nursing has been developed as a method of organizing and delivering nursing care. This change in nursing practice has resulted in the need to establish a knowledge base that relates specifically to nursing. Conceptual models of nursing, advocated by nursing theorists, have come into use in Ireland, the UK and the USA. These models aim to promote greater understanding of people and their nursing needs. They advocate a certain approach to nursing and attempt to define nursing as a role independent from other health care roles. The need to develop a knowledge base specific to nursing remains a central tenet of the profession (Aggleton and Chalmers, 2000). Nursing models serve to provide this knowledge base through the description of the nature of people, health, environment and nursing. The aim of this article is to explore the use of the Roper–Logan–Tierney (RLT) nursing model in a neonatal transport setting. The first section provides an overview of the model. The second section describes the background information on a selected patient, followed by a detailed assessment of this patient using the activities of living. The final section evaluates the use of the model in this clinical situation with reference to literature on the topic.
Nurses must start fighting for higher status as a profession
Authors: Narayanasamy Aru
Published: May 2014

Nursing continues to be considered a low status profession, both culturally and internationally (Parfitt, 1998). Nurses must therefore start taking a closer look at the issues surrounding power and politics in health care. The question that nurses need to ask is who has the power in health care?
Degree vs diploma education: increased value to practice
Authors: Swindells Carole , Willmott Sasithorn
Published: May 2014

Graduate education for nursing and midwifery has been debated for some years, with current opinion in favour of at least an increase in degree provision (Nursing and Midwifery Council (NMC), 1999). The professions as well as consumers and purchasers of nursing and midwifery education need to be sure, however, that they are getting ‘added value’ with the graduate practitioner. Educationalists identify ‘critical thinking’ as the level that distinguishes diploma from graduate preparation. This article intends to clarify whether academic achievements are restricted to the theoretical aspects of the award or whether a degree adds value to clinical practice. The study design was an experimental case-control cross-sectional survey carried out on samples of nursing and midwifery graduates and diplomates. The graduates were grouped as experimental cases, while the diplomates were controls. A measurement tool of 42 items covering a range of attributes and skills was employed in the study to provide a rating score for individual samples. Statistical analysis was carried out and showed that the scores from graduates were significantly different from the diplomates, indicating that there are genuine differences between the graduates and diplomates. Furthermore, from discriminant analysis of item scores, it appeared that the graduates' overall item scores were higher than the diplomates as indicated by the centroid of the functions being positive for the graduates and negative for the diplomates. The evidence from this study seems to support current thinking that a degree adds value to practice.
Patients' quality of life and clean intermittent self-catheterization
Authors: Woodward Sue , Rew Maggie
Published: May 2014

This article examines the available literature surrounding the procedure of clean intermittent self-catheterization (CISC) and its impact on patients' quality of life. Many articles have been written about, and much research has been carried out into, the practicalities of performing CISC regarding dexterity, disability, etc. and its advantages and disadvantages related to infection rates and complications. However, there appear to be very few articles addressing the day-to-day problems that having to perform CISC presents to patients. While many articles do acknowledge that CISC improves patients' quality of life, very few go on to identify and discuss the daily life activities that are impacted upon by having to perform the procedure. There is a need for further research from patients' perspectives to identify the issues that they have in living with this inconvenience and in order for carers to understand fully the implications of CISC on a patient's quality of life. With this insight, carers will be better armed to help patients overcome their fears and more supportive in the ongoing care of the patient. Non-compliance is the main reason for patients' inability to perform CISC and with a better understanding of the problems, carers will be able to give practical help and support.
New flexible healthcare roles and the purpose of nursing
Authors: Hewitt-Taylor Jaqui , Melling Sue
Published: May 2014

Current policy aims for healthcare professionals to be trained to workacross traditional boundaries. The intention of this move is to improve understanding between the professions, to enhance patient care,to promote job satisfaction and to achieve cost-effectiveness (Department of Health (DoH), 2000). However, there is a risk that the blurring of professional boundaries may result in a loss of the unique contributions of specific professions. In the case of nursing, this may mean that the provision of care that is based on holism, empowerment, and partnership may be lost. This may have an adverse effect on nursing morale and job satisfaction as well as patient care. Nurses need to be clear about the nature of their professional priorities and remit. Where these are incongruent with a culture in which meeting quantifiable targets is a major focus, they must be able to articulate clearly the importance of the unquantifiable and humanistic aspects of care.
Overcoming barriers to delivering information to cancer patients
Authors: Moody Richard
Published: May 2014

The benefits of providing high-quality information to patients are well documented, and include promoting active participation in decision making and improved psychological and physical wellbeing. Within this article the need for high-quality information is discussed and some of the common pitfalls in producing patient information are examined and suggestions for avoiding these pitfalls are proposed. The article looks at some of the problems in ensuring that those people who require information have access to it, specifically the potential barriers that may arise because of ethnic background, gender and social class, and recommendations to reduce the impact of such factors are made. The implications for the practice of all healthcare professionals caring for people with cancer are evident.
Quadrennial review of a paediatric emergency assessment unit
Authors: Aitken Penny , Birch Simon , Cogman Genevieve , Glasper Edward Alan , Wiltshire Maureen
Published: May 2014

The primary aim of this article is to report on one aspect of a quadrennial study designed to explore the appropriateness and impact of the development of a paediatric emergency assessment unit (PEAU) as a response to increases in paediatric emergencies presenting to a south-western regional child health unit. In particular, this article will present the findings of a prospective audit of admissions to the PEAU over a 1-month period during the latter part of 2002. The primary method of data collection utilized a structured survey instrument developed using a design and automatic data computer software package, completed by the nursing staff. Anonymized descriptive data were obtained from 223 children admitted to the PEAU during one calendar month and authorized by the appropriate clinical directorate audit committee as part of its ongoing commitment to the full implementation of clinical governance. The data presented primarily relate to children admitted during the official opening times of the PEAU, and those presenting out of hours. The data analysis demonstrates a reduction in the number of children staying overnight in hospital since the opening of the PEAU, with the majority of children being referred by their own family doctor. Only one child in the sample was readmitted to the PEAU within 24 hours, and two within 24 hours of discharge as inpatients. Although thought to be pertinent, only one child admitted after official closing of the PEAU and out of hours was described as being admitted for social reasons. The International Classification of Diagnosis (ICD) 10 (World Health Organization (WHO), 1994) classifications of the children admitted to the PEAU reflect those found in other similar studies. Overall, the results of this investigation demonstrate that a PEAU can offer an efficient service to GPs, families, and others as a route of referral, thus mitigating unnecessary overnight stays for individual children.
Tissue Viability Nurses' Association Update
Authors: Cobb Ann
Published: May 2014

It is almost a year since the launch of the Tissue Viability Nurses' Association (TVNA) at the Tissue Viability Society annual conference in the Winter Gardens, Blackpool, 2002. In this first year we have attracted 260 members to an association that is vital to those of us working in the nursing specialty of tissue viability. This first year has been a year of laying foundations for the future with the executive committee working tirelessly on the members' behalf to ensure the organization can promote the development of the specialty in the future.
The use of povidone-iodine in superficial partial-thickness burns
Authors: Norman Debbie
Published: May 2014

Infection is of primary concern to those practitioners treating burns patients, as it is one of the primary complications associated with acute wounds and particularly with superficial partial-thickness burns. In the fight to reduce the risks many practitioners deploy common antimicrobial agents prophylactically to help reduce risks, e.g. povidone-iodine. This review will examine the evidence to support this practice. The deployment of povidone-iodine in wound care is highly controversial, with questions being raised concerning not only the effectiveness of the product but also its safety and effect on wound healing. The use of povidone-iodine has been investigated both in vitro and in vivo, resulting in conflicting and often contradictory results. Of the work completed to date, researchers have failed to identify or control for extraneous variables which makes it difficult to compare and interpret research findings. The potential benefits or harm that the use of povidone-iodine may elicit in acute wounds is yet to be established.
Sharing best practice: developing a web-based database
Authors: Gerrish Kate , Entwistle Barbara , Parmakis Gerry , Morgan Lyn , Taylor Cath , Debbage Sam , Warnock Clare , Gerrish Paul , Szasz Sandra
Published: May 2014

This article reports on the development of a web-based interactive database that was designed to facilitate the dissemination of practice development, research and audit projects across a large NHS trust. A multidisciplinary team worked collaboratively to design the database in order to ensure that it incorporated features which made it easy for the end user. Concise structured information on each project was recorded and search facilities incorporated to facilitate access to information. Hyperlinks to other web pages on the internet and the Trust intranet were created and full reports/publications of projects were included for those who wanted more information. The subsequent implementation across the organization involved promoting the database, helping practitioners develop skills to access information, setting up quality review procedures for projects and evaluating its use. The development of the database has highlighted that time, the availability of computers in clinical areas and skills development are important considerations when taking forward information technology (IT) initiatives.
Psychological, sexual and cultural issues for patients with a stoma
Authors: Black Patricia K
Published: May 2014

Patients undergoing stoma surgery will more readily adapt to their new body image and way of life if they receive professional and voluntary input from the ostomy agencies such as the British Colostomy Association, from the preoperative stage through to rehabilitation and their return to the community. Nursing has moved away from mechanistic, task-oriented care to holistic care and, apart from the physical changes that a stoma will cause, there are other areas to be considered to improve the patient's quality of life after surgery. Patients undergoing stoma surgery experience a profound threat to their sense of physical integrity and self-concept with the change of body image in relation to bodily functions. Sexuality is an integral part of the whole person and is a highly complex phenomenon. Many patients find it difficult to discuss their sexual feelings, especially after a body image change and the nurse should be able to help patients identify and adapt to alterations in sexual self-concept. Cultural background plays an important part in patients' lives, including their beliefs, whether personal or religious, their perceptions of recovery, behaviour and concepts of and attitude towards the disease process. Nurses must combine sound, general information with open, respectful questions to the patient or family and be committed to responding flexibly and constructively. This article describes some of the potential problems that may be faced by patients after stoma surgery and increased knowledge of these areas will allow nurses to improve patient care and satisfaction.
Caring for people with learning disability using care management
Authors: Leyshon Stephen , Clark Louise L , Epstein Laura , Higgins Stephen
Published: May 2014

Current Government health policy is moving towards the delivery of services for clients with a learning disability through mainstream primary care services. At present there are difficulties in providing health services that meet the needs of clients. These include lack of resources (financial, physical and human), time and expertise. Yet clients with learning disabilities often have some of the most complex physical and mental health needs and they have a right to expect access to services that are responsive and sensitive to their requirements. In light of the current policy and stated difficulties, all service providers and stakeholders need to work together to review how services are provided and to negotiate shared resources. This article suggests adopting a care management approach, where clients are supported by different providers with a lead practitioner taking responsibility for assessment, planning and review in partnership with the client and his/her carers.
A study into the use of restraint in nursing homes in Norway
Authors: Kirkevold Øyvind , Engedal Knut
Published: May 2014

The aim of this study was to describe the reasons for the use of restraint, the decision-making procedure for their use and the documentation of their use in Norwegian nursing home units. Structured interviews were carried out with the carers of 1362 patients in 160 regular nursing home units and 564 patients in 91 special care units for people with dementia. The reasons given for the use of restraint were to protect the patient or others, and to carry out necessary care or treatment. The main reason for the use of force or pressure in medical treatment was non-compliance of the patient. The nurse in charge (44%, n=670) or a carer (13%, n=201) most frequently decided that restraint should be used. In 65% (n=892) of all the instances of restraint, no documentation was found in the patients' records. It was concluded that routines for quality assurance for decision-making about, and the documentation of, the use of restraint are lacking in Norwegian nursing homes.
Current practice in administration of parenteral nutrition: venous access
Authors: Brogden Bridgette J
Published: May 2014

Today, there are many alternative feeding options for patients unable to eat and drink and nutrition support has become part of everyday clinical practice. Although feeding via the enteral route used to be considered optimal, recent experts have re-examined the role of parenteral nutrition, and found it to be as beneficial. This article will review current practice surrounding parenteral nutrition, its indications and the associated complications. Successful feeding via the intravenous route relies on the selection of the appropriate intravenous access, optimum nursing care and close patient monitoring. The range of venous access options will be discussed and advantages and disadvantages identified.
Equality and the children's National Service Framework
Authors: Glasper Professor Edward Alan
Published: May 2014

The final instalment of the National Service Framework (NSF) for Children, Young People and Maternity Services was published in September 2004 (Department of Health (DoH), 2004). This is part of the Government's commitment to children exemplified in its Green Paper, Every Child Matters (Department for Education and Skills, 2003). This document sets out the Government's proposals for reforming the delivery of services for children, young people and families, augmenting existing measures to ensure that children at risk of harm and neglect are protected and enabled to develop their full potential.
Master's degree -- why bother?
Authors: Currie Capt
Published: May 2014

At a recent social function I was asked about my current clinical role; when I replied that I was studying for an MSc in advanced clinical practice I received a stark glare, swiftly followed by the words ‘why on earth do you want to do a master’s, you're a nurse'. I was disappointed to hear that remark, especially from a fellow nurse.
Pharmacological approaches to stable chronic obstructive pulmonary disease
Authors: Booker Rachel
Published: May 2014

Chronic obstructive pulmonary disease (COPD) causes disabling, slowly progressive breathlessness on exertion, chronic cough and sputum production. Its natural history is punctuated by increasingly frequent exacerbations which in turn accelerate disease progression and reduce a patient's quality of life. COPD has previously been ignored in the mistaken belief that nothing could be done. There are now a number of therapies that can be used to reduce symptoms and prevent exacerbations. In turn this reduces disability, improves the patient's health-related quality of life and has the potential to reduce costs to the health service and to society.
Nursing management of urinary tract infections for catheterized patients
Authors: Hampton Sylvie
Published: May 2014

Nosocomial urinary tract infections account for up to 40% of all hospital-acquired infections with 80% of these associated with the use of urinary catheters. The most important risk factor for infection is duration of catheterization. Clinical practices in catheter management vary widely and frequently are not evidence based. It is vital that all indwelling catheters should be connected to a sterile closed urinary drainage system and that the connection between the catheter and the urinary drainage system is not broken except for good clinical reasons. Catheter care is a nursing procedure, the importance of which is sometimes overlooked and cleansing of the perineum and meatus should be performed twice daily using soap and water.