bluuebunny/crossref_metadata_2025 huggingface dataset:
Wound management following orbital exenteration surgery
Authors: Cooper John
Published: May 2014

Exenteration of the orbital contents is a rare but mutilating surgical procedure which can have a profound effect on a patient’s life. As a specialist nurse working within the oculoplastics team at Manchester Royal Eye Hospital, the author has taken a particular interest in the wound management of post-operative exenteration patients. Using evidence-based practice relating to cavity wound healing as a cornerstone, he has developed guidelines for the post-operative wound management of these patients both for nurses and other allied professionals. Several surgical approaches to the exenteration of the orbital contents are outlined. The implications for wound healing and other elements of the post operative care for these patients are also explored. Selected dressing products which may be used in patients having undergone orbital exenteration surgery are reviewed, and practice recommendations and guidelines proposed.
Evaluating Cutimed®> Sorbact®>: using a case study approach
Authors: Powell Gail
Published: May 2014

This article uses a case study approach to demonstrate good clinical outcomes using a bacterial binding dressing range on a variety of difficult wounds. A case study approach can demonstrate a clinician’s perspective on the practicalities of dressing choice in practice. All wounds, whether acute or chronic, offer pathogenic micro-organisms the opportunity to flourish – this can result in slow healing. Antimicrobial dressings use active ingredients but the Cutimed®> Sorbact®> range is a bacterial binding wound dressing that offers an alternative approach to the management of bio-burden. All dressings have a cost implication and holistic wound assessment is the key to accurate diagnosis and treatment, as well as directing the practitioner to an appropriate management strategy.
Managing physical postoperative stoma complications
Authors: Black Pat
Published: May 2014

Stoma surgery often changes a person’s lifestyle and body image permanently, and can negatively influence recovery. Literature consistently demonstrates the profound impact that stoma formation can have on a person, bringing about not only physical changes, but also affecting psychological recovery. For the person who encounters additional problems with their stoma post-surgery, their recovery and return to their normal life in the community may be hindered and never fully complete. The complications associated with a stoma may be categorized into two areas: physical and psychological. For people who experience physical complications after stoma surgery, such as parastomal hernia, prolapse, retraction, obstruction and stenosis, their long-term recovery and adaptation will be hindered. This article explores the physical complications that may occur in people with a stoma and discusses the ways that healthcare professionals can help
A nurse-led response to unmet needs of homeless migrants in inner London
Authors: Collinson Susan , Ward Richard
Published: May 2014

The economic recession has left many undocumented migrants from the European Union accession states stranded and unemployed in the UK, without recourse to public funds. The TB team at Homerton University Hospital found a significant number of eastern Europeans squatting in derelict buildings in the London borough of Hackney. Because of the high rate of tuberculosis (TB) in Hackney, the team developed an outreach clinic to screen people for TB. During this screening initiative, which took place between August 2008 and March 2009, team members compiled a database of 98 eastern European citizens, and screened 62 for TB. Team members became aware during this time that, while eastern Europeans had significant health problems ranging from alcohol dependency to trench foot and scabies, very few of them had access to any form of health care except the local accident and emergency department. The team extended the screening programme to other homeless people. It has developed strong, collaborative links with a range of agencies to sustain its work with Hackney’s vulnerable populations.
International electives: nursing idealism, or safaris?
Authors: Meetoo Danny
Published: May 2014

Why should we care? Millions of people around the world die every day of treatable diseases stemming largely from extreme poverty, often compounded by natural disasters. Personally, I don’t perceive such problems as doom and gloom. Instead, I balance the visuals of destruction and health problems with images of international teams working together, smiling faces, locals at work and team leaders from many nationalities keeping alive the spirit of hope. We need, occasionally, to remind ourselves of Dr Orbinski’s words of wisdom
Pressure ulcers: understanding the challenges of promoting quality
Authors: Ousey Karen
Published: May 2014

Pressure ulcers affect quality of life and general wellbeing, and create significant difficulties for patients, their carers and families. Pressure ulcers are associated with morbidity and mortality, and prove costly for healthcare providers. This article identifies the Government’s quality agenda and the importance of maintaining, developing and delivering quality care for the prevention of pressure ulceration
Supporting prison nurses: an action research approach to education
Authors: L Bennett Clare , Perry Jane , worth Lap , Davies Judith , Preece Vicky
Published: May 2014

Since April 2006, commissioning responsibility for healthcare services in public prisons has been fully devolved to NHS primary care trusts (PCTs), with the expectation that offenders will have access to the same range and quality of health services available to the wider population. In order to support prison nurses in meeting this goal, a PCT and university established a partnership, which used an action research approach to develop, instigate and evaluate a bespoke educational programme for nurses working in two local prisons. This article outlines the processes involved in the design and implementation of the programme. It also reports on findings from pre- and post-intervention questionnaires and focus groups with course participants, and semi-structured interviews with key stakeholders, which suggest that the innovation had a positive impact on the nurses’ confidence, assertiveness, clinical expertise and approach to change. The article concludes that the action research project should continue, but its scope should now broaden to address educational support for healthcare assistants, collaborative learning between prison officers and prison nurses, and the implementation of clinical supervision and action learning sets
Psoriasis: characteristics, psychosocial effects and treatment options
Authors: Ryan Sheila
Published: May 2014

Psoriasis is a complex chronic non-infectious inflammatory skin disease with a variety of different presentations. The classic presentation is of well-defined red plaques with silver scale. The characteristic scale makes the disorder highly visible and intrusive on the patient’s lifestyle. The visible nature of the disease ensures that psoriasis has both physical and psychosocial effects. In normal skin, epidermal cell reproduction and proliferation takes 28 days. In psoriasis this process is considerably accelerated to approximately 4 days, resulting in the deposit of immature cells on the skin. While the exact cause of this process is unknown, certain environmental and genetic factors are known to be triggers. Disease management depends on disease severity, psychosocial effects and the patient’s lifestyle. To effectively treat this disease the nurse must be skilled in psoriasis management, and in patient education and motivation. This article reviews the characteristics, aetiology, psychosocial effects and treatment strategies of psoriasis
Health professionals’ views on sexual information following MI
Authors: Ivarsson Bodil , Sjoberg Trygve , Fridlund Bengt
Published: May 2014

Following myocardial infarction (MI), patients often have unanswered questions about resuming sexual activity. Coronary care nurses can play an important role in counselling. However, this sensitive area is frequently neglected in nursing practice. This article discusses patient and nurse perceptions of such discussions and explores ways to increase nurses’ awareness, so that they might offer sexual counselling to patients post-MI. Health professionals representing 18 Swedish coronary care units answered two open-ended questions, and their answers were analysed and categorized by content. Two main categories were identified: ‘Difficulties and challenges’ and ‘Future needs’. These two categories were further divided into subcategories respectively: ‘Information flow’, ‘Patients’ responsibility’, ‘Information to partners’ and ‘Cooperating with other experts’; and ‘Preparing information tools’ and ‘Highlighting sexual issues’. It was found that when sexual concerns arise, contact with medical social workers, urologists and gynaecologists is scarce. It was also found that the current written information is insufficient. Responsibility currently falls on patients to ensure that both they and their partners have been adequately informed regarding any sexual concerns. It is essential that health professionals are well-educated and have the necessary skills to inform patients and their partners about sexual issues following MI
Human relationships: an exploration of loneliness and touch
Authors: Playfair Catherine
Published: May 2014

The aim of this article is to provide a cursory review of some of the literature relating to loneliness, existentialism and touch. With reference to the critical incident analysis (see Box 1), a reflection on the learning that has been achieved both intrapersonally and interpersonally will also be provided. A consideration of how exactly this experience of structured reflection may be used to enhance and develop practice will also be explored. The review will analyze the key concepts of loneliness, existentialism, the therapeutic relationship and touch within the realms of nursing practice, specifically in relation to death and dying. This article seeks to highlight the importance of having an understanding of loneliness in nursing, particularly when caring for patients who are dying.
Sleep: the nursing implications
Authors: Castledine George
Published: May 2014

The importance of sleep is, like many fundamental subjects in nursing these days, neglected and left to the patient to find a solution for themselves. Old habits take a long time to be replaced, and I am sure that if one visited a hospital or nursing home and reviewed the night nursing records, one would still find the most common comment would be, ‘good night slept well’. The divide between day and night staff still continues and in many healthcare facilities the night staff are seen as nothing more than night watchers, and those who make sure patients have a ‘good’ night. What is meant by the term ‘good night’ is of course left wide open for interpretation. Often it means that the patient has not caused the night nurses any trouble, or that the night staff can’t think of anything else to say which describes the patient’s sleep. The problems of sleeping at night in a hospital ward are often very difficult, especially if the patient has an acute physical or emotional problem. The environment itself is often noisy, beds uncomfortable, and pillows hard and hot due to their protective under-covers. Many night nurses claim that despite the continence pad manufacturers’ claims, they still have to go round patients at night feeling the sheets and checking that the mattresses are dry.
Providing best practice in manual pulse measurement
Authors: Alexis Obrey
Published: May 2014

This article focuses on the knowledge and pulse measurement skills that healthcare professionals require in order to safely care for patients. This paper will define pulse rate and explain why measuring pulse rate is important. In addition, it provides an overview of the different pulse sites, factors affecting the pulse, the equipment and guidelines used and information on significant groups. It will conclude by highlighting the importance of healthcare professionals acquiring the knowledge and skill of pulse monitoring
Cerebral palsy: classification, diagnosis and challenges of care
Authors: Hayes Catherine
Published: May 2014

This article aims to build capacity between nursing and allied healthcare practitioner staff in highlighting the unique challenges that caring for people with cerebral palsy (CP) brings. It gives an insight into how CP is classified and diagnosed, and briefly outlines issues of political correctness in labelling people with this condition. It covers the complexities of brain development in people with CP, with consideration of the key aetiological contributors to the incidence of the condition. A straight forward approach to unravelling the classification of movement disorders in CP is adopted. It concludes that a multidisciplinary approach to the management of CP, with the nurse at the centre of this holistic approach to patient care, is pivotal to future healthcare provision.
Nutritional management after Roux-en-Y gastric bypass
Authors: Furtado Luís Carlos do Rego
Published: May 2014

Changes in the anatomy and function of the gastrointestinal tract after bariatric surgery markedly change patients’ eating patterns. Malnutrition is a significant risk associated with all bariatric procedures, which can lead to dangerous nutritional deficiencies. However, if correct patient selection is conducted and if patients receive thorough preoperative nutrition education and postoperative nutritional follow-up, these deficiencies are largely preventable. Nurses are important members of the multidisciplinary team; assisting in patient selection, providing hands-on care, and educating the patient on the surgical process and post-operative dietary restrictions. It is critical for nurses to understand immediate and projected nutritional consequences of surgery, in order to monitor the patient for diet tolerance and nutrient deficiency symptoms, to encourage dietary compliance, and to reinforce the long-term dietary restrictions. With appropriate supplementation and patient compliance, all nutritional deficiencies can be avoided or corrected.
Biological nurse specialist: goodwill to good practice
Authors: Palmer Deborah , Miedany Yasser El
Published: May 2014

The extensive use of biological agents in recent years for the treatment of rheumatological diseases has required a steep learning curve for the specialist nurses who manage and work in this specialty. Safe prescribing of biological therapies requires good infrastructure and specialist nursing personnel. With additional training, the specialist nurse may take responsibility for a number of tasks in the patient pathway including screening, treatment administration, patient education, prescription coordination for home drug delivery, patient support, monitoring and data collection. Biological treatment is becoming more widely used in several specialities, in particular gastroenterology, dermatology and ophthalmology. Since 2002, rheumatology specialist nurses have taken the lead in assessment and providing biologic therapy, not only for patients suffering from rheumatic diseases but also for those with immune-mediated inflammatory disorders. The unique nature and variable safety profiles of these agents led to the development of immune-mediated inflammatory disease infusion (IMID) centres and highlighted the importance of having biological specialist nurses. This article will discuss the evolution of the IMID/biologic specialist nurse role and how IMID services started with goodwill from the rheumatology nurse specialists to develop into a main component of the holistic approach to care.
The nutritional management of COPD: an overview
Authors: Shepherd Alison
Published: May 2014

Chronic obstructive pulmonary disease (COPD) is highly prevalent in elderly individuals (Sin et al, 2006) and has a huge impact on both families and individual patients’ lives (Barnett, 2007). Active smoking remains the main risk factor, but other factors are becoming better known, such as occupational factors, infections and the role of air pollution. Prevalence of COPD varies according to country, age and sex (Raherison and Girodet, 2009). Nutritional depletion in patients with COPD is common and has a negative impact on respiratory and peripheral muscle function. Therefore assisting patients with COPD to attain and maintain optimal nutritional status is crucial to enhancing their physical wellbeing and function. In COPD, achieving an optimal nutritional status can delay the progression of this disease and may also reduce the risks of morbidity and early mortality (Raherison and Girodet, 2009). The aim of this article is to provide an overview of this condition and to identify ways in which nurses may optimize the nutritional management of patients with COPD.
Training in safer and healthier patient handling techniques
Authors: Carta Angela , Parmigiani Francesca , Roversi Annamaria , Rossato Rita , Milini Cinzia , Parrinello Giovanni , Apostoli Pietro , Alessio Lorenzo , Porru Stefano
Published: May 2014

The aim of the project was to educate nursing staff on patient handling techniques to prevent low back pain. Within the framework of a multidisciplinary preventive intervention, a pre-post study design was implemented in a hospital. One hundred and forty nurses and healthcare assistants attended a two-hour lesson and a three-hour practical training session; 48 nurses attended a train-the-trainer programme that was comprised of three-hour classes, two-hour lessons on communication techniques and four hours of practical training. Improvements were tested using questionnaires and direct observations. A statistically significant improvement was noted in questionnaire scores (p<0.001) and handling techniques (p<0.001); use of equipment and low back symptoms improved remarkably. The train-the-trainer programme improved knowledge, communication skills and ability to evaluate manual handling techniques; this allowed the education programme in patient-handling techniques to be extended to all healthcare workers. This approach was effective in increasing the knowledge, practical abilities and communication skills of the workforce. It also allowed a network of internal trainer nurses to be set up, who enabled the implementation of safer and healthier working techniques in nursing staff.
The effects of silver dressings on chronic and burns wound healing
Authors: Elliott Chris
Published: May 2014

Silver (Ag) has been thought to improve wound healing and reduce instances of associated infections for many years. There are centuries-old records of silver being used in wound treatment, but the past two decades in particular have seen an increasing clinical application of silver-impregnated wound dressings and as such, have seen the number of research articles similarly increase. The majority of these articles focus on the positives and potential negatives (e.g. the toxicity of silver as a heavy metal) of using silver-impregnated dressings in the clinical management of wounds. This article examines the potential advantages and disadvantages of using silver in the management of chronic and burn wounds, and provides a physiological understanding of the body’s response to silver absorption. The author also attempts to critically appraise the opposing literature related to the clinical relevance of microbial kill-time and the volume of silver contained in dressings, while investigating the efficacy of silver-impregnated dressings in the management of burns and chronic wounds. In order to collect literature relevant to this review, the author searched CINAHL, Medline, BMJ, Medscape, Journal of Advanced Nursing, the Electronic Medicines Compendium (EMC), and the Cochrane Library, using the terms silver, silver sulfadiazine, impregnated, wound, burn, dressing, review, quantative, efficacy, in vitro, in vivo, nanocrystalline, toxicity, infection, microbial kill-time and comparison
Why does wound care remain a low priority?
Authors: Maylor Miles E
Published: May 2014

There has been a credit crisis in tissue viability for a long time. I think there is a deficit in terms of the investment made in good wound care as part of everyday practice. For a few years companies were generous in providing educational support for tissue viability nurses and many others with enthusiasm for the subject. Commercial representatives seemed to call round very frequently, and miscellaneous gifts of hospitality, pens, bags, and so forth were in good supply. In recent years I think they have been strapped for cash. Previously, more than one would call to offer grants to attend the major wound conferences, perhaps even a couple each year. There was a groundswell of support for the newly instituted Tissue Viability Nurses Association (TVNA), set up in 1992, but by 2009 this had merged with the Wound Care Society to become the Wound Care Alliance UK. The TVNA’s initial promise to raise the profile of wound care and give a voice to specialists does not seem to have materialized. In the ‘outside world’, companies promised a low-cost solution for personal aspirations. Banks lent at tempting rates, and though their customers could not be sure of stable employment they were still invited to commit themselves to buying a lifestyle that had few strings attached. When they realized people could not fulfil their side of the bargain, banks started to dispossess them. Have wound care companies started to do the same?
Addressing the challenge of wound cleansing in the modern era
Authors: Cutting Keith F
Published: May 2014

Over the past two decades a body of evidence has been generated to support the traditional use of water in cleansing wounds, with studies showing that the use of clean water does not increase the risk of infection or delay healing. However, recent advances in the understanding of wound management have encouraged reforms and led to the development of wound cleansing agents that have the potential to improve clinical outcomes. This article draws on in vitro and in vivo evidence including comparative studies of patients with acute and chronic wounds to consider the evidence supporting alternatives to water in wound cleansing.
Optimizing safe and effective IV practice
Authors: Dougherty Lisa
Published: May 2014

In an American journal article last month, I read with interest about the 30-minute rule for drug administration (Smetzer et al, 2010). This is a guideline that dictates that all scheduled medications must be administered within 30 minutes before or after the scheduled time. A survey prompted a massive response from 17 500 nurses highlighting the difficulty with complying with this rule, and that although 70% of organizations enforced the rule, only 5% were able to comply. This, along with the National Patient Safety Agency (NPSA) Rapid Response Report (RRR) 2010) on reducing the harm from omitted and delayed medicines in hospital, made me think about practice within my own Trust, practice on a wider scale and more specifically, within IV therapy:
COPD: criteria to assist in the identification of the palliative phase
Authors: Trueman Jacqui , Trueman Ian
Published: May 2014

For people with chronic obstructive pulmonary disease (COPD), hospital admission can be associated with a poor prognosis. Consequently, the end stage of the illness needs to be recognized for timely palliative care to be initiated. Tools to enhance the palliative phase such as the Gold Standards Framework and the Liverpool Care Pathway rely on the recognition of the final phase of a person's life. The illness trajectory of cancer makes this recognition far easier than for COPD, as a result many patients and their families manage at home with limited support.

Lincolnshire Respiratory Network has developed criteria to help recognize the end-stage COPD, which correlate well with recent recommendations from the Consultation on a Strategy for Services for COPD in England ( Department of Health, 2010 ). However, there needs to be appropriate training to assist practitioners in their confidence to refer patients with end-stage COPD to palliative care providers.
Introducing evidence into nursing practice: using the IOWA model
Authors: Doody Catriona M , Doody Owen
Published: May 2014

Evidence-based practice has gained increasing popularity in all healthcare settings. Nurses are urged to use up-to-date research evidence to ensure better patient outcomes and inform decisions, actions and interactions with patients, to deliver the best possible care. Within the practice setting, there is an increasing challenge to provide clearly measurable care of the highest quality, which is evidence-based. In order for nurses to operate from an evidence-based perspective, they need to be aware of how to introduce, develop and evaluate evidence-based practice. This article presents how evidence may be introduced into practice using the Iowa model, offering practical advice and explanation of the issues concerning nurses in practice.
Do medicines OSCEs improve drug administration ability?
Authors: Meechan Ronnie , Valler-Jones Tracey , Jones Helen
Published: May 2014

Aim:

To examine the efficacy of the early introduction of a medicines management ‘objective structured clinical examination’ (OSCE) into an undergraduate adult nursing students' programme of education and to determine if the acquisition of applied drug/pharmacology knowledge and drug administration of medicines had improved prior to qualification.

Methods:

A longitudinal comparative design was selected for this study. A convenience random samples method of three cohorts of adult nursing students (N=90) undertaking a pre-registration nursing programme was used to identify participants. Participants were assessed at the following points during their preparatory educational programmes. Cohort one (N=30) had completed 8 months of their programme, cohort two (N=30) had completed 20 months of their programme and cohort three (N=30) had completed 30 months of education. Students were asked to undertake a drug administration simulated activity (DASA) to generate the data for this study and differences between the students' performance was compared against the criteria of the DASA.

Results/Findings:

There were statistical differences observed on almost every criteria of the DASA between the three groups of students. Students who had been previously exposed to medicines management OSCEs as an assessment method demonstrated superior medicines management skills and pharmacology knowledge than the control group (group three).

Conclusion:

The authors of this study conclude that early introduction of clinical examinations, namely OSCEs with an integrated approach to pharmacology and medicines management teaching, does facilitate and improve students drug administration and applied pharmacology ability.
Blurring the boundaries: technology and the nurse-patient relationship
Authors: Aylott Marion
Published: May 2014

Nurses, like the rest of the world's population are increasingly participating in online social media. Nurses must be mindful to avoid situations that could ultimately compromise past, present and future patient health and wellbeing, as well as their professional identities and reputations and that of the nursing profession. Unprofessional uses of social networking tools are common. This article aims to inform nurses of the public accessibility to professionally inappropriate online behaviour and activities. It asks nurses to carefully consider the risks posed by online social media with a focus on boundary crossing in an e-society. Forethought is required to ensure that private information stays private and that the nature of the professional relationship between nurse and patient continues to be respected.
Hirsutism: causes and treatment for women
Authors: Van Onselen Julie
Published: May 2014

Hirsutism is defined as an androgen-dependent, male pattern of hair distribution in women. It affects between 5-15% of all women across all ethnic backgrounds ( Azziz, 2003 ). The presence of unwanted female facial hair (and male hair patterns in other body areas) is the devastating consequence of hirsutism. It is also estimated that up to 40% of the general female population have some degree of unwanted facial hair ( Hamzavi et al, 2007 ). The treatment of hirsutism is twofold; treating the underlying cause and reducing visible hair. This article will seek to define the causes of hirsutism, explore current treatment options for the removal of unwanted hair and discuss the psychosocial effects for the woman with hirsutism.
Rheumatoid arthritis: diagnosis and multidisciplinary management
Authors: Firth Jill
Published: May 2014

Rheumatoid arthritis is a long-term condition involving inflammation of the synovial joints, systemic features and the potential for organ involvement ( Scott et al, 2010 ). Diagnosis is made based on clinical features and investigations, according to established classification criteria ( Arnett et al, 1988 ; Aletaha et al, 2010 ). Early diagnosis is important to initiate disease-modifying treatment and optimize outcomes. The role of the specialist nurse includes assessing and treating disease activity, providing patient education to support self-care, facilitating access to the multidisciplinary team, and assessing and addressing associated psychosocial issues.
Promoting healthy living in 2011: can nurses lead by example?
Authors: Gasper Alan
Published: May 2014

Professor Alan Gasper discusses the Great Swapathon—making small, manageable changes to encourage healthier behaviours—and how nursing professionals can lead by example
The vital role of emollients in the treatment of eczema
Authors: Voegeli David
Published: May 2014

Eczema is one of the most common dermatological diseases, with the number of cases in the UK rising. The use of emollients to maintain skin hydration and help restore barrier function, remains the principal treatment. Unfortunately, many health professionals, and patients themselves, fail to consider emollients an active treatment and may overlook the vital role they play in the maintenance of intact, healthy skin. Despite the overwhelming acceptance of the importance of emollient therapy, there remains a lack of good quality evidence on their effectiveness or whether one is better than another. Even when appropriate emollients are supplied, they are often used incorrectly or accompanied by conflicting/limited advice from health professionals. This article aims to explore normal skin barrier function, the disruption caused by eczema, and some of the contemporary issues surrounding emollient therapy.
Is care planning still relevant in the 21st century?
Authors: Cardwell Pauline , Corkin Doris , McCartan Rachael , McCulloch Amber , Mullan Claire
Published: May 2014

As we progress into the second decade of the 21st century, the healthcare needs of an increasingly diverse population are changing. Children's nurses must respond to these challenges by creating clear and effective plans of care in collaboration with children and their families. Legally and professionally, children's nurses are required to accurately record plans of care given to individual patients to provide a legal document demonstrating that care has been delivered ( Nursing and Midwifery Council (NMC), 2008 ). Within this article, an overview of the nursing process and its components will be discussed, considering how this process assists in organizing and prioritizing care delivery to the child or young person and family. In addition, the support offered by a framework such as the Roper, Logan and Tierney model of nursing ( Roper et al, 2000 ; Holland et al, 2008 ), in systematically assessing, planning and documenting care to meet individuals' needs, must be reinforced and its application practiced. Subsequently, the use and contribution of such processes and frameworks to the organization and delivery of care will be examined within the context of a clinically-based scenario, which has helped to explore students' knowledge and skills in the second year of a 3-year undergraduate programme. The authors firmly believe that care planning skills are fundamental to safeguarding vulnerable children, their families and, indeed, the nursing profession in this current challenging socioeconomic environment.
Concepts of advanced practice: what does it mean?
Authors: Pearson Helen
Published: May 2014

‘Advanced practice nursing’ may be a familiar concept, but a definition of advanced practice, its scope and its responsibilities, remains elusive. This article discusses the origins of advanced practice, and its practical meaning for nurses working in the NHS today.
The clinical utility of the Distress Thermometer: a review
Authors: Snowden Austyn , White Craig A. , Christie Zara , Murray Esther , McGowan Clare , Scott Rhona
Published: May 2014

The Distress Thermometer (DT) is a well validated screening tool, demonstrably sensitive and reasonably specific to the construct of distress in cancer. Its brevity makes it ideal to incorporate into a system of distress management. To ascertain how far this idea has been developed in practice, and to support future research, a literature review was undertaken. Medline, CINAHL, PsyclNFO, Embase, ASSIA, British Nursing Index, AMED, CCTR, and HMIC were systematically searched. Forty studies were reviewed that examined the function of the DT alone, together with the problem list (PL), and/or other validated measures. The majority of studies validated the DT against other robust measures of distress in order to establish ‘caseness’ in these populations, and establish factors associated with distress. Many of the studies recommended that further research should test their findings in clinical practice. A small section of the literature focused on the clinical utility of the DT as a facilitator of consultations, and found it to have potential in this regard. It is concluded that there is enough validation research, and in line with the majority of these studies’ recommendations, future research should focus on the utility of DT as part of a structured distress management programme.
The variance in distribution of cancer nurse specialists in England
Authors: Leary Alison , Mak Vivian , Trevatt Paul
Published: May 2014

Background

The role of the specialist nurse in the UK evolved in the 1970s. In cancer care, policy drivers have seen an increase in the number of, and an increase in the role of, the pathology‐based, or ‘site‐specific’, cancer clinical nurse specialists, and also an increase in the variety specialist cancer nursing roles; the recommendation being that every cancer patient has access to a specialist cancer nurse.

Methods

A census of the specialist cancer nursing workforce was undertaken in 2008. These data were then compared with cancer registry data (incidence) to give an indication of caseload and access to a clinical nurse specialist by patients.

Results

There is a wide variation in provision of clinical nurse specialists both geographically and by pathology across England.

Conclusions

Cancer specialist nursing is a pivotal part of cancer care. Given the uneven distribution of cancer clinical nurse specialists, it is unlikely that patients and families have equitable access across pathology or geography. In terms of a realistic workload, more research is needed into optimum caseload guidance.
Student experiences of medicines management training and education
Authors: Hemingway Steve , Stephenson John , Allmark Howard
Published: May 2014

Nurses on registration are expected to have sufficient knowledge and skills in medicine management to practice safely and competently. This article reports on research involving midwifery and nursing students, who were asked to complete a questionnaire related to their experiences of medicines-related training and education, and how it prepared them for practice. The results showed an overall satisfaction with the pre-registration delivery, but differences emerged in the perceived efficacy of different educational strategies. Clinically-based and simulated aspects of the programme delivery were highly rated, with theoretical delivery scoring poorly in contrast. A stepped approach is suggested, with medicine course delivery needing to be strongly highlighted as a lead up to safe and competent nursing interventions when administering medication and all other related interventions. A grant from the innovation fund at the University of Huddersfield funded an evaluation of students' experiences of medicines management education and training using a self-administered questionnaire.
Exploring urinary catheters: the perspectives of patients and nurses
Authors: De Jaeger Melanie
Published: May 2014

This literature review is part of a larger dissertation project that explores the lived experience of patients using long-term urinary catheters and nurses’ attitudes towards urinary catheters. Systematic examination of the literature revealed six relevant primary research studies. These were critically appraised to assess their worth. Further studies were also reviewed, although these were often from neighbouring fields as relatively little research has been undertaken in this field. Findings suggest that there is a disparity between the care that nurses provide to patients with long-term catheters and the holistic care that patients need. Furthermore, nurses’ decision-making skills are hampered by poor multidisciplinary documentation practices in the acute sector. It is concluded that nurses’ attitudes towards urinary catheters do affect the care that patients receive.
Effectively managing chemotherapy—induced nausea and vomiting
Authors: Middleton Janice , Lennan Elaine
Published: May 2014

This article examines the unpleasant side effect of chemotherapy-induced nausea and vomiting (CINV). What was once the main reason for withdrawing from treatment is now much more tolerable owing to the advent of modern antiemetics. However, because of the improvements in these antiemetics, the focus on CINV appears to have lapsed. Despite this, some patients continue to experience problems and under-report this side effect. This article looks at the mechanism of CINV and clarifies terminology and definitions surrounding it. Risk factors are discussed and management strategies advised, including appropriateness of modern antiemetics and non-pharmacological strategies. To conclude, a brief look at nursing implications and self-management strategies are explored.
Clinical evaluation of Allevyn Gentle Border Lite™ within one health trust
Authors: Stephen-Haynes Jackie , Greenwood Michelle
Published: May 2014

This article outlines the financial cost of wound care and the importance of appropriate dressings to achieve both clinical and economic outcomes. A clinical evaluation of Allevyn Gentle Border Lite™ including 50 patients within one health trust was undertaken to assess ease of application, wear time, ease of removal, durability and patient comfort. An observation is made that wound care is complex and health professionals require a knowledge and understanding of the wound healing process, pain, dressing products, asepsis, microbiology, pharmacology, psychosocial factors, and ethics, and should possess good communication skills. A conclusion is made that the 50 patient evaluation demonstrates the flexibility of the Allevyn Gentle Border Lite, which allows for a secure fit, provides active fluid management in its control of exudates, may be applied to patients with fragile skin, thereby avoiding the need for secondary retention, and may be used on difficult-to-dress areas.
Smart practice: the introduction of a dose error reduction system
Authors: Quinn Chris
Published: May 2014

This article describes a dose error reduction system (DERS), a relatively recent IV infusion delivery innovation that prevents infusion administration error, and the reasons why it was developed. It has been used in the United States for around 10 years and is now increasingly being used in the UK because of the recognized safety impact. However, it is important to understand why medication safety, and in particular IV medication safety, must be one of the main priorities for clinicians and how and why a DERS can impact positively on infusion practice.
Assessing the impact of breakthrough cancer pain
Authors: Burton Beth , Zeppetella Giovambattista
Published: May 2014

Breakthrough pain is a transient exacerbation of pain that occurs either spontaneously or in relation to a specific predictable or unpredictable trigger despite relative stable and adequately controlled background pain. Breakthrough pain is a common and distinct component of cancer pain and is typically of rapid onset, severe in intensity, and generally self-limiting with an average duration of 30-60 minutes.

Despite the self-limiting nature of breakthrough pain, it can place significant physical, psychological, and economic burdens on both patients and their carers. Patients with breakthrough pain are often less satisfied with their analgesic therapy, they have decreased functioning because of their pain, and may also experience social and psychosocial consequences, such as increased levels of anxiety and depression.

Successful management of breakthrough pain is best achieved by a thorough assessment which includes determining the severity, pathophysiology, and aetiology of the pain and takes into account both background and breakthrough pains while considering whether the underlying disease, co-morbidities or precipitating events are amenable to interventions.

The features of breakthrough pain and the challenges it presents to patients, their carers, and health professionals are illustrated with a case study.
Peristomal skin irritation and the use of a silicone-based barrier film
Authors: Rudoni Caroline
Published: May 2014

Maintaining skin integrity is vital to ensure good adhesion of the stoma pouch, and to avoid discomfort for the person with a stoma, ensuring a good quality of life. However, there are many risk factors associated with potential peristomal skin soreness, and a large number of research studies have highlighted the vast number of patients who actually experience these problems ( Mahjoubi, 2005 ; Ratliff et al, 2005 ; Herlufsen et al, 2006 ; Lynch et al, 2008 ; Meisner and Balleby, 2008 ). Clinical nurse specialists in stoma care are responsible for ensuring that all patients are fully assessed, and also that patients are given appropriate evidence-based care to avoid peristomal skin irritation, where possible. This article will discuss the common causes of peristomal skin breakdown, the tools available to assist with assessment, and how to best treat peristomal skin irritation.
Second primary peristomal carcinoma: a case study
Authors: Varma Sarah
Published: May 2014

Literature has highlighted that peristomal skin problems are common among ostomists ( Williams et al, 2010 ); however, peristomal metastases are considered to be very rare. Peristomal metastases tend to manifest as cutaneous or subcutaneous nodules, or as a rash on the anterior abdominal wall ( Lyon and Smith, 2001 ), and are therefore easily mistaken for a more common stoma complication. The role of the specialist nurse in stoma care is crucial to recognizing unusual skin lesions and referring appropriately for further assessment and treatment. Highlighting the need for education and sharing of clinical skills, this article explores the care of a patient who was diagnosed with a second primary peristomal adenocarinoma. The patient has consented to the use of this case study, and, to maintain confidentiality, his name has been changed.
Research ethics application: a guide for the novice researcher
Authors: Greaney Anna-Marie , Sheehy Agnes , Heffernan Catrina , Murphy Joan , Mhaolrúnaigh Siobhán Ni , Heffernan Elizabeth , Brown Gary
Published: May 2014

The aim of this paper is to assist the novice researcher in the research ethics application process. The novice researcher in this context refers to any researcher negotiating a research ethics application for the first time. This may be a student or a more experienced registered nurse engaged in research activity. The paper applies ethical principles to the varied elements of a research ethics application form to explain the theoretical basis of the application criteria. The impetus for this paper arose following an internal audit of the decisions made by the research ethics committee of the nursing department at the Institute of Technology in Tralee, Ireland. The audit revealed the common reasons why full approval was not granted following initial review. This information prompted the development of a paper which would assist novice researchers in avoiding common errors and omissions in the research ethics application process. Despite the specific requirements of individual research ethics committees in different jurisdictions, the fundamental elements of research ethics approval remain unchanged. While the paper has local origins, its relevance holds a wider appeal. The paper takes a structured approach using the three ethical principles of respect for persons, beneficence, and justice, as outlined by the Belmont Report ( 1979 ) to provide a framework for discussion. Despite the advent of other frequently used frameworks for research ethics, the principles of the Belmont report remain constant as guidance for good practice in the research ethics context.
Safeguarding children: the benefits of a peer-review process
Authors: Morris-Thompson Trish , Shepherd Janet , Roger Maggie , Ladbury Briony , Kirk Catherine , Marks-Maran Di
Published: May 2014

Nurses in hospitals and in the community are increasingly taking a leading role in safeguarding children. NHS London established a Safeguarding Improvement Team (SIT) in 2009. The SIT project was designed as a one-off activity to raise performance related to safeguarding children in London. This article presents a peer-review process that was established by NHS London and implemented across the 31 PCTs across London. This article presents the peerreview process methodology and a summary of the findings from the SIT visits. Feedback was requested from participants about participants' perceptions of the peer-review process immediately after the SIT visits and again, several months after the completion of all SIT visits. Findings show that the peer-review process was of value, both organisationally and professionally, and the process itself led to identification of good practice as well as gaps in existing practices. The non-threatening nature of the peer-review process was particularly valued, as was the feedback offered by the review teams.
Quality of life after percutaneous coronary intervention: part 1
Authors: Cassar Stephen , Baldacchino Donia R
Published: May 2014

Quality of life (QOL) is a complex concept comprised of biopsychosocial, spiritual and environmental dimensions. However, the majority of research addresses only its physical function perspectives. This two-part series examines the holistic perspective of QOL of patients after percutaneous coronary intervention (PCI). Part 1 explains the research process of a cross-sectional descriptive study and its limitations. Data were collected by a mailed WHOQOL-BREF questionnaire in Maltese from a systematic sample of patients who had undergone PCI; the response rate was 64% (n=228; males n=169, females n=59, age 40-89 years). Part 1 also considers limitations, such as its cross-sectional design and retrospective data collection. The hierarchy of human needs theory ( Maslow, 1999 ) guided the study. Part 2 gives the findings on the holistic view of QOL. Having social and family support, as a characteristic of Maltese culture appeared to contribute towards a better QOL.
A strategy to improve the health of children and young people
Authors: Glasper Alan
Published: May 2014

Professor Alan Glasper discusses how proposals by the Children and Young People's Health Outcomes Forum seek to improve the health of children and young people.