bluuebunny/crossref_metadata_2025 huggingface dataset:
The puzzle of spirituality for nursing: a guide to practical assessment
Authors: Narayanasamy Aru
Published: May 2014

Increasingly nurses are called upon to meet patients' spiritual needs. However, there is evidence to suggest that nurses are unable to do this adequately because of confusion about the notion of spirituality. This is compounded by the uncertainty surrounding the role of nurses in spiritual care interventions. Emerging research suggests that nurses, as primary carers, may have to initiate spiritual care interventions. This article offers practical guidance to nurses seeking to improve spiritual care for their patients. A working definition of spirituality is offered and spiritual needs are explained in the context of a case scenario. Practical guidance is given on how spiritual care can be put into action, using the Actioning Spirituality and Spirtual care in Education Training (ASSET) model as a framework for assessment of spiritual needs, planning, implementing and evaluating spiritual care, and a spiritual assessment tool for practice is outlined.
A clinical evaluation of Urgotul to treat acute and chronic wounds
Authors: Benbow Maureen , Iosson Gilly
Published: May 2014

This article describes the first UK clinical open study of Urgotul®, a new dressing, in the management of acute and chronic wounds. A single-centre, qualitative, descriptive, non-comparative study was carried out to evaluate the tolerance, acceptability and efficacy of Urgotul® in practice. Urgotul® comprises a new concept in wound management: lipido-colloid technology. It is a class IIb medical device and takes the form of a non-occlusive, thin-sheet, lipido-colloid dressing. Twenty-two out of 27 hospital inpatients who were selected by the tissue viability nurse and vascular nurse completed the study. Informed written consent was obtained before inclusion and photography of the wounds. Wounds were photographed and traced on entry, at each dressing change and on exit. The clinical report forms were completed weekly until wounds healed, or up to a maximum of 4 weeks. Patient and nurse acceptability was documented weekly and on exit from the study. The results were very positive regarding ease of application, conformability and non-adherence, absence of trauma, pain and bleeding on removal, with minimal maceration of the surrounding skin and odour. The study involved a limited sample of patients but demonstrated good efficacy, tolerance and acceptability of the dressing in a wide range of acute and chronic wounds.
Nutrition 2: a vital consideration in the management of skin wounds
Authors: Lansdown Alan BG
Published: May 2014

The first part of this review focused on the essential biological features of human skin, their origins and cellular relationships as a basis for understanding nutritional requirements in health and disease (see Vol 13(19; Tissue Viabil Suppl): S22–S28). The second part will discuss the importance of a good, well-balanced diet sufficient in proteins (amino acids), fats, carbohydrates, vitamins and minerals in the management of skin wounds. Evidence is drawn from clinical trials, case studies of patients with known genetic deficiencies affecting dietary metabolism and metabolic studies. Experimental studies in laboratory animals have provided limited information on the role of nutrient deficiencies in wound repair. There is still an urgent need for prospective controlled studies on the importance of key nutrients at principle phases in the wound-healing cascade and how uptake and metabolism is regulated by growth factors, cytokines and hormones.
An investigation to find strategies to improve student nurses' maths skills
Authors: Wright Kerri
Published: May 2014

Being able to perform drug calculations accurately is an essential skill for nurses. Many studies, however, have demonstrated that nurses need to improve this area of their practice and in particular their mathematical skills. Several strategies have been implemented to develop the drug calculation skills of nurses, with mixed success. This article reports on a study that was carried out to investigate whether strategies implemented within a second-year preregistration course were perceived by students to be helpful in improving their mathematical skills for drug calculations. The results demonstrated that students felt their mathematics and confidence improved as a result of these strategies. The students' evaluation of the learning strategy that they found most helpful in learning drug calculations gave a mixed result, indicating that students have differing learning styles and needs. The study also indicates that student nurses were able to integrate the mathematical skills into their nursing practice by having different strategies that allowed them to develop conceptual, mathematical and practical skills concurrently. The study recommends the implementation of integrated strategies to address drug calculation skills in student nurses, although further research is still required.
Multiprofessional follow up of patients after subarachnoid haemorrhage
Authors: Jarvis Anne , Talbot Louise
Published: May 2014

Subarachnoid haemorrhage (SAH) is a life-threatening illness that affects people suddenly and without warning. Previous research has estimated that only 7% of SAH survivors suffer physical deficits (Stegan and Freckmann, 1991), whereas two-thirds of those classed as having made a good recovery actually experience a range of debilitating cognitive or emotional difficulties (Bindschaedler et al, 1997; Buchanan et al, 2000). At Hope Hospital, a structured system was set up to help support the survivors of SAH through follow-up via the neurovascular team providing patients with information, guidance and early intervention including screening for potential cognitive and emotional difficulties and fast-track referral to neuropsychology services. Behavioural indices demonstrated that patients experienced a range of difficulties in everyday functioning such as problems that prevent a return to work and excessive fatigue, among others. Although this innovative system does address follow-up need, improvements could be made to ensure that all patients receive an equitable service.
Role of hospital nursing in promoting patient recovery
Authors: Castledine George
Published: May 2014

The modernization of the British hospital system is in danger of ignoring the fundamental values of the nursing profession. Hospitals are rapidly evolving from being highly valued centres of acute and rehabilitative clinical care to very expensive cost centres concerned only with the acute aspects of medical treatment. In the past, hospitals had time to nurse patients and allow them to recover properly before they were transferred, if necessary, to appropriate places of convalescence.
The clinical definition of death and the legal implications for staff
Authors: Dimond Bridgit
Published: May 2014

John, Kathy's son, was injured in a road traffic accident and Kathy was rushed to intensive care to see him. He appeared to be sleeping very peacefully assisted by a ventilator. The doctors told her that John was dead. She could not accept that view since he was clearly breathing and his heart was beating and he did not look dead. The doctors said that they intended to switch off the ventilator but Kathy protested that that would kill him. What is the law?.
Deputy matron who physically and verbally abused patients in her care
Authors: Castledine George
Published: May 2014

Jean, the nurse in this particular case, was a registered mental nurse (RMN) who worked at a large 50-bedded elderly mentally ill (EMI) nursing and residential care home. She often acted as the named person in charge of the home, but always refused to take the post permanently. Jean did, however, accept a post as deputy matron, but she still preferred to see herself as ‘one of the workers’ and liked to fraternize with the untrained staff.
Elder abuse: a wake-up call to nurse educationalists
Authors: Nolan Mike
Published: May 2014

According to a recently published House of Commons Health Select Committee report the abuse of older people remains a hidden and often ignored phenomenon (Health Select Committee, 2004). In marked contrast to the high profile given to child abuse, and the numerous measures in place to identify and tackle the problem, elder abuse has no standard definition and lacks legal status. To compound matters the dearth of research on the subject means that very little is known about the numbers of older people who experience abuse in its many and varied forms.
Complex wounds: a partnership approach to patient documentation
Authors: McMath Elizabeth , Harvey Caroline
Published: May 2014

A concern regarding the lack of effective communication experienced within Ayrshire in relation to patients with complex wounds initiated the development of a patient-held record. The aim of the patient-held record was to promote patient empowerment by providing a method by which patients and professionals share information. Interested stakeholders worked in partnership to produce a draft record which comprises three main sections: a core section, wound section and personal notes section. Other sections which can be included, where relevant, are nutrition, continence and podiatry. After obtaining ethical approval, patients with complex wounds were involved to refine the record before participating in a successful pilot of the document. Evaluation of the pilot demonstrated that patients felt empowered and communication improved between everyone involved in the patient's care. The final record was printed with a planned, phased introduction to be undertaken across Ayrshire and Arran.
Examining adult male genitalia: providing a guide for the nurse
Authors: Peate Ian
Published: May 2014

This article provides the nurse with an overview and guidance concerning examination of the adult male genitalia. Issues such as ensuring privacy, developing a relationship and explaining the procedure are discussed. Advice is provided that will allow the nurse to perform the examination using sight, palpation and transillumination, activities that are central to the examination. An overview of the structure and function of male genitalia is provided. Examination of the male genitalia is an intimate activity and in this article emphasis is placed on the issues of informed consent and the importance of ensuring that each patient has a chaperone present during the examination. Detailed discussion is provided to enable the nurse to use a step-by-step approach to ensure a thorough and detailed examination is performed. A check list and review of the examination process is included.
Improving palliative care provision for patients with heart failure
Authors: Lewis Clare , Stephens Barbara
Published: May 2014

In the last 14 years, research has identified that patients with heart failure suffer symptoms as severe as people with cancer and would greatly benefit from a palliative care approach. In spite of this fact, it is recognized within the National Service Framework for Heart Failure (Department of Health (DoH), 2000b) and the Cancer Plan (DoH, 2000a) that service provision from a palliative care perspective remains inadequate. In order to address the palliative care needs for patients with heart failure and their families a multidisciplinary team approach between primary and secondary care is needed. This article will review the literature relating to improvement of services from a palliative care perspective. It discusses the quality of life experienced by patients with heart failure and their families and the barriers to providing a palliative care approach from a multidisciplinary team perspective. Finally, it attempts to present future recommendations to develop a structured service provision.
Staff nurse who disregarded authority, protocol and confidentiality
Authors: Castledine George
Published: May 2014

The Princess Hospital is a small 20-bedded medium acute hospital with a small minor injuries unit. The provision of medical care at the hospital is contracted out to the local GP practice. The provision of nursing care necessitates the presence of a trained nurse 24hours a day at the hospital.
Supporting the parents of children with atopic eczema
Authors: Lawton Sandra , Roberts Amanda , Gibb Colin
Published: May 2014

Atopic eczema is a chronic skin condition affecting between 5% and 20% of children aged up to 11years, and the numbers are increasing. While eczema is often seen to be a minor problem, research has shown that it can cause considerable disruption to the lives of children and their carers, and can incur significant cost for the family and the healthcare system. Access to good quality, relevant information on the seriousness of atopic eczema, problems that are likely to occur during the illness, and how these may affect the child and his/her family's everyday life is an important consideration when providing care. This article focuses on the information needs and the role that support groups can have in relation to caring for children and their families living with atopic eczema.
Electronic health record and electronic patient record
Authors: Dimond Bridgit
Published: May 2014

This article considers the government plans for the development of electronic health and patient records as set out in the NHS Plan and the progress and problems which have been encountered in their realization.
Information for young people when multiple sclerosis enters the family
Authors: Mutch Kerry
Published: May 2014

Multiple sclerosis (MS) typically affects people aged 20–40years and, by its very nature, is characterized by unpredictability, uncertainty and variability, and is therefore bound to have an impact on children who have a parent with MS. There has been little work done to assess the needs of young people living with MS in their family. A series of workshops specifically aimed at 9–14-year-olds who have a parent with MS have been successfully conducted. This article reviews the background to setting up the workshop and identifies implications for future MS specialist nurses to help this potentially vulnerable group of people. By breaking the silence and talking about MS with young people, the myths can be removed and the anxieties reduced.
The value of the role of the rehabilitation assistant
Authors: Pullenayegum Shirley , Fielding Beverley , Du Plessis Estel , Peate Ian
Published: May 2014

This article outlines the experiences of nursing and therapy staff regarding the introduction of rehabilitation assistants. The authors discuss issues concerning a role (the rehabilitation assistant) that was created after staff identified that therapeutic input (nursing, physiotherapy, occupational therapy, speech and language therapies), which was provided from Monday to Friday, was not continued over weekend periods. A small-scale audit was carried out to assess the role and the efficacy of the rehabilitation assistant. The results demonstrate specific areas of the rehabilitative process that patients and their carers considered important. These include activities of living, general wellbeing and the patient's view towards rehabilitation over the weekend. This article demonstrates the value of the role of the rehabilitation assistant and how, together with effective multidisciplinary team working, it provides the impetus for a consistent and goal-directed rehabilitative process.
Disaster preparedness and response: more than major incident initiation
Authors: Davies Kevin
Published: May 2014

To ensure an efficient and effective response to disaster situations, communities must be prepared at all levels. A disaster presents problems that go beyond the scope of major incident preparedness and requires a response that utilizes all of the available resources that a community may posses, as well as assistance from outside the affected community. In order that the optimum response to a disaster situation is forthcoming, planning must take place that ensures the appropriate response across the service spectrum, including voluntary organizations. The lessons that can be learned from non-governmental organizations in developing world contexts must also be acknowledged and incorporated into the planning process.
NMC will help nurses who find they have a mental illness
Authors: Castledine George
Published: May 2014

One of the main reasons for the large influx of overseas nurses into the UK health service has been the acute shortage of domestic nurses. Some critics have argued that trusts have been too hasty in their desire to fill vacancies and have used overseas nurses as a short-term answer to a longer term problem. There is no doubt that internationally recruited nurses are a valuable resource and a quick fix, but there are problems which may arise if they are not treated well and supported in their posts. This case history plots the course of a typical overseas nurse who came to Britain to work, but ended up with personal health problems which affected her work and disrupted her professional career.
The Wolverhampton Prolific and Other Priority offenders' Programme
Authors: Bateman Malcolm
Published: May 2014

This article considers the increasing involvement of the criminal justice system within substance misuse treatment services, through the example of the Prolific and Other Priority Offenders' treatment programme. It outlines some of the inherent potential professional conflicts that this generates and how these have been overcome, at the local level, to progress multi-agency working with the criminal justice system. The article is written as a descriptive presentation of good practice, with the intention of reassuring other treatment professionals that if the necessary changes are managed appropriately, professional obligations can be maintained, with the resulting service development benefiting both the clients and the community as a whole. Although the article is written from a nursing perspective, it is equally applicable to other health and social care professionals working within substance misuse treatment.
Lawful disclosure of confidential information
Authors: Dimond Bridgit
Published: May 2014

The last article considered the duty of confidentiality and the various ways in which health professionals could be held accountable for unjustified breaches of confidentiality. This article considers what those lawfully justified situations cover. The main justifications for disclosure include: consent of the patient; the interests of the patient; court order; statutory requirement; and public interest.
Use of lubricant in female urethral catheterization
Authors: Woodward Sue
Published: May 2014

Urethral catheterization is a commonly undertaken nursing procedure, with up to 12.6% of hospitalised and 4% of community patients having indwelling urethral catheters (Rew and Woodward, 2001). It is well known that this is often a procedure that can cause physical trauma to the urethra and can be painful for the patient and a recent systematic review identified that urethral trauma and discomfort could be minimised by using a sterile-use lubricant or anaesthetic gel (Department of Health, 2001). This article will consider the use of lubricants for female urethral catheterization.
Pilot study to show the loss of important data in nursing handover
Authors: Pothier David , Monteiro Pedro , Mooktiar Mutuzua , Shaw Alison
Published: May 2014

A good nursing handover process is a crucial part of providing quality nursing care in a modern healthcare environment. The conservation of patient data during the handover process is vital to ensure good continuity of care and safe practice. Any errors or omissions made during the handover process may have dangerous consequences. The authors observed the handover of 12 simulated patients over five consecutive handover cycles between nurses. Three handover styles were used and the amount of data loss was recorded for each style. A purely verbal handover style resulted in the loss of all data after three cycles. A note-taking style (the traditional style used in most hospital wards) resulted in only 31% of data being transferred correctly after five cycles. When a typed sheet was included with the verbal handover, data loss was minimal. Current handover methods may result in significant loss of important data that may impact on patient care. The authors recommend that prior to handover, a formal handover sheet be constructed that can be transferred as part of the handover process.
Competition - the `missing link' in the NHS
Authors: Newbold David
Published: May 2014

The concept of evidence–based practice (EBP) originated in Canada in 1991 (Guyatt, 1991). At the start of the EBP movement, the persistence of obsolete and ineffective practices and failure to implement others of known cost-effectiveness, was widely documented (e.g. Antman et al, 1992). The result was often suboptimal, or even lethal, health outcomes, with variations in care standards and practices within the system. EBP was seen as the solution to these problems.
Practice nurse who expanded her role without appropriate training
Authors: Castledine George
Published: May 2014

Recently there have been proposals to increase the nurse's role in general practice settings. There are three types of nurses who work in GP surgeries: practice nurses, nurse practitioners and district nurses. The following case concerns a practice nurse called Jean who developed and expanded her role without appropriate education, training or supervision.
NMC Consultation on Fitness to Practice
Authors: Castledine George
Published: May 2014

Following some very vociferous concerns expressed about the competence of newly qualified nurses, the NMC completes its consultation on the matter next month. For a long time there have been concerns about nursing programmes and their ability to ensure that students are fit for practice at the point of registration. Many people would put this problem down to the time when universities or higher education took over the preparation of nurses, but it is probably a little bit too simplistic and naïve to think that the whole pattern is down to the universities.
Influenza: incidence, symptoms and treatment
Authors: Banning Maggi
Published: May 2014

Influenza is a common respiratory condition that has a history of developing into epidemics and pandemics. Individuals at risk of influenza and related complications include older people, young children and individuals with chronic renal, cardiac and respiratory diseases. Influenza can begin suddenly and is accompanied by fever, chills, aches, pains, headaches, fatigue, cough and generalized weakness that can last up to 14days. Complications of influenza include secondary bacterial pneumonia, post-influenza encephalitis, changes in cardiac electrocardiogram and secondary bacterial infections, such as Staphylococcus aureus-induced myositis. The influenza vaccine is the main form of treatment. Suitably qualified nurse prescribers and nurses who supply and administer the vaccine under patient group directions should be sufficiently knowledgeable about the virus and how its transmission can be prevented in order to educate patients at risk of developing influenza about the role of the vaccine in the prevention of the disease.
Prescription and medication records
Authors: Dimond Bridgit
Published: May 2014

All nurses are required to keep contemporaneous records which are unambiguous and legible. The NMC has reprinted the UKCC guidelines for records and record keeping (UKCC, 1998). The Department of Health has provided advice in its guidance on the implementation of independent nurse prescribing on the standards for prescription writing (DH, 2002).
Exploring the role of an acute pain specialist nurse in the Royal Navy
Authors: Haslam Clair , Haslam Clair
Published: May 2014

There is a strong research base to support the value and importance of acute pain management. There have been significant improvements in this specialty in the NHS since the introduction of acute pain teams in the early 1990s. The Armed Forces have embraced the concept more recently, and are making progress in this valuable area. This article examines the role of an acute pain specialist nurse in the Royal Navy and the importance of high-quality, evidence-based pain management in the Armed Forces. The value of a military specialist nurse working as an integral part of a large NHS trust and how that relates to an operational role in the Royal Navy is also explored. The article draws conclusions about the importance of retaining senior specialist nurses in the clinical setting in order to ensure that the Armed Forces have access to up-to-date clinical expertise, especially when medical staff are deployed in operational roles.
The importance of the ward team must be remembered
Authors: Castledine George
Published: May 2014

Only through collaborative effort can nursing move forward to meet its own professional targets. Following recent adverse publicity about nursing, as reported in BJN (‘Undercover cameras show nursing in a poor light’; Vol 14(3): 129), there is an urgent need to get back to, and re-emphasize, the importance of the ward leader and the team approach.
The term ‘expert patient’ is unfortunate
Authors: Waterlow Judy
Published: May 2014

Iwould like to correct the general assumptions regarding the ‘expert patient’ within the article ‘The role of the expert patient in the management of chronic illness’ by Jane Fox (BJNVol 14(1): 25–8.
Exploring the financial provisions available following death
Authors: Dimond Bridgit
Published: May 2014

Arthur Jones is terminally ill with cancer and his wife, Joan, who visits every day, is overcome with grief. The staff nurse takes her aside to offer support and counselling and discovers that one of her anxieties is that she has no money to pay for a funeral. Arthur was a gambler and Joan was unable to save any of their social security income for the future. She says that she would not want him to have a pauper's funeral, although she clearly does not know what that is or what help is available. What is the situation?
Exploring debridement options for chronic venous leg ulcers
Authors: Davies Colin E , Turton Glenda , Woolfrey Gina , Elley Rachel , Taylor Maxine
Published: May 2014

The presence of devitalized tissue in a wound is a common problem facing practitioners and is regarded by many as a major inhibitory factor in the wound-healing process and can act as a focus for microbial proliferation. Therefore, for wound healing to proceed in a logical and ordered fashion, it follows that any necrotic material should be cleared from the wound bed. Wound bed preparation is now recognized as crucial to facilitating ordered restoration and regeneration of damaged tissue. However, there is a clear lack of good clinical evidence to support available wound debridement options, particularly for chronic ulcers of the lower extremities. This article reviews the debridement options available to practitioners and discusses rationales for treatment and implications for clinical practice with specific reference to chronic venous leg ulcer management.
Writing for publication: Key Points and questions
Authors: Fox Jane
Published: May 2014

Students frequently receive positive feedback and encouragement to develop an assignment for publication, but are unsure how best to proceed. Having a strategy that guides conversion of an assignment into an article can ease the task. Such a strategy can be informed by a few key questions and steps which are explored below.
Multiple sclerosis and continence issues: an exploratory study
Authors: Wollin Judy , Bennie Mary , Leech Christine , Windsor Carol , Spencer Nancy
Published: May 2014

The study described in this article aimed to identify issues relating to incontinence and assess the impact of referral to a continence adviser on the lives of people with multiple sclerosis (MS). The study design used an in-depth, two-phase anonymous mail survey within a general community as nominated by the participants. Fifty-six people participated in phase 1 and eleven people completed phase 2. The results indicated that incontinence is a problem for the vast majority of participants — people with MS. One-third of the eligible participants took up the option of a consultation, assessment and treatment from a continence nurse. Reasons for not taking up the visit from the continence nurse included ‘managing OK’, ‘didn’t think it would help’, ‘embarrassed’ and ‘too busy’. Increasing awareness of urinary incontinence in the community is important and education needs to focus on at-risk groups in presenting the range of options available to assist people experiencing incontinence.
Exploring the principles of good record keeping in nursing
Authors: Dimond Bridgit
Published: May 2014

Record keeping is an integral part of patient care. This article considers the basic principles which should be followed in the light of guidance from the Department of Health, Nursing and Midwifery Council and the Clinical Negligence Scheme for Trusts. Apart from the Mental Health Act 1983 and abortion regulations there are few statutory provisions covering record keeping, but the courts would apply the Bolam Test of the reasonable standard of care to documentation.
Depression can cause severe physical symptoms
Authors: Mustapha Amelia
Published: May 2014

A recent survey of members of Depression Alliance revealed that 99% of patients with depression experience one or more physical symptoms but many are reluctant to discuss such symptoms with their doctor (Depression Alliance, 2005a). At Depression Alliance, we are keen to encourage both patients and healthcare professionals to discuss physical signs associated with depression, as well as the more traditional psychological manifestations such as low mood.
Signs and symptoms of hypothetical wound assessment by nurses
Authors: Maylor Miles E
Published: May 2014

This is a report of a study in which tissue viability nurses, MSc student nurse practitioners, and postregistration nurses on a wound management module (n=61) ranked signs and symptoms of wound healing, stasis and deterioration relative to their supposed importance. The top ranked sign for a healing wound was ‘size’ (reduction), for a static wound it was ‘no’ (change), and for a deteriorating wound ‘increase’ (pain). This was a convenience sample, and caution is indicated in generalizing results. However, there were statistically significant differences between assessors in the number of words they used (ANOVA P < 0.001), and in the words they used for different wound phases (c2 P < 0.001). The study supports the view that there are some words used in common by different respondents in specific wound phases. However, a previous study raised questions about what people actually mean when they use a particular word (Maylor, 2003).
End-of-life care in end-stage renal disease: renal and palliative care
Authors: Murtagh FEM , Murphy E , Shepherd KA , Donohoe P , Edmonds PM
Published: May 2014

The numbers of patients with end-stage renal disease are growing, with a disproportionate increase among those who are elderly, dependent and with multiple co-morbidities. More of these patients are choosing to be managed conservatively, without dialysis. Palliative provision for these patients within UK renal services is limited, but the recent National Service Framework for Renal Services (Department of Health, 2005) has promoted service development. However, few models of service provision have been described. This article describes a retrospective review of a new service for conservatively-managed patients with end-stage renal disease. The range and complexity of the health needs of this population is demonstrated, and an example of service development described. A model of the stages of the conservative pathway and appropriate interventions was developed. The absence of research evidence prevented development of formal audit standards, and highlighted the urgent need for evaluation of models of care.
Are nurses concerned over legalizing euthanasia?
Authors: Castledine George
Published: May 2014

The recent debate about euthanasia in the House of Lords appeared to stir up medical opinion against the move towards legalizing it. The Bill, proposed by human rights lawyer Lord Joffe, would have enabled adults who are suffering ‘unbearably’ as a result of a terminal illness, and who are of sound mind, to die at their own request. In practice, this would have meant that nurses would witness doctors either prescribing lethal drugs or being asked to administer such drugs to patients. Now what do you think of that scenario?
Equipping nurses to support genuine patient choice
Authors: Streetly Alison
Published: May 2014

Choice is the new watchword in health care. But what does this really mean? Without adequate information and the right support from frontline health professionals, people struggle to understand their options. Primary and secondary care settings provide valuable opportunities to inform people about health needs, and nurses have an important role to play. The challenge, however, is to ensure that clinical services are geared up to deliver genuine choice and that health professionals are themselves informed enough to help patients assess what is right for them.
Fluorescence diagnosis of bladder cancer
Authors: Chatterton K , Ray E , O'Brien TS
Published: May 2014

Standard management of newly presenting superficial bladder tumours is to remove the tumour endoscopically and to administer a single dose of a chemotherapeutic agent into the bladder postoperatively. However, between 20–40% of patients will develop a tumour in the bladder again within 12months (Herr, 1997). There is controversy about whether these tumours are genuine recurrences or previously undetected tumours. Photodynamic diagnosis is currently the subject of clinical trials for detection and surveillance of bladder cancer. A solution is administered into the bladder preoperatively which is absorbed by the cancer cells. These areas within the bladder then fluoresce under blue light, aiding the surgeon to detect tumours that may not have been visible to the naked eye. The authors present a review of this developing technique and their early experiences of photodynamic diagnosis in clinical trials which appear to be clinically relevant in decreasing recurrent bladder tumours.
Symptoms and treatments of polycystic ovary syndrome
Authors: Banning Maggi
Published: May 2014

Up to 10% of women may suffer from polycystic ovary syndrome (PCOS). The clinical symptoms may vary, so the biochemical profile and ultrasonography are used to predict an accurate diagnosis. Many studies have indicated that a relationship may exist between hyperinsulineamia and hyperandrogenism but the exact pathogenesis remains obscure. PCOS is treated by a combination of surgery or pharmacological management. Treatment is not always successful therefore women in these cases require support and care from nursing staff to help overcome the disappointment of treatment failure. To support women with PCOS, nurses need to be knowledgeable about the condition and its clinical manifestations and available treatment options. This article aims to examine the current aetiology, clinical manifestations, pathophysiology, diagnosis and treatment options available to women with a diagnosis of PCOS.
Recognizing depression after a coronary artery bypass graft
Authors: Martin Fiona
Published: May 2014

The purpose of this paper is to review the literature on the impact of depression on rehabilitation following coronary artery bypass graft. It describes how depression, which is often unrecognized, is one of the major factors to influence the outcome of cardiac rehabilitation programmes. The review will highlight that depression is a more important determinant of the successful outcome of a cardiac rehabilitation programme than many of the cardiac function indicators. It also describes the implications for clinical practice and presents a framework for the assessment of depression which can be used by all staff.
HCAIs can be minimized through effective teamwork
Authors: Schramm Mary , Hannan Christine
Published: May 2014

Healthcare-acquired infections (HCAIs) are contracted frequently and hospital staff, in particular nurses and cleaners, must go to the root of the problem to deal with it effectively and ensure that preventative action is taken. Employees must work together, as well as individually, to ensure that a high standard of cleanliness is achieved and maintained. This standard will only be preserved if a multidisciplinary approach is adopted.
Professional expectations outside the work setting
Authors: Castledine George
Published: May 2014

Some nurses find it a dilemma as to what to do when faced with an emergency situation outside their work environment. Others just ignore what is going on and turn a blind eye when ever a situation arises. Their excuses range from, ‘I am off duty’ to ‘I don’t have the expertise' or ‘Someone may try and sue me’. The following cases illustrate how nurses have acted when faced with such a challenge.
Medicines for hypertension: changes to the UK NICE guidelines
Authors: Ransome Sarah , Gower Jan
Published: May 2014

New NICE guidance on the use of medicines for hypertension, published in June 2006, will prompt a major review of treatment for those already receiving medication and also sets out a new treatment pathway for the newly diagnosed. The major change in the guidelines is in the status of beta blockers, which are no longer to be used as a routine treatment for hypertension. The guidelines provide a consensus on treatment, and nurses and their patients now have a clear and straightforward algorithm to follow. It is envisaged that these changes to the way medicines are prescribed for hypertension will have a significant impact on the number of people reaching their target blood pressure, and therefore the number of cardiovascular events occurring each year.
How prepared are nurses for terrorist attacks?
Authors: Castledine George
Published: May 2014

Following the increased threat of terror attacks in the UK, concern has been raised about how adequately the NHS could cope with such major disasters. A recent survey carried out by a team from Wycombe Hospital, tried to find out how prepared hospitals and their key emergency teams were if faced with a major incident. The doctors questioned were anaesthetists, emergency care doctors, general surgeons, trauma doctors and orthopaedic specialists at large hospitals in major cities around the UK.
IV therapy: nurses must be competent to perform new duties
Authors: Dimond Bridgit
Published: May 2014

This article considers the professional duty of the nurse to keep up to date and the extent, if any, to which she could refuse to take on expanded role activities, which in the past have normally been undertaken by other health professionals. It also considers the implications of the role of the new healthcare post of registered medical care practitioner.
Accelerating workforce redesign: threat or stimulus
Authors: Castledine George
Published: May 2014

There are many changes going on in the NHS at the moment with some alarming tales of nurses losing their jobs. As one senior non-NHS colleague remarked to me after some dramatic sackings and appointments, ‘Doesn’t the NHS like to eat its young!'
The function of stem cells and their future roles in healthcare
Authors: Cedar SH
Published: May 2014

Adult stem cells from bone marrow have been used in the treatment of cancer for many years. Recently, however, interest has developed in the isolation and growth of adult, cord and embryonic stem cells for use in regenerative medicine. Their therapeutic use will undoubtedly be implemented in nursing practice in a variety of clinical areas. This article is a brief introduction to stem cells and addresses the biology of these cells and their potential clinical applications, looking at three possible diseases as examples: myocardial infarction, type 1 diabetes and osteoarthritis.
Evaluation of Biatain Soft-Hold foam dressing
Authors: Vogensen Hanne
Published: May 2014

Foam dressing products were introduced in the 1970s and quickly became accepted in clinical practice due to a wide range of benefits. Today, various foam dressings are available on the market. They can appear rather similar, but may well have different performance characteristics. A well-established product is Biatain foam dressing, which was introduced in 1998 and quickly became popular due to its superior exudate management properties. The aim of this article is to describe a recent innovation in the Biatain dressing range, Biatain Soft-Hold (Coloplast A/S), and summarize some of the evidence that supports it. The new product feature consists of a soft and skin-friendly adherent layer covering less than 50% of the foam surface, thus providing a third hand in application and atraumatic removal while maintaining superior exudate management.
Developing a perspective on restraint and the least intrusive intervention
Authors: Paterson Brodie
Published: May 2014

This article explores contemporary practice in the use of restraint in the light of recent European Council Guidance endorsing the principles of least restrictive environment/least intrusive intervention. Violence is a source of concern in many European mental health services but approaches to its immediate management continue to display remarkable diversity reflecting the adoption of differing perspectives on what constitutes ‘least intrusiveness’. This article examines the basis for practice in terms of the range of procedures available, reviews the literature on restraint safety and presents a model based on the concept of reasonableness which can be used to evaluate whether a given intervention meets the European guidance. Current practice across Europe is largely a function of tradition and local values rather then evidence based. Collaborative large-scale studies are required to determine the relative risks of the range of interventions in use such that practice is informed by evidence rather than opinion.
Knowlege of cervical cancer and the HPV vaccine
Authors: Paniagua Hilary
Published: May 2014

Cervical cancer is responsible for approximately 1100 deaths a year in the UK (Cancer Research UK, 2005) and about 3000 women are diagnosed with cervical cancer in the UK each year (CancerBacup, 2005). A vaccine against the Human papillomavirus (HPV), which is linked to its cause, could offer a way forward in any attempts to combat this potentially fatal disease.
Nurse whose inexperience and negligence in bladder washout put her patient at risk
Authors: Castledine George
Published: May 2014

The following case focuses on the procedure of bladder washout. It is usually a registered nurse's responsibility which is carried out after further training, supervision and evaluation of the individual's competence.
Constipation in older patients: effects on quality of life
Authors: Norton Christine
Published: May 2014

Constipation, often related to diet, physical immobility, concurrent illness or multiple medication use, is common in older people. Despite potential for serious complications, constipation may often be overlooked. Management of constipation is a critical part of the care of older patients with chronic conditions. Risk assessment and appropriate nursing interventions and/or medication should mean that constipation can be minimized, preventing additional medication burden and reducing the risk of non-adherence. The relationship between quality of life and constipation has been assessed in numerous studies, showing that patients with constipation generally have an impaired quality of life compared with the general population, although studies in older patients are limited. In long-term survivors of colorectal or anal carcinoma, constipation is one of the factors that has the most negative impact on quality of life. Strategies for prevention and minimization of constipation have the potential to substantially improve quality of life for older people.
Breast-feeding initiation among post-caesarean women of the Negev, Israel
Authors: Chertok Ilana R
Published: May 2014

The objectives of the study were to increase post-caesarean breast-feeding rates and decrease timing of post-caesarean breast-feeding initiation in multicultural populations following a post-caesarean breast-feeding intervention. The study was a prospective population-based evaluation of a breast-feeding intervention for post-caesarean women of different cultures at a southern Israeli hospital. The study population consisted of 570 Jewish and Muslim post-caesarean women who had delivered healthy, term infants. The control group (n=264) received standard hospital care and the intervention group (n=306) received early, culturally sensitive, post-caesarean breast-feeding guidance and education by trained professionals. Timing of post-caesarean maternal–infant contact and breast-feeding initiation outcomes for the Jewish and Muslim women significantly improved following the intervention.
Parastomal hernia: an exploration of the risk factors and the implications
Authors: McGrath Anthony , Porrett Theresa , Heyman Bob
Published: May 2014

Risk may be defined as ‘the chance that something may happen to cause loss or an adverse effect’ (Concise Oxford Medical Dictionary, 2003). Patients undergoing stoma formation are at risk of developing a wide range of complications following surgery. A parastomal hernia is an adverse effect that can contribute to postoperative morbidity. The risk of developing a parastomal hernia is dependent upon a number of variables, and stoma care nurses need to be aware of these to plan the appropriate care for patients undergoing stoma formation. This article discusses the issues surrounding the development of parastomal hernias and also looks at ways in which the risk factors associated with the development of a parastomal hernia may be minimized.
Full nursing assessment of patients at risk of diabetic foot ulcers
Authors: Fletcher Jacqui
Published: May 2014

A common complication of diabetes is the occurrence of foot ulcers. Good foot care can, in many instances, prevent ulcers or increase the potential to heal in those patients who do ulcerate. All healthcare professionals working with patients with diabetes should reinforce the importance of caring for the feet each time they see the patient. A focus on foot care reiterates to the patient the importance of self care and prevention of ulceration. Examination of the feet and timely referral to appropriate specialist teams are of particular importance.
Has packing sinus wounds become a ritualistic practice?
Authors: Kerr Andy , Young Steve , Hampton Sylvie
Published: May 2014

Wound healing is both a science and an art, and modern advances in wound management are ensuring that advanced clinicians use both clinical knowledge and experience when deciding on wound dressings and therapies. When there is a lack of evidence, then selection of dressings or therapies becomes extremely difficult and inappropriate treatment can occur. This is generally the situation with sinus wounds. There is very little evidence available to help decide on suitable dressings for these intractable wounds. The use of high frequency ultrasound (HFU) can help to guide practice on whether or not to pack sinus wounds. This article will explore the potential of ultrasound use by describing a case study of a patient with a sinus wound where HFU was used to examine the sinus and inform the practitioners on the appropriate choice of wound dressing.
Pathway for patients admitted with gastroenteritis to a military hospital
Authors: McFadden-Newman Kerry , Fenby Tony , Myers Lieutenant Jenny
Published: May 2014

As part of the Clinical Effectiveness Programme, a care pathway was developed for use within the isolation facility in a military hospital in Iraq. The development of the care pathway was necessary to provide direction and to standardize the care provided. A care pathway using a structured and planned approach was developed, critically appraised and amended to ensure evidence-based and patient-focused care. This article provides an amended methodology for the development of further pathways suitable for use within military nursing based on the standard pathway produced by De Lue (2002). The production of the pathway and supporting guideline will ensure standardized care for patients admitted with gastroenteritis