bluuebunny/crossref_metadata_2025 huggingface dataset:
Part 2: Nurses’ guide to the impact of alcohol on health and wellbeing
Authors: Harrington-Dobinson Anne , Blows William
Published: May 2014

In this the second part of this series, the authors map the impact of alcohol on human health and social wellbeing. While historically nurses have thought of these matters as being distinct, they interact regularly and challenge health professionals in accident and emergency departments, the community and the mental health services. This article discusses how nurses can begin to determine when alcohol consumption has become ‘too much’ – threatening not only personal health but the wellbeing of others. The article then examines physical problems that follow alcohol abuse (e.g. brain and liver damage) as well as those associated with social dysfunction (e.g. accidents, aggression and violence).
Osteoporosis: not only in women, but in men too
Authors: Gardiner Annie , Miedany Yasser El , Toth Mathias
Published: May 2014

Osteoporosis is a chronic disease where the nurse specialist can make a significant impact. The osteoporosis nurse specialist has an important role, not only in the prevention and management of osteoporosis but also in the promotion of skeletal health across the public health and social care arenas and in the continuing development of services across primary and secondary care. The scale of the problem in women and the potential role of hormone replacement therapy in the prevention and treatment of osteoporosis has played down the problem of osteoporosis and osteoporotic fractures in men, thus facilitating a negligent attitude. This article summarizes the outcome of a dedicated male osteoporosis clinic, which was started by the lead clinicians in metabolic bone disease and falls and subsequently was run by the osteoporosis nurse specialist. A clinic proforma which can be used as a standard in clinical practice is presented. In addition, an algorithm for the management of men with osteoporosis is discussed.
Step-by-step guide to critiquing research. Part 2: qualitative research
Authors: Ryan Frances , Coughlan Michael , Cronin Patricia
Published: May 2014

As with a quantitative study, critical analysis of a qualitative study involves an in-depth review of how each step of the research was undertaken. Qualitative and quantitative studies are, however, fundamentally different approaches to research and therefore need to be considered differently with regard to critiquing. The different philosophical underpinnings of the various qualitative research methods generate discrete ways of reasoning and distinct terminology; however, there are also many similarities within these methods. Because of this and its subjective nature, qualitative research it is often regarded as more difficult to critique. Nevertheless, an evidenced-based profession such as nursing cannot accept research at face value, and nurses need to be able to determine the strengths and limitations of qualitative as well as quantitative research studies when reviewing the available literature on a topic.
Problems experienced by haemodialysis patients in Greece
Authors: Kaba Evridiki , Bellou Panagiota , Iordanou Panagiota , Andrea Stavroula , Kyritsi Eleni , Gerogianni Georgia , Zetta Stella , Swigart Valerie
Published: May 2014

Even though Greece has a disproportionate number of haemodialysis stations for the treatment of end-stage renal disease (ESRD), and a rapidly raising number of patients on dialysis, there has been no study of the lived experience of haemodialysis treatment in Greece. ESRD and dialysis drastically impact patients’ everyday life, therefore expectations and desires play a major role in adapting to alterations and restrictions. An understanding of these culturally-influenced expectations and desires is essential for the delivery of holistic nursing care. This study aimed to explore how Greek patients receiving longterm haemodialysis perceived their problems and to describe the impact of haemodialysis on their lives. Using a grounded theory approach, 23 patients with ESRD receiving haemodialysis were purposively recruited from two hospital dialysis centres in Athens, Greece. Data were collected during 2006 by personal interviews. Given a distinctive patient experience of haemodialysis, some insight into their common concerns can facilitate provision of healthcare services that adequately meets their needs. By developing an understanding of the experience of renal illness and therapy for a group of people using dialysis, this study was intended as a contribution towards enabling healthcare professionals to provide more effective support to people who are living with this chronic condition.
Blaming the victim
Authors: Castledine George
Published: May 2014

Over the past few months there has been a lot of publicity given to victims of various tragedies and incidents, for example, there have been the victims of the summer floods, the disappearance of Madeleine McCann and the parents of Rhys Jones. The majority of the support and public interest shown has been very positive and helpful towards these victims. This is probably because of the nature of the events which led up to the incidents and because it was not really the victims fault for what happened. They just happened to be caught up in a chain of events that happened outside of their control.
Making a difference with telehealth service
Authors: Holt Fatima
Published: May 2014

Chronic obstructive pulmonary disease (COPD) kills 30 000 people every year (National Statistics, 2006) in England and Wales alone, making it the fifth biggest killer (British Thoracic Society, 2006). Moreover, it is the only major cause of death whose incidence is on the increase – 95% of all COPD cases are linked to smoking and given our ageing UK population, the mortality rate is set to rise (British Thoracic Society, 2006).
Erasing the word ‘lift’ from nurses’ vocabulary when handling patients
Authors: Franklin Barnes Abbie
Published: May 2014

The incidence of back injuries is catastrophic to the nursing profession. It is paramount that individual practitioners attempt to significantly reduce the number of back injuries in nursing teams. Erasing the word ‘lift’ from nurses’ vocabulary when handling patients can empower patients and promote good safe practice. This article offers a literature-based discussion of patient handling in relation to safety for both patients and nurses. Nurses’ handling practice is governed by legislation and NHS Trust policies. This article suggests ways of developing safe practice that is empowering for both nurses and patients, advocating team working and safeguarding the interests of the patient and handler.
Ostomy bag management: comparative study of a new one-piece closed bag
Authors: Voergaard Lise Lotte , Vendelbo Grethe , Carlsen Bente , Jacobsen Lotte , Nissen Birthe , Mortensen Jannie , Hansen Grethe , Bach Kirsten , Bæch Sussi Boberg
Published: May 2014

The aim of this study was to compare the performance of a new one-piece closed ostomy bag, SenSura, to an already established bag with a focus on minimizing problems related to use of stoma bags for individuals with a colostomy. There were 68 Danish participants with a colostomy who tested each bag for 1 week in a randomized, open, comparative, crossover study. The SenSura bag was perceived more secure than the reference bag (p=0.0006). Crucial performance and safety parameters were rated significantly better for SenSura than for the reference bag. The high preference for SenSura (85%) reflected these results (p<0.0001). Individuals with a colostomy can expect a higher sense of security with the SenSura bag than with the reference bag. This may relate to good adhesion, tack, flexibility and effective filter performance. Future studies should examine the long-term effects of SenSura on peristomal skin conditions. To our knowledge, this is the first published comparative study of one-piece closed ostomy bags
Requirements of the ‘would be’ nurse
Authors: Karstadt Lyn
Published: May 2014

Nursing and midwifery education has evolved over the past few decades, making many in the profession — as well as education — slightly confused as to what is going on. In this fifth column, Lyn Karstadt discusses the admission and selection of student nurses and the changing NMC criteria.
Section 5(4) of the Mental Health Act 1983: the art of applying the Act
Authors: Dickinson Tommy
Published: May 2014

Section 5(4) of the Mental Health Act 1983 allows patients to be detained by nurses of the ‘prescribed class’ for a maximum of 6 hours. There is a paucity of research on the subject of Section 5(4); however, the little research that has been conducted has shown that there are gaps in the knowledge of registered nurses and nursing students due to be registered with regard to the following areas of Section 5(4): duration of the holding power; whether the client can be treated against their will; eligibility for detention; and criteria for implementation. This article will seek to clarify these gaps and provide nurses with a comprehensive systematic guide to follow should they have to invoke the section.
High expressed emotion: precipitating relapse in substance misuse disorders
Authors: Watts Malcolm
Published: May 2014

There is a considerable body of evidence on the effect of high expressed emotion on individuals suffering severe mental illnesses; there is also considerable work on those people suffering the dual diagnosis of severe mental illness and substance use disorders. However, in the latter, the majority of studies appear to concentrate on the mental illness aspect of the condition. Literature searches identified that there were few scholarly articles on how expressed emotion affects relapse in those people with a substance use disorder, and yet there is a great deal of evidence regarding the disruption substance use can have on a family and on the individual. This article intends to provide an evaluation on the reasons why high expressed emotion should be addressed in substance use disorder and suggests that, if the benefits of reducing high expressed emotion in these disorders are as significant as in severe mental illness, then there is a sound basis for the increased use of family interventions in substance use disorders.
The use of antiembolic stockings. Part 1: a literature review
Authors: Walker Linda , Lamont Sue
Published: May 2014

Aim: To determine, through literature review, the current best practice for selecting and using graduated elastic compression stockings (GECS). In particular, literature was sought to clarify which patients should be given GECS, and whether there were any underlying research recommendations as to which length of stocking should be worn. Background: A procurement exercise identified that the clinical areas within the Surgical Services Directorate at each of the three hospital sites were spending significantly different amounts of money on the purchase of GECS and purchasing significantly different numbers per ward. Further analysis revealed that different hospital sites had different preferences for either knee-length or thigh-length stockings. Nurses and medical staff gave conflicting ideas for the correct use and type of stockings, which prompted the authors to access the literature to establish best guidelines.

Methods: A literature review was used to develop best practice guidelines for the use of GECS.

Results: There is good evidence from the literature demonstrating that the use of GECS in patients undergoing surgery can be effective in the prevention of deep vein thrombosis, used in conjunction with drug therapy, other prophylactic methods, or alone.

Conclusions: There is strong evidence for the use of knee-length stockings instead of thigh-length stockings. It is critically important that patients are thoroughly assessed prior to the application of GECS.
Are British hospitals losing their appeal?
Authors: Castledine George
Published: May 2014

I love hospitals; my whole life has been, in some way, associated with them. When I was a child I used to play in the hospital grounds while I waited for my mother to finish her work as nurse. She soon got fed up with me and eventually decided that the best way to occupy my time was for me to visit some of the wards and talk to the patients. It was not until many years later that I realized that it was probably this introduction to hospital life that got me hooked on nursing and hospitals.
Multiple sclerosis nursing - what makes it so special?
Authors: Gutteridge Victoria
Published: May 2014

Multiple sclerosis (MS) is a long-established condition of unknown aetiology, with the elusive holy grail of cause and cure still not on the immediate horizon. It is a condition of younger people, often diagnosed at the cusp of their professional and personal lives, bringing uncertain prognosis, potential lifetime disability and limited treatment options. MS specialist nurses are unique in their work across the wellness–illness continuum. People with MS (PwMS) may have periods of being well, and then experience sudden and extremely disabling attacks. Or they may not, experiencing relatively mild episodes at long intervals. Some will become very disabled very quickly, with no remission in the relentless progression of disability, some will have a long period of instability followed by a plateau of disability. Many will have consequences that are difficult to define in medical terminology, but are debilitating, disabling and socially isolating.
Transition from paediatric to adult service in epidermolysis bullosa
Authors: Foster Lesley , Holmes Yvette
Published: May 2014

Children with chronic health needs are living longer than they have in the past (Department of Health, 2006) and are becoming adults with complex health needs. This has implications for the health service, which needs to address the arrangements for transfer of young adults from paediatric to adult centres. This article describes the transitional care arrangements established at Great Ormond Street Hospital to address the needs of children with severe epidermolysis bullosa as they move on to adult care. It emphasises the close liaison between paediatric and adult clinical nurse specialists, and recognizes the role of the wider family who also have long-standing links with staff in the paediatric environment and can find transfer to an adult unit traumatic. The article concludes by recognizing that the young adult and specialist teams need to work together to continue to improve the transition process for future generations.
Helping the ‘hidden poor’ when the poor are helpers
Authors: Cuthbertson Cathy
Published: May 2014

We all have our money worries from time to time. Nurses, as much as anyone, learn to live with that as simply going with the territory. But that doesn’t mean to say that we ever expect to face real hardship.
The usability and acceptability of a needleless connector system
Authors: Casey Anna , Elliott Tom
Published: May 2014

Needleless connectors were introduced into clinical practice to reduce the rate of needlestick injuries to healthcare workers (HCWs). There have, however, been limited reports of user acceptability of these devices. The usability and acceptability of the Clearlink® needleless connector (Baxter Healthcare, UK) was therefore completed by HCWs at University Hospital Birmingham NHS Foundation Trust following a 12-month clinical evaluation. Seventy per cent (28/40) of HCWs reported that they would prefer to use Clearlink® needleless connectors rather than conventional luers caps, 15% (6/40) would use either, and only 15% (6/40) preferred to use luer caps. In total, 85% of HCWs reported that Clearlink® was acceptable to use in the clinical situation. The results demonstrate that comprehensive training and technical support both before and after new device implementation were essential to ensure a smooth transition.
Cognitive behavioural therapy group work with voice hearers. Part 2
Authors: McLeod Terry , Morris Mervyn , Birchwood Max , Dovey Alan
Published: May 2014

This is the second of two papers that present a small, randomized control trial of cognitive behavioural therapy (CBT) within a group setting for the treatment of auditory hallucinations. In the previous paper, a method was described for an eight-session CBT group. Assessments were undertaken measuring control, power, frequency, and symptoms of distress and anxiety on commencement and on completion of the group. This second paper details the experience of the group and reports on the outcomes of the assessment measures. The study concludes that group CBT was helpful in the treatment of auditory hallucinations.
Role of the nurse in managing patients with hepatic cerebral oedema
Authors: McGuinness Anna
Published: May 2014

Acute liver failure occurs abruptly often without pre-existing liver disease being present. Management comprises support of the patient and treatment of symptoms until recovery or transplantation can occur. Cerebral oedema is one of the recognized complications of acute liver failure with a mortality rate of 30-50% when it occurs. Effective supportive nursing management includes use of sedative agents, positioning and thermoregulation if the patient is to recover or be optimized for transplantation.
Clinical skills: bowel elimination and management of complications
Authors: Pellatt Glynis Collis
Published: May 2014

Bowel elimination is a basic bodily function that most people carry out in private and are often embarrassed to discuss publicly. Nurses will encounter patients with bowel elimination issues in all areas of care. Knowledge and understanding of both normal function and the problems that can occur with that process will enable nurses to support and care for patients with bowel elimination problems. This article discusses the normal anatomy and physiology of elimination, problems, such as faecal incontinence, diarrhoea and constipation, and the nurse’s role in their management. The importance of empathy, understanding, knowledge and consent is highlighted.
Racism in nursing education: a reflective journey
Authors: Markey Kathleen , Tilki Mary
Published: May 2014

This article discusses the personal and professional journey of discovery experienced by a nurse lecturer as a result of engagement in a project exploring the impact of racism in the nursing classroom. The findings of the study demonstrated the existence and complexity of racism, the impact of racism on student learning, the limitations of lecturers in recognizing and addressing racism and organizational factors which perpetuate institutional racism. The authors describe the insight gained from the research process and how this has influenced the practice of the first author and how reflection and mentorship by the second author have challenged personal ethnocentricity, encouraged new ways of thinking, enhanced confidence and encouraged experiential teaching strategies. The article highlights the ways in which nurse lecturers might become culturally competent and in particular addressing issues of racism in the classroom and enabling learning which is applicable in practice.
Caring for people with dementia in the acute setting: a study of nurses’ views
Authors: Nolan Louise
Published: May 2014

Caring for people with dementia in an acute hospital setting presents a number of challenges. This article reports the findings of a study which explored nurses’ experiences of caring for older people with dementia in a unit caring for older people within an acute hospital. The study used a thematic approach to produce an interpretation of the care experience and a purposive sample of seven nurses was interviewed regarding the research aims. The findings revealed the structural inadequacies of the acute hospital as a dementia care environment and the resultant challenges and complexities of the care experience. Despite the identified challenges, nurses considered the specific needs of people with dementia and the environmental effects of the acute setting on their ability to meet identified needs.
Collaborative working to improve leg ulcer outcomes for injecting drug users
Authors: wheatley Carolyn
Published: May 2014

This case study features a 37-year-old drug user with a chronic leg ulcer caused by injecting Heroin into his leg veins. The case study demonstrates collaborative working between two specialist services based in Leicester. This joint working and knowledge sharing has allowed for appropriate leg ulcer management in this erratic and vulnerable group of mainly young people. Many factors need to be taken into account when prescribing a dressing regimen for this group, and the successes and complications encountered are described.
Progress, opportunity and unintended consequences
Authors: Morris Mervyn
Published: May 2014

We are living in a time of seismic events! The earthquake in Kent was, thankfully, one of little consequence. Nature’s bigger event is global warming, the underlying cause of our current fine weather. It is a fine example of how progress can have unintended consequences.
The management of lipohypertrophy in diabetes care
Authors: Hambridge Kevin
Published: May 2014

Lipohypertrophy has been a recognized complication of insulin therapy for many years, yet research shows that its prevalence in insulin-injecting patients with diabetes remains high. The problem for the patient is that the injection of insulin into a site of lipohypertrophy, although painless, may lead to erratic absorption of the insulin, with the potential for poor glycaemic control and unpredictable hypoglycaemia. Despite the important implications of this for diabetes control in insulin-injecting patients, there is a dearth of information and completed research into the condition. This article raises awareness of lipohypertrophy by reviewing the available literature on the prevention, identification and management of the condition from a nursing perspective. Recommendations for medical and nursing practice in diabetes care to improve prevention and management of lipohypertrophy are made.
Developing disaster management modules: a collaborative approach
Authors: Douglas Valerie
Published: May 2014

Disasters, whether natural or human induced, can strike when least expected. The events of 9/11 in the US, the 7/7 bombings in the UK, and the anthrax incident in the US on 10th October 2001 indicate that there is a need to have a nursing workforce who is able to respond effectively to mass casualty events and incidents involving chemical, biological, radiological and nuclear substances. Multi-agency collaboration is one of the fundamental principles of disaster preparedness and response. It was therefore necessary to take a similar multi-agency collaborative approach to develop modules on the management of mass casualty events and incidents involving hazardous substances. The modules are offered to registered nurses and registered paramedics. They can be taken independently or as part of a BSc in nursing or health pathway, on a part-time basis. Since the commencement of the modules in September 2004, registered paramedics and registered nurses who work in a wide range of specialties have accessed them.
Consent and capacity: other aspects of the mental capacity act
Authors: Fullbrook Suzanne , Sanders Karen
Published: May 2014

This article concentrates on elements of the Mental Capacity Act that may be glossed over when people are concentrating on the issue of living wills (advanced directives). New powers have been introduced under the Act and these do have the power to alter people’s lives. A ‘lasting power of attorney’, for example, now has the power to take decisions relating to a person’s health issues or welfare.There is a new court – the Court of Protection, designed to settle disputes about the validity or applicability of a living will. With the powers of a High Court, the Act reveals the seriousness with which the law now regards the issues that surround the making of a living will and the granting or refusal to grant consent to treatment and care.
Use of sterile maggots in an unusual trauma injury
Authors: James Carol
Published: May 2014

Sterile larvae of the common green bottle, Lucilia sericata, have been shown to be a highly cost-effective alternative to conventional treatments for the debridement and cleansing of all types of chronic wounds (Thomas, 2006). One or two treatment cycles each lasting approximately 3 days are often sufficient to achieve complete debridement of such wounds, provided sufficient numbers of maggots are applied on each application. Maggots are less commonly used in traumatic injuries, although in these wounds their remarkable wound cleansing properties could be of considerable value.
Time in the professional gym
Authors: Castledine George
Published: May 2014

This New Year celebrates 60 years of the formation of the NHS. Over this period much has changed and in particular the patient has become more involved than ever before in their own treatment and care. Long queues were a feature of the past in GP’s waiting rooms and hospital outpatient departments. Aspidistra evergreen plants were everywhere, there was a smell of antiseptics, and the body odour of the sick and malnourished. It was just after the war and there was a feeling of exhaustion, sadness and a little guilt around. People were tired, and although the NHS came in with the promise of health for all and equal free treatment, there was still much superstition about how this would be achieved. Perhaps this uncertainty and suspiciousness about the new health system led many patients to become subservient and in awe of doctors and nurses. There was certainly an attitude of ‘doctor or nurse knows best’, and this resulted in many doctors becoming paternalistic in the way they treated their patients
The student-supervisor relationship in the phD/Doctoral process
Authors: Gill Paul , Burnard Philip
Published: May 2014

Many nurses in the United Kingdom are now undertaking PhDs; however, the process is both complex and time consuming. Research has shown that effective supervision can significantly influence the quality of the PhD and its eventual success or failure. Consequently, many common problems experienced during a PhD often relate to difficulties in the supervisory process. PhD students and supervisors often have different expectations, needs and ways of thinking and working. The purpose of this paper is, therefore, to provide an overview of the key elements of research supervision. The paper is aimed at students, prospective students and supervisors involved in the PhD process and explores the perspectives of a student and a supervisor and discusses what each can and should reasonably expect from supervision, how to identify and address potential supervisory problems and how to maintain an effective working relationship.
Younger people with dementia: time for fair play
Authors: Roach Pamela , Keady John
Published: May 2014

The recent diagnosis of Terry Pratchett with Alzheimer’s disease has once again thrown the spotlight on the fate and lives of younger people with dementia living in the United Kingdom (UK). Far too often the needs and experiences of younger people with dementia, i.e. those aged under the age of 65 years, are overlooked even though the group total around 15 000 people in the UK (Alzheimer’s Society, 2007), and are in need of specialist service provision, as recommended by current National Institute for Health and Clinical Excellence guidelines, Dementia: Supporting People With Dementia and Their Carers in Health and Social Care(NICE, 2006). This specialist service provision is all the more pressing as younger people with dementia are likely to be living through discrete and enduring mid-life challenges, such as mortgage repayments, meeting children’s university and accommodation fees, caring for parents and career pressures; such pressures ripple through the entire family unit and disruption is felt by all.
Effectiveness of home detoxification: a clinical audit
Authors: Callow Trasi , Donaldson Stephen , Ruiter Marian de
Published: May 2014

Aim: An audit of home detoxifications undertaken during a 2-year period in a community drug and alcohol service was performed to explore the impact of suitability criteria on the successful completion of the intervention, and to inform future practice. Method: A retrospective analysis of home detoxifications was undertaken in a community setting using a designed audit tool. Results: Of the 154 referrals for home detoxification, 59 commenced detoxification and 95 did not. The absence of a suitable carer and a pre-existing medical-psychiatric condition were the main reasons for home detoxification being deemed an unsuitable intervention. Of those who commenced detoxification, 96.6% completed the programme. Conclusion: Clear and rigorous screening by an experienced professional before home detoxification is commenced is important to ensure positive treatment outcomes; however, more can be done to improve the service offered and ensure appropriate referrals.
Sleep disruption experienced by surgical patients in an acute hospital
Authors: Lane Tamsin , Anne East Linda
Published: May 2014

Background: Sleep has a common structure and pattern and is thought to be a restorative process. Sleep deprivation and disruption can cause a myriad of physical and psychological changes, which can all have an impact on health care. As such, sleep is recognized as being beneficial to health and an important aspect of nursing care. Method: This study used an expansion component mixed-method design to describe the sleep experience of patients on surgical wards. This involved establishing the factors which disturb sleep and describing patients’ experiences of sleep disruption. Results: 17 of the 24 patients approached participated in the study, providing a 71% response rate. Environmental factors were found to be strongly correlated with sleep disruption with a Pearson’s coefficient of +0.795. Personal factors were also found to be correlated with sleep disruption although, with a Pearson’s coefficient of +0.590, not as strongly as environmental factors. Discussion: This study found that environmental noise, pain and tension were most likely to disrupt the sleep of surgical patients. It has also established four recommendations to improve the sleep of hospital patients. Limitations: This study has some limitations that need to be considered: limited database access, a small sample size and a data collection tool which had not previously been tested for validity or reliability. Conclusion: This study produced some compelling findings. It is recommended, however, that these findings be tested by larger studies using simple random sampling and in-depth interviews.
Skin integrity and silicone: Appeel® ‘no-sting’ medical adhesive remover
Authors: Stephen-Haynes Jackie
Published: May 2014

This article offers an overview of skin and the importance of maintaining intact skin in relation to wound and stoma care. Various patients and their conditions are considered in relation to their potential for skin damage with the removal of adhesive products, including paediatrics, those with epidermolysis bullosa, haemangioma, fragile skin, elderly skin and ostomates. The importance of protecting fragile skin and protecting the peri-wound and peri-stoma area is discussed and the impact of such damage on quality of life is considered. The evidence relating to the impact that silicone-based adhesive removers can have is reviewed with a conclusion that an evidence-based approach can significantly affect patient outcomes.
The lived experience and meaning of stress in acute mental health nurses
Authors: Currid Thomas Joseph
Published: May 2014

Background: While studies into stress in mental health nursing are small, studies specifically looking at acute mental health nurses are even fewer. Acute mental health nurses work in environments that are challenging and unpredictable, and care for some of the most seriously ill patients. This area, therefore, needs staff that are physically and psychologically fit for purpose. However, little is known about this cohort of nurses. Aim: In an attempt to address this imbalance, this study aims to ascertain the stressors – the lived experience and meaning – for acute qualified mental health staff. Methodology: Using a hermeneutical phenomenological tradition, eight qualified staff from a London mental health Trust were interviewed. Results: Heavy workloads and violent and aggressive behaviours were among the stressors giving rise to staff experiencing difficulties with switching off from work, poor support from management and fear of blame. These experiences culminated in feeling professionally compromised, less valued and struggling for recognition of the therapeutics of nursing interventions. Conclusion: There is an urgent need to implement stress reduction strategies in this nursing specialty.
IV therapy: recognizing the differences between infiltration and extravasation
Authors: Dougherty Lisa
Published: May 2014

Infiltration and extravasation are complications that can occur during intravenous therapy administered via either peripheral or central venous access devices. Both can result in problems with the siting of future venous access devices, nerve damage, infection and tissue necrosis. The nurse is the key to reducing the risk of infiltration and extravasation, through her knowledge and skill in cannulation and the intravenous administration of drugs (by bolus injection or infusion). The nurse must also be able to recognize the early signs and symptoms of infiltration and extravasation and act promptly and effectively to limit tissue damage. The first sign of possible leakage of drugs into the tissues is pain and discomfort, so patients must be informed of what symptoms to look out for and be asked to report any change in sensation as soon as they are aware of it. Finally, accurate documentation of the event is vital to facilitate patient care and in case of litigation.
Guidance for the assessment of pain in older adults: a literature review
Authors: Schofield Patricia , O’Mahony Sinead , Collett Beverly , Potter Jonathan
Published: May 2014

This paper presents guidance for the assessment of pain in older adults, which was developed as a collaborative project by the British Pain Society and the British Geriatric Society. The guidance was published in November 2007 and was designed to provide health professionals with practical skills to assess pain as the first step towards its effective management. The guidance did not seek to differentiate between acute and persistent pain as the literature relating to pain in older people renders such distinction impractical. The next stage will involve the development of guidance for the management of pain in older adults, which will commence this year.
Are nurses being gagged or are they frightened to write?
Authors: Castledine George
Published: May 2014

Nurses have never been known for their enthusiasm to write for publication but, with the changes in the standards of educational preparation over the past few years, one would now hope to see an increase and improvement in their interest. There are many reasons to write, such as sharing ideas and expertise, disseminating research and innovations, developing one’s own knowledge and skills, increasing one’s professional profile and career prospects, and sounding off about political and professional issues, which are of particular concern and interest to colleagues.
Tackling infection: optimizing the hygiene environment
Authors: Glasper Alan
Published: May 2014

The recently published report, The Impact of Organisation and Management Factors on Infection Control in Hospitals: A Scoping Review(National Nursing Research Unit, 2008), reveals that the United Kingdom is not alone in fighting healthcare-associated infection (HCAI). Although this review confirms that there is little evidence that HCAI rates are increasing, fear and anxiety among members of the public regarding the potential to develop infection while a patient are running at an unprecedented level.
Audit of referrals for cataract extraction: are they appropriate?
Authors: Tattersall Chris , Sullivan Shona
Published: May 2014

Aim: To investigate the correlation between community cataract referral information and hospital ophthalmic opinion in order to assess if the referrals for cataract extraction are appropriate. The secondary aim is to identify if any streamlining of the service is indicated. Method: Patients referred from the community with a cataract were assessed with regard to the given referral data against the hospital ophthalmic opinion at their first outpatient assessment.

Results: Twenty-three (76.7%) patients referred with cataract were listed for a cataract extraction. The reason for not listing patients was due to lifestyle issues in 86% (n= 7) of cases. There proved to be no association (P = 0.62) between an indication of a compromised lifestyle on the referral letter and being listed for cataract surgery. Conclusion: Community cataract referral data only appears lacking in their consideration of patients’ quality of life, which needs to be clarified prior to a hospital visit – either by better communication with the community optometrists or by contact with the patient. A nurse led service receiving cataract referrals direct from the community is warranted if current practice uses multiple preoperative hospital visits.
Breast cancer. Part 2: present and future treatment modalities
Authors: Harmer Victoria
Published: May 2014

This is the second article in a series of three on breast cancer. Part 1 discussed breast anatomy, the principles behind breast awareness and breast health, detailing common benign breast diseases, types of breast cancer and staging. In this article, treatment for breast cancer is discussed. The article will follow the usual order of modalities in the trajectory, starting with surgery, then chemotherapy, radiotherapy and endocrine treatment, finishing with a discussion of future and biological treatments.
Breast cancer. Part 3: advanced cancer and psychological implications
Authors: Harmer Victoria
Published: May 2014

This is the last article in this 3-part series on breast cancer. The previous two articles have outlined the principles behind breast awareness and breast health, detailing common benign breast diseases, types of breast cancer and staging, and treatment for breast cancer, including surgery, chemotherapy, radiotherapy and endocrine treatment. The series concludes by giving information on advanced disease, including when a patient presents late with a fungating breast lesion, or if the disease has metastasized from the breast to other organs. Lymphoedema is also described and discussed, and the latter half of this article discusses psychological implications of breast cancer, from diagnosis through the individual treatments.
Knowing when it’s right to get involved
Authors: Karstadt Lyn
Published: May 2014

Nursing and midwifery education has evolved over the past few decades, leaving many in the profession — as well as education — slightly confused as to what is going on. In her ongoing column, Lyn Karstadt discusses the duty of care, legal obligations and liabilities when dealing with an emergency situation outside the normal realm of nursing care.
Mixed-sex wards and patient dignity: nurses’ and patients’ perspectives
Authors: Baillie Lesley
Published: May 2014

With the exception of specialized units, adults have historically been cared for in single-sex hospital wards in the UK. However, over the past two decades, concerns about mixed-sex wards have been reported. Respect and dignity are essential to provide high-quality health care. The issue of whether patients’ privacy and dignity are compromised by mixed-sex wards is addressed in this article. Qualitative data were obtained from both nurses and patients on a mixed-sex surgical ward specializing in urology, to obtain individual perspectives relating to factors affecting dignity on the ward. Nurses tried hard to keep bays single-sex but, due to bed shortages, they were under continual pressure to mix the bays. Some patients of both sexes and varied ages perceived that a mixed-sex care environment threatened their dignity. They experienced a lack of privacy, worried about bodily exposure and felt uncomfortable. Nurses used various strategies to reduce patients’ discomfort. Mixed sex accommodation is an unacceptable solution to bed shortages.
Stress and burnout in forensic mental health nursing: a literature review
Authors: Dickinson Tommy , Wright Karen M
Published: May 2014

Forensic mental health nurses who work with patients who have severe and enduring mental health needs have been identified as at risk of suffering from occupational stress, and even developing burnout syndrome. Therefore, this article reviews the available literature on stress and burnout in inpatient forensic mental health nursing to identify the stressors and to highlight recommendations. From the review, the main stressors placed on forensic nurses are identified as interprofessional conflicts, workload, and lack of involvement in decision-making. Recommendations to reduce stress and burnout for nurses within this specialty are highlighted. These are identified as follows: staff should have easy access to support systems including clinical supervision; managers should foster an open and honest culture to enable staff members to express their feelings openly or in confidence and learn how to deal with their frustrations; and staff should be encouraged to rotate wards to increase personal and professional development and reduce boredom and apathy. Furthermore, staff should be provided with, and encouraged to undertake, continuing professional development which may include psychosocial interventions training
Professional regulation. Part 10: professional relationships
Authors: Fullbrook Suzanne
Published: May 2014

Some years ago the Government set out their plans for the regulation of Nurses and other health professionals in The NHS Plan (Department of Health [DH], 2000) and Making a Difference (DH, 1999). This year the government produced a new series of White Papers, aimed at bringing to fruition the earlier plans and the ideology that underpinned them. This article considers two such papers – neither produced by a nurse, despite their impact on nursing work. High Quality Care for All (DH, 2008a) and A High quality Workforce (DH, 2008b) are discussed considering the power and control of health care delivery that doctors and nurses now enjoy. A conclusion is reached that whereas there is much talk of innovations in nursing ideology and clinical practice, and significant advances in nurse education and training designed to facilitate advanced and autonomous practice within the nursing profession, it is just that. The real positions of power and influence within clinical provision and practice have remained the same: held by civil servants and members of the medical profession. While nurses are represented it is at a lower level of influence and they are missing from the top table. The political level of decision making for Healthcare directly involves members of the medical profession but not nurses.
Promoting effective continence care for older people: a literature review
Authors: Dingwall Lindsay
Published: May 2014

Recent United Kingdom guidelines have identified the need for integrated continence services within health regions. While there is evidence of improvements in community services there is little evidence that the quality of nursing care offered for older people with urinary incontinence in care settings has improved. This literature review identifies some of the underpinning issues that impact on continence promotion for older people. Despite evidence that older people suffer physical, social and psychological distress as a result of mismanaged urinary incontinence, costs of promoting continence are higher in financial terms than containing incontinence. The extent of the problem is difficult to identify in terms of how many older people are affected by different types of urinary incontinence. Nurses’ attitudes are found to affect the quality of continence care delivered, and there continues to be a lack of evidence around sustainable strategies for continence promotion in care settings.
The Mental Capacity Act 2005: mental capacity and mental illness
Authors: Dimond Bridgit
Published: May 2014

In this series of articles on the Mental Capacity Act 2005 (MCA) the author now turns to the interrelation between mental capacity and mental disorder and between the Mental Health Act 1983 (MHA) (as amended by the Mental Health Act 2007 [MHA, 2007]) and the Bournewood safeguards. The article explains how the MCA and the MHA are designed to cover distinct situations: the one mental capacity; the other mental disorder and the different definitions are considered. The article also looks at the different principles which apply and the different powers available under each Act. The different forms of protection under each Act are contrasted. Because of criticism of the UK by the European Court of Human Rights in the Bournewood case, amendments have been made by the MHA 2007 to the MCA to provide protection for those incapable of making decisions who suffer from mental disorder and whose best interests require a loss of liberty.
Nurses’ knowledge of mouth care practices
Authors: Costello Thomas , Coyne Imelda
Published: May 2014

Aim: To assess nurses’ knowledge and practices concerning oral care on surgical and medical wards in a district general hospital in Ireland

Methods: A survey of all qualified nurses on three medical and three surgical wards was carried out. Two hundred questionnaires were distributed and 50 were returned with 43 of these rendered useable.

Results: The majority of nurses (90%) viewed oral care as an important aspect of nursing care. However, nurses lacked adequate knowledge of oral care practices, and experienced problems attending to oral care as a result of time constraints, lack of oral care packs, patients being confused or uncooperative, lack of toothpaste and toothbrush, limited education and low status attached to oral care. Although most nurses (over 70%) had received education on oral care, this was of short duration. Sixty-four per cent did not use an assessment tool to measure the condition of the patients oral cavity, while 73% believed that an assessment tool would be important to measure a baseline of the condition of the patients oral cavity.

Conclusion: Although oral care is an essential component of quality nursing care, it appears to be given low priority by some nurses. This study indicates the need for educational updates for qualified nurses, adequate supply of oral care equipment and promotion of formal assessment tools usage in the hospital setting.
Mild cognitive impairment: a review and nursing implications
Authors: Hodson Ruth , Keady John
Published: May 2014

The concept and classification of ‘mild cognitive impairment’ is disputed territory. This article reviews the literature on mild cognitive impairment and suggests that despite the complexity, early identification of dementia presents an ideal opportunity for nurses to work together with other statutory and voluntary partners, to provide support and intervention for people living with this stage of the condition and their families. Practice that is evidenced through individual and family history, coupled with a range of psychosocial interventions, including a quality-of-life appraisal, would seem an ideal way to structure support at this transitional point in time. A fictitious case study is included which demonstrates that stress and negative adjustment are just as likely to occur early in the course of dementia as later on in the condition.
Presumed common sense
Authors: Bailey Asa
Published: May 2014

Determined and resolute words from the Prime Minister, Gordon Brown, on an emotive issue which has understandably provoked passionate feelings both for and against it – United Kingdom (UK) organ donation and a proposed system of ‘presumed consent’.