bluuebunny/crossref_metadata_2025 huggingface dataset:
Older people and hypothermia: the role of the anaesthetic nurse
Authors: Ayres Una
Published: May 2014

Older clients are at increased risk during surgical intervention because of age-related system changes and comorbid conditions. However, recent advances in surgical and anaesthetic techniques, together with modern monitoring technology and the proliferation of ambulatory surgery, have reduced mortality in older patients undergoing surgery. Nevertheless, inadvertent hypothermia in older clients remains problematic. Therefore, an understanding of specific diseases prevalent in old age, coupled with a comprehensive knowledge of the physiological impact of ageing in all body systems, underpins the role of the anaesthetic nurse.
An overview of the current asthma disease management guidance
Authors: McAllister Judith
Published: May 2014

Asthma is a common chronic disease that carries considerable costs both to the individual and to the NHS, despite the availability of effective treatments. All nurses will encounter patients with asthma during their professional careers; therefore, a basic understanding of asthma and its management is required. Asthma responds well to treatment, yet asthma deaths still occur. The variability of asthma symptoms requires the patient to bear the responsibility of disease management from day to day. Patient education is needed if asthma is to be managed well and, while inhaler devices provide an effective delivery system, inhaler technique needs to be taught and devices used correctly if maximum benefit is to be achieved. Personal asthma action plans improve asthma control, yet are currently underused. While compliance with long-term treatment is poor and the reasons for this are complex, understanding some of these reasons and adopting a non-judgmental attitude may reduce frustration among healthcare professionals when managing asthma.
Quality of life and leg ulceration from the patient's perspective
Authors: Ballard Wilson Anne
Published: May 2014

Chronic leg ulceration can have a profound impact on a patient's quality of life. Studies have shown that pain, and general interference with normal activities of living, are the major themes emerging which are often not dealt with in a consistent manner by healthcare professionals. A literature review of this subject shows that although a number of studies have been carried out on quality of life related to chronic leg ulceration, there is little evidence that these findings are being addressed in daily management of these often complex leg ulcer patients. The aim of this article is to examine the research relating to quality of life and leg ulceration, and to attempt to determine what the most important issues are from the patient's perspective, in an effort to improve the way nurses manage their care.
The relationship between nurses and doctors
Authors: Castledine George
Published: May 2014

In my previous column I discussed how the Royal College of Physicians is beginning to examine how the medical profession should adapt in response to the new demands of the modern healthcare service (Castledine, 2005). I suggested that some rethinking was needed with regard to the doctor/patient relationship. In this column I would like to raise certain issues relating to the doctor/nurse relationship.
GP views of nurse-led telephone referral for paediatric assessment
Authors: Birch S , Glasper EA , Aitken P , Wiltshire M , Cogman G
Published: May 2014

Following the introduction of a new nurse-led telephone referral service to a dedicated paediatric emergency assessment unit (PEAU), a study was conducted to determine the views of general practitioners (GPs) who use the service. The PEAU operates between 10am and 10pm on weekdays and between 10am and 6pm at weekends. The unit has four beds and treatment and stabilization areas, plus associated services in a dedicated area of a regional child health unit. The design utilized a faxed questionnaire over a 1-month period to all consenting GPs using the PEAU with a postal questionnaire follow-up. Non-parametric Likert scores and qualitative data were used to determine levels of satisfaction with the service and the subsequent management of the referred children. Sixty-nine GPs referred 80 children to the PEAU via the service over a period of 1month. All consented to participate and were sent a faxed questionnaire, which generated 39 (57%) responses. A follow-up questionnaire sent to the 39 respondents achieved a return of 25 (64%) reponses. Thirty-four GPs agreed that referral via the dedicated nurse service was easier than the previous senior house officer referral system. Of the 25 GP respondents to the follow-up postal survey, the majority (17) agreed that the follow-up morning after discharge telephone call to parents by the PEAU nurses was helpful. Four GPs indicated that the 24-hour open access system, offered by the nursing staff, in which a parent may attend PEAU with a discharged child causing concern without a previous appointment, does not always work. This study has shown that a nurse-led telephone referral system to a PEAU for GPs and the subsequent management of the children has been favourably received.
Supporting people with long-term conditions
Authors: Porter Bernadette
Published: May 2014

There are 17.5 million people in the UK with a long-term condition (Department of Health (DoH), 2005a), often with inadequate health or social care plans in place. The fragmentation of the health and social care structures are mirrored in the fact that 5% of people with long-term conditions account for 42% of hospital admissions (DoH, 2004a). As an increase in the number of people living with chronic illness is anticipated to rise it is now recognized globally that steps must be taken to identify those most at risk who have complex needs which are not being met.
Senior nurse who repeatedly slept while on night duty
Authors: Castledine George
Published: May 2014

There are some nurses who go on night duty hoping to catch a short nap here and there to see them through their shift. Fatigue caused by working too many hours or sleeping for too few can result in problems for the nurse and can jeopardize patient care. In the following case, Ann, a senior registered nurse working regular nights on a gerontological ward, had little time for adequate rest and sleep. Recovery from fatigue and sleep loss can and should occur during off-duty hours, but Ann filled her non-working hours with too many commitments. This left her and her patients very vulnerable.
Defence nursing: the need to raise its profile among nurses
Authors: Harper Phil
Published: May 2014

I am very pleased to welcome you to the BJN's first Defence Nursing supplement. Its aim is to present different aspects of nursing within the armed forces, not only in peacetime but also when defence nurses are required to provide support during conflicts or other deployments. Although the focus is defence nursing by full-time, reservist or Ministry of Defence (MoD)-employed civilian nurses, I hope that the articles will be of interest to other nurses, particularly as many defence nurses now work within civilian organizations during peacetime.
Agency nurse who used the same speculum to carry out smear tests
Authors: Castledine George
Published: May 2014

Tunstone Medical Centre was a large inner-city GP unit which was well organized and maintained high professional standards of patient care. All the members of the nursing team were up to date with their practice and several members of staff were qualified in various aspects of the expanded role of the nurse. This culture of dedication to high standards of patient care extended to the healthcare assistants, who were also well trained and prepared for their role in the healthcare team.
The nurse practitioner in primary care: alleviating problems of access?
Authors: Perry Catherine , Thurston Miranda , Killey Mona , Miller Julia
Published: May 2014

Improving access to primary care services is an essential component of the NHS modernization plan and the advent of independent nurse practitioners in primary care has focused attention on the extent to which this group of nurses can effectively substitute for GPs. This study was designed to explore the role of a nurse practitioner in primary care, particularly whether the provision of a nurse practitioner facilitated access to care that met the needs of patients. Semistructured interviews were conducted with 14 patients who had consulted with the nurse practitioner, 10 staff within the practice who had knowledge of the role, and the nurse practitioner herself. With the permission of interviewees, interviews were audiotaped, the tapes transcribed verbatim, and the data were coded by theme. It was perceived by both groups of interviewees that access to care had been improved in that there were more appointments available, appointments were longer than they had been previously and were available at different times of the day. However, some areas in which access was ‘restricted’ were articulated by staff interviewees, such as limitations to the nurse practitioner's prescribing and problems with referring patients to secondary care. Additionally, while access to a member of the primary healthcare team was improved for many patients, access to a specific member of the team, such as a GP, was not always improved. Concerns were also expressed about how the role of the nurse practitioner needed to be developed in the practice. It can be concluded from this study that, potentially, the role of nurse practitioner has much to offer in terms of addressing problems of access in primary care for some patients. However, this is not a straightforward solution and in order for the role to be effective several issues highlighted in this study require addressing.
Matron who continued to make numerous drug administration errors
Authors: Castledine George
Published: May 2014

Brenda is a pharmacist who works in the community and helps with the inspection of private nursing homes. Each home she inspects has one announced inspection per year and one that is unannounced. If there are any issues which make it necessary for her to visit the home again, she does this unannounced.
Older people in acute hospitals need more care
Authors: Castledine George
Published: May 2014

Caring for sick older people has always been a big role for the nursing profession. Before the development of modern nursing, the majority of older people were cared for in the family home. Those who were without family and needed care became the responsibility of designated social institutions, usually the religious community.
Staff nurse who stole fentanyl from a syringe and refilled it with saline
Authors: Castledine George
Published: May 2014

Jane was a senior staff nurse on a cardiothoracic intensive care unit at a large inner-city hospital. She had over 3 years' experience and was one of the key members of the night shift team. Over the past 6 months she had worked regularly with another staff nurse called Susan who was fairly new to intensive care nursing. Jane found Susan to be a friendly person who was always very professional and knowledgeable in her work. Susan was one of those colleagues who never particularly sought advice or support, and who was very independent and confident. She never indicated to anyone that she had any problems and everyone on the unit tended to get on with her well.
Sickle cell anaemia 1: background, causes and incidence in the UK
Authors: De Diana
Published: May 2014

Sickle cell anaemia (SCA) and beta thalassaemia are severe inherited blood disorders. Despite some reports indicating that haemoglobinopathies are the most common serious genetic disorder in the UK, some parts of Europe, Africa and the Caribbean, sickle cell disorders still receive relatively little attention from the public or the healthcare service industry. The aim of this article, the first of two parts, is to provide an overview to the background, causes and incidence of sickle cell disorders in the UK and how an acute crisis state develops. Readers should note that the term ‘painful episode’ is now used in preference to ‘crisis’, which suggests catastrophe. The second article will look more closely at the pharmacological treatments for SCA painful episode management.
Health visitor who falsely claimed she had carried out patients' reviews
Authors: Castledine George
Published: May 2014

Regular auditing and evaluation of nursing services helps to not only monitor quality, but also review the performance of nurses. It was during such a procedure that Ann's patient caseload was scrutinized and questions were asked about the care she gave to patients.
Workload of postanaesthesia care unit nurses and intensive care overflow
Authors: Kiekkas Panagiotis , Poulopoulou Maria , Papahatzi Argiri , Androutsopoulou Christina , Maliouki Marianna , Prinou Aikaterini
Published: May 2014

The admission of intensive care unit (ICU) overflow patients in the postanaesthesia care unit (PACU) has come about as a result of an increasing demand for ICU services, which is not followed by a respective increase in the number of available beds. This has raised many concerns from nurses, with extensive workload and lack of personnel being the most important. This study was conducted in the General University Hospital of Patras, Greece, from 1 January 2003 to 30 June 2004. Admissions of ICU patients in the PACU were recorded and Project Research in Nursing (PRN), a Canadian workload measurement system, was used to estimate nursing workload. One hundred and three ICU patients were admitted and they stayed for a total time of 2812 hours. PRN scores of these ICU patients were much higher than for postanaesthesia patients. Clinically important increases of total PRN score, total care time and nursing personnel needs were evident in the presence of an ICU overflow patient during all shifts. Unless there is the appropriate number of personnel, increases in total care time are likely to lead to the neglect of postanaesthesia patients' needs.
Sickle cell anaemia 2: management approaches of painful episodes
Authors: De Diana
Published: May 2014

The first of this two-part series (Vol 14(8): 447–50) highlighted how sickle cell disorders were the most common genetic disorder in the UK. It also described how recurrent sickle cell painful episodes led to many social restrictions on a sufferer's life. In the UK, painful episodes still remain the main reason for the hospital admission of people with sickle cell disease. This often means lengthy periods spent as an inpatient for many sufferers, as well as a lifetime reliant upon health professionals to prescribe strong analgesics in an attempt to try and control the painful symptoms associated with sickle cell disease. Readers should note that the term ‘painful episode’ is now used in preference to ‘crisis’. Despite recommendations that initial hospital management of sickle cell painful episode should be aimed at providing rapid pain control, this article will show that choosing the right analgesic is not always easy to decide. National guidelines may aid this process, incorporated alongside increased patient empowerment and the important role of the nurse.
Pressure ulcer benchmarking within a primary care setting
Authors: Burbridge Naomi , Kiernan Sarah
Published: May 2014

Patient-focused benchmarking was initially launched by the Department of Health. This article examines how the tissue viability service of Camden and Islington primary care trusts implemented the pressure ulcer benchmarking process within the nursing teams of these trusts. This was achieved by: agreeing best practice through examination of local and national guidelines; developing a suitable audit tool for nursing teams to assess their clinical areas against this best practice; nursing teams producing core action plans to facilitate movement towards best practice; disseminating results; and reauditing. The results of the audits carried out in October 2003 and February 2004 are presented. A plan for future work is described including: the involvement of other members of the multidisciplinary team and the Patient Advice Liaison Service; and linking pressure ulcer benchmarking to the benchmarks of communication, privacy and dignity and record keeping.
Ethical issues in deriving stem cells from embryos and eggs
Authors: Cornwell Glenda
Published: May 2014

Human embryonic stem cell (ESC) research has attracted wide media coverage. It has been headline news for the past several months, revealing the complex case of Professor Hwang Woo-Suk and the scientific fraud where he purported to have created the first human patient-specific stem cell lines generated by cell nucleus replacement (CNR). To ethically obtain the raw materials (eggs, sperm and embryos) for human ESC research is an enormous challenge, yet essential if this research is to proceed in its quest to try to deliver some of the expectations placed upon it: developing treatments and possible cures for a range of serious diseases. This article examines some of the ethical issues surrounding human ESC research using the four principles frequently applied to healthcare and medical research; autonomy, beneficence, non-maleficence and justice. The author strives to ask questions throughout which will encourage debate and discussion.
The potential of integrated multi-agency care pathways for children
Authors: Davies Ruth
Published: May 2014

In 2004, a Framework for the Development of Integrated Multi-agency Care Pathways for Children with Life-Threatening and Life-Limiting Conditions, funded by the Department of Health, was developed by a working party. It included the Association for Children with Life-Threatening or Terminal Conditions and their Families, the Royal College of Nursing and the Royal College of Paediatrics and Child Health. This article will identify the need for this framework and its potential to transform the delivery of palliative care services to overcome present inequalities based on condition and geography that currently beset children with these conditions and their families. It will show how the three stages of the pathway (diagnosis or recognition, living with a condition, and end of life and bereavement) follow the patient's journey and complement guidance set out in the Children's National Service Framework (2004) for multi-agency assessments, protocols and standards to ensure high-quality coordinated care and services. It concludes with the need to evaluate the effectiveness of pathways that may develop from this initiative through audit and research.
‘A tour of duty’…world nursing perspectives
Authors: Wells Mandy
Published: May 2014

I have the honour of holding the position of Chair of the Nursing Education Sub-Committee (NESC) and am a Nurse Member of the Education Committee for the International Continence Society. I am the only nurse member on the main Education Committee of 17. The only other member of this committee who is not a medic, is a physiotherapist. This rather unequal balance means that the physiotherapist and I sometimes have a bit of a fight on our hands getting our voices heard.
International prisoner health care: how nurses can do more
Authors: Norman Ann , Tysoe Elizabeth
Published: May 2014

This short article provides a summary account of the authors' recent visit to an international prisoner healthcare conference in Estonia, where there were a number of medical model presentations. The authors have explored the nursing contribution to prisoners' health care and have offered some examples of where this good practice is evident in England. The article highlights the value of nursing initiatives and how this should be given greater emphais within international prisoner health care in the future.
An introduction to thoracic surgery: assessment, diagnostics, treatment
Authors: Myatt Rebecca M
Published: May 2014

Thoracic surgery is an exciting and dynamic specialty. Many of the conditions treated can be regarded as life-limiting so practitioners require expert skills in communication as well as knowledge of the specific illnesses and complications that can arise. This article explains the types of surgery performed and discusses the factors that need to be taken into consideration before operating on malignant lung disease. The specific postoperative care required by patients following thoracic surgery is also discussed.
A comparison of two methods of blood pressure measurement
Authors: Jones Soraya , Simpson Heidi , Ahmed Hafez
Published: May 2014

In current practice, a two-stage approach to measuring blood pressure (BP) has been widely accepted as the most accurate and reliable method. However, by changing the local haemodynamics, this procedure might alter the blood pressure. In a study of 39subjects, blood pressure was measured using two indirect methods (two-stage and one-stage approaches). Results showed no statistically significant difference in values for systolic blood pressure obtained from the two methods. Statistically significant lower diastolic blood pressure values were obtained using the two-stage compared to the one-stage approach. It is proposed that initial inflation of the cuff to estimate systolic blood pressure in the two-stage approach might lead to reactive hyperaemia and, therefore, a lower diastolic value. This two-stage approach might not provide the accurate readings it claims, and in addition it requires more time and subjects the patient to longer periods of stress.
Developing older people's champions
Authors: Castledine George
Published: May 2014

The care of older people in hospital is severely testing every aspect of the NHS's resources. To say that the nursing care of such people is in crises would not be an exaggeration, especially given some of the scandals highlighted by the media. One television programme showed such appalling conditions regarding the nursing care of older people that the producers claimed that judging by the intensity and content of the general public's responses, they could have filmed in numerous other locations around the UK.
Softform Premier Active Mattress: a novel step-up/step-down approach
Authors: Thompson Geoff
Published: May 2014

In the UK it is estimated that as many as 412000 patients who are already ill will develop pressure ulcers (Bennett et al, 2004), which are an unnecessary and expensive complication to treat (Hitch, 1995). One way to try and reduce these risks is by investing in suitable mattresses. The author's investigations into existing mattress stock in the years 1996–97 illustrated the inadequacy of the NHS standard mattress (Santy, 1995; Fox, 1997). Investigators (e.g. Rithalia, 1996) were recognizing the inadequacy of the pink marbled standard NHS foam mattress for pressure reduction (Medical Device Directorate, 1993; Dunford, 1994) which included reports necessary to help develop guidelines in pressure ulcer prevention and management (Coull, 2004), as well as make value-for-money recommendations about product purchases (Fletcher et al, 1994; Value For Money Update, 1994; Cullum et al, 1995).
Ethical issues in caring for people with carotid artery rupture
Authors: Frawley Theresa , Begley Cecily M
Published: May 2014

Nurses working in the head and neck oncology field will be conscious of the possible risk of carotid artery rupture in their patients. This complication occurs swiftly and the patient requires the nurse to rapidly change focus from acute care and cure to palliative care and comfort. Prior decisions need to be made as to whether or not active resuscitation is to be undertaken. In this final article, the ethical issues surrounding this decision-making process are discussed, including patient autonomy, advocacy, beneficence and justice. The facts as they relate to each individual patient should be discussed truthfully and openly with them and their significant others. Each person should be assisted to come to his own decision, following discussion of the prognosis and risks that are pertinent to that individual. Respect for the autonomy of patients should be a guiding principle governing the conduct of decisions.
Recognizing and defining clinical nurse leaders
Authors: Stanley David
Published: May 2014

This article addresses the issue of clinical leadership and how it is defined. The concepts and definitions of clinical leadership are considered as well as the results of new research that suggests that clinical leaders can be seen as experts in their field, and because they are approachable and are effective communicators, are empowered to act as a role model, motivating others by matching their values and beliefs about nursing and care to their practice. This is supported by a new leadership theory, congruent leadership, proposed as the most appropriate leadership theory to support an understanding of clinical leadership. Congruent leaders (clinical nurse leaders) are followed because there is a match between the leader's values and beliefs and their actions.
Malnutrition in hospitals. What can you and I do?
Authors: McAtear Carole Anne
Published: May 2014

We all require food and fluid to survive and good nutrition plays an important role in recovery and rehabilitation from illness. Along with these physical properties, eating and drinking contributes to our quality of life by being a source of great pleasure with important social, cultural and religious functions. It would be reasonable, therefore, assume that when individuals are sick — at their most vulnerable in hospital — the provision of adequate food, fluids and nutritional care is a high priority on the agenda of managers, healthcare professionals and all those responsible for providing care.
Mental capacity requirements and a patient's right to die
Authors: Dimond Bridgit
Published: May 2014

This article reviews the situation of a patient who has suffered a severe stroke whose daughter knows would not wish to continue in that situation. It explores the law relating to the refusal of life-saving treatment by a patient with mental capacity compared with a person who lacked mental capacity. It also considers the implications of the failure of the Assisted Suicide Bill to be passed into law.
Behavioural phenotypes: an emerging specialist role for nurses
Authors: Higgins Steve , Duffy Jean
Published: May 2014

The idea that behaviour can be influenced by genetics is not new and developments in the field of behavioural genetics suggest this is an area of increasing relevance to healthcare professionals who support people who have learning disabilities associated with genetic disorders. This paper considers both the evidence for behavioural phenotypes and the possible roles healthcare professionals have when supporting affected individuals and their families. The paper argues that nurses in all areas of health care need to have a foundation of skill and knowledge of behavioural phenotypes to ensure effective care is provided for individuals and their families. In addition, the paper proposes that a specialist nursing role is essential in providing direct support to clients and their families as well as in providing a consultancy and educational role to the health and social care professionals who support these families.
Duty to report: legal implications of nurses stealing from patients
Authors: Dimond Bridgit
Published: May 2014

This article explores the situation when a nurse receives a report from a patient that a colleague is stealing from the patient. It looks at the duty of the nurse and the issues which may arise when she tries to put her duty into action. It also considers the legal situation of the colleague who is the subject of the allegations.
Preserving sexuality in mixed-sex wards
Authors: Castledine George
Published: May 2014

The problem of mixed-sex wards has recently hit the media headlines as the latest issue upsetting people regarding the NHS. This is particularly poignant given that Tony Blair, when leader of the opposition in 1996, said of mixed-sex wards: ‘Is it beyond the wit of the Government and the health administrators to deal with that problem?’ After 10 years, sadly the answer is yes (Cann, 2006).
How old is too old (or too young) to resuscitate?
Authors: Castledine George
Published: May 2014

The prospect of becoming ill and dependent in old age is a worrying factor in today's world. What was once hailed as a great achievement of the 20th century, i.e. adding 20 years to the average life expectancy of British people, has now become, for some, a nightmare scenario. Many doctors, nurses, health and social care professionals are becoming very concerned about the increasing gaps in service provision and the ability of the NHS to cope with the ever-increasing numbers of older people. It is estimated that about 40% of the NHS budget is spent caring for the elderly.
Advanced nursing practice in cancer
Authors: Behi Ruhi
Published: May 2014

The Royal Marsden has taken another step in the development of courses specific to cancer – one which should be welcomed by nurses and patients. The 2–3-year Postgraduate Diploma/MSc Nurse Practitioner: Cancer Care, is accredited by the Royal College of Nursing (RCN) and in a press release the course is described as one that ‘develops clinical practice skills, supports practitioners in their personal development and career planning and organization in the development of their cancer services’.
Diagnosis of early arthritis: outcomes of a nurse-led clinic
Authors: El Miedany Yasser , Palmer Deborah , El Gaafary Maha
Published: May 2014

Recent data suggest that early treatment of inflammatory arthritis can improve patient outcomes. While rheumatologists recognized this need for early evaluation and treatment, the current load on the rheumatology service nationwide may limit the capacity for timely evaluation. The authors developed a protocol to be applied through a specialized early arthritis clinic that is able to discriminate between different categories of early arthritis, to shortening the time taken to reach the correct diagnosis and provide the appropriate management. A total of 108 patients have been reviewed in the early arthritis clinic over 12months. It took 3weeks for the patients to be fully assessed in the rheumatology clinic instead of 16weeks. Completing the clinic proforma helped the assessor to cover all causes of arthritis/arthralgia. Disease-modifying antirheumatic drug (DMARD) therapy was initiated within a few weeks (2–5weeks) once diagnosis was confirmed, instead of 8–10months previously. This early arthritis clinic model helped to shorten the referral lag time (duration between symptoms onset and first rheumatologist assessment) as well as lag time to DMARD therapy (duration between symptom onset and the institution of DMARD therapy).
Attends Slip with S-Form: a new design of an all-in-one product
Authors: Williams Cath , Lorton Lindsay
Published: May 2014

Disposable absorbent containment products (continence pads) should only be used after a thorough assessment of the client's needs with regard to preference, independence, comfort and security. This article offers a list of criteria that can be used to examine the quality of products. It then looks at a new product using this criteria.
Evolution of a model for the thrombolysis of acute stroke patients
Authors: Carty Richard , Mooraby Raouf , Paterson John
Published: May 2014

The National Audit Office (NAO, 2005) has reported that the priority afforded to stroke care should be increased, given its impact on health and cost to the NHS. It recommends improvements in preventing, treating and managing stroke patients in line with recent evidence. Thrombolysis for acute ischaemic stroke is a proven treatment that produces good results in significant numbers of patients (Mar et al, 2005). However, owing to various barriers many hospitals in the UK have failed to implement effective systems to facilitate the delivery of this treatment to acute stroke patients. These barriers include a lack of skill, nursing knowledge, and ‘fast-track’ organization relating to thrombolysis as a treatment for acute stroke. Fears of intracranial bleeding and lack of appropriate stroke unit beds and issues of consent have also been identified as further problems (Innes and International Stroke Trial (IST-3), 2003). Taking these concerns into consideration, Scarborough District General Hospital has developed a multidisciplinary model with the Coronary Care Unit (CCU), integral to the delivery of treatment. Between 2003 and 2005, 24 stroke patients have received thrombolysis treatment and have been cared for in CCU. Outcome results have been positive, with 51% of patients demonstrating a significant benefit at 7days post-stroke. This model has broken traditional professional and speciality boundaries to allow patients to receive treatments they otherwise would not have received. Moreover, it provides the potential for further exploration into the wider implementation of thrombolysis for acute stroke patients in the UK.
An introduction to various types of leg ulcers and their management
Authors: Hampton Sylvie
Published: May 2014

There are many reasons for tissue breakdown in the leg, and each cause requires a different treatment to either correct the abnormality or to manage the symptoms that cause the patient distress. The pathway to appropriate treatment relies on a working knowledge of anatomy and physiology and good assessment. This article aims to provide a basic knowledge in how to recognize different leg ulcer types.
Survey comparing clinicians' wound healing knowledge and practice
Authors: Ashton Janine , Price Patricia
Published: May 2014

A cross-sectional design in the form of a self-administered postal questionnaire was sent to 238 staff of a general hospital to compare wound healing knowledge and practice. Seventy four questionnaires were returned (response rate=31.09%). No significant statistical differences were identified between the groups. Wound care practices demonstrated a lack of evidence-based care along with the continued use of outdated and hazardous practices. Knowledge was primarily sourced from colleagues and personal experience, with journals and courses favoured by the specialized clinicians. The clinicians rated pre-graduate training as inadequate. Medical staff dominated decision making in specialized groups, while the responsibility was shared between the nurse and the tissue viability nurse in non-specialized areas. The clinicians identified clinical effectiveness and availability as influencing their dressing choices.
Keeping experience at the bedside: the emergency consultant nurse role
Authors: Currie Jane
Published: May 2014

The consultant nurse concept has not yet been transferred to the military setting. The motivation for developing the role in the NHS was to improve the quality of patient care by strengthening professional leadership and extending the clinical career ladder. The consultant nurse may be defined as an expert in their clinical field, possessing expert leadership and visionary skills. The role is based on four domains: expert practice, professional leadership, education and research. Typically, the emergency consultant nurse spends 50% of their time working clinically, thereby providing senior clinical expertise and adding value to the clinical role. In a military context the consultant nurse role could be perceived as the coming together of the senior command and administrative role and the clinical role. The military has the opportunity to develop a senior clinical emergency nurse role encompassing elements of the civilian consultant nurse model, which may strengthen leadership, provide a central resource of expertise and raise the profile of military nursing. This has the added potential to provide inspiration for junior nurses and retain experienced emergency nurses in the clinical arena.
Informal carers – where is the support?
Authors: Barber Chris
Published: May 2014

Well, that’s another Carers Week over and done with for another year, the 21st of such weeks apparently. What do you mean you didn’t know that there was one? This is the one week of the year where ‘informal carers’ are allowed to be ‘out and proud’. This is the one week of the year where informal carers are allowed ‘me time’ to be pampered and made a fuss of before being put back into our boxes and told to get on with the job of caring, a job which encompasses the full range of caring and nursing functions, including administration of complex medication regimens and nasal-gastric and PEG feeding, among many others.
Parental mental illness: the effects on children and their needs
Authors: Singleton Laura
Published: May 2014

Parental mental health problems can have a major impact on children and studies indicate that they increase the risk of children developing behavioural, social, emotional and educational problems (Royal College of Psychiatrists, 2004). While this impact has been acknowledged for some time, there appear to be few interventions in the UK to help reduce the effect that parental mental illness has on children. This article discusses the impact of parental mental illness on children and gives examples of interventions that have been found to be useful in other countries. Potential interventions that mental health services in the UK could adopt are also discussed.
Developing a telephone follow-up service for myeloproliferative disorders
Authors: Tonkin Joanne
Published: May 2014

Each year in the NHS there are 37 million follow-up appointments. A significant proportion of these are clinically unnecessary, create inconvenience and anxiety for patients, and waste valuable resources. The nature of haematological disease means that some patients are followed-up on a long-term basis as outpatients at varying degrees of frequency ranging from monthly to annually. These patients often attend hospital for a review and are then advised that their disease is stable and a further follow-up appointment is scheduled. This frequently means that the patient has to travel to the hospital, pay to park, wait for a blood test, wait for the test result and then wait to see the doctor for a very short consultation. This article discusses the development and early evaluation of a nurse-led telephone followup service for patients with stable haematological disease. Responses to an initial patient satisfaction survey identified that the majority of patients found the system to be effective and convenient. From this experience it would appear that telephone follow-up positively impacts on the patient and the service. Patients receive appropriate and timely care in the right setting and this in turn has created additional capacity in the outpatient setting for those who require it.
Using ‘cling film’ to protect lower limb plaster casts in babies with club foot
Authors: K Patel Nirav , Jeer PJS , S Cornell Mark
Published: May 2014

Club foot or congenital talipes equinovarus is a common condition affecting babies and non-surgical treatment involves serial manipulation and plaster casting for many weeks. The casts are susceptible to soiling during this time which makes management and child care even more challenging. The authors report initial experience in a typical district general hospital club foot clinic where the parents of a baby used conventional cling film to cover the casts and provide a low-cost, effective and well-tolerated method of protection. Informal reports received from these parents were very positive and encouraging throughout the duration of treatment. The authors believe parents with babies undergoing such treatment for club foot could be advised of the benefits of using cling film to protect plaster casts. More formal analysis of feedback from parents and collaborative experience with other hospitals is required before widespread use is recommended. There may also be scope for using cling film to protect lower limb casts used in managing developmental dysplasia of the hip or fractures in children and potentially adults.
The Mental Capacity Act 2005 and decision-making: best interests
Authors: Dimond Bridgit
Published: May 2014

This article continues the series in analysing the implications of the Mental Capacity Act (MCA) 2005 by looking at how the best interests of a person (P) lacking the requisite mental capacity are determined. While the MCA does not provide a statutory definition of best interests, it does set out the steps which must be taken to decide on what P’s best interests are. These steps are taken only after the decision has been made that P lacks the requisite mental capacity. If there is a likelihood that P could eventually make his own decisions then this must be taken account of. The steps to be taken include making no unjustified assumptions based on the person’s age or appearance, condition or an aspect of his behaviour. All the relevant circumstances must be taken into account including the person’s past and present wishes and feelings, any relevant written statement made by him, the beliefs and values. There must be consultation with specified others not to establish what others would wish to see happen, but to determine what P’s best interests are. These steps are then applied to a typical situation in health and social care. Special provisions relating to lifesaving treatment and restraint are also noted.
A reflective case for valuing nurse practitioners in ophthalmology clinics
Authors: Hartry Nicola
Published: May 2014

Following recent publicity regarding the downgrading of specialist nurses and nurse practitioners (NPs) in an effort to balance the books, a reflective article has been compiled using Driscoll’s reflective model in order to assess the value of using NPs in medical-retinal ophthalmology clinics. From reflection on a case study and review of the literature, it appears that nurses trained in this speciality with sufficient cognitive and practical knowledge and experience could positively affect both the smooth running of eye clinics and the psychological outcome for patients long-term. Strategies are currently being considered to restructure skill mix within the clinics to facilitate this change in traditional working practice.
Discovery of neuropathic pain following breast surgery
Authors: Ferguson Anne
Published: May 2014

Mrs Clark is a 45-year-old woman who had undergone a lumpectomy (Figure 1) for cancer of the right breast approximately 6 weeks ago. An incision had been made in the inner curvature of the breast and a drain inserted on the outer aspect. She subsequently had to attend the minor injuries unit for dressings to her breast as the drain site had initially become infected, with the wound producing purulent exudate. Mrs Clark’s infection had resolved and the exudate had diminished. However, the exudate had irritated the skin and she was left with a large area of excoriation. Up to this point the area of excoriation had been treated using CavilonTMNo Sting Barrier Film to protect the skin from further irritation.
Modernizing nursing careers report outlines the future
Authors: Castledine George
Published: May 2014

No one can doubt that healthcare services across the United Kingdom are going through a period of profound change’ so begins the report on Modernising Nursing Careers which is supported by the four UK chief nursing officers.
Nutritional support for patients with infected wounds
Authors: Ord Helen
Published: May 2014

Many factors affect wound healing, including nutritional status and recent nutritional intake. Patients with infected wounds have increased requirements for nutrients and often have a reduced food intake. It is therefore important that nutritional status is carefully considered, and all patients should be screened for malnutrition using a nutrition screening tool. Nutrition plans should aim to provide sufficient energy while maintaining good glycaemic control, adequate protein and hydration, and a minimum of 100% reference nutrient intake for micronutrients. Measures required to achieve this will vary, as all patients should be assessed on an individual basis.
Nurses’ knowledge and attitudes in pain management practice
Authors: Matthews Elizabeth , Malcolm Colette
Published: May 2014

Nursing a patient in pain is a challenging task requiring up-to-date knowledge, skilled interventions and attitudes that convey trust, care and an honest belief in what the patient says (Carr, 1997). This study examined the knowledge and attitudes of nurses who have completed a knowledge and competency training programme within an orthopaedic centre (Group one) against a group of nurses who were attending a pain conference who had not completed this programme (Group two). The questionnaire used was the Nurses’ Knowledge and Attitudes Survey Regarding Pain (Ferrell and McCaffery, 2002). Findings from the survey revealed that there was no significant difference in the total correct responses between the two groups and there was a severe deficit in knowledge relating to questions about non-pharmacological methods of treating pain and opioid use in chronic pain conditions. However Group one had a higher correct response rate (p=0.001) in the vignettes that are based on daily nursing practice.
Contribution of specialist nurses in managing patients with IBD
Authors: Younge Lisa , Norton Christine
Published: May 2014

Inflammatory bowel disease (IBD) is a collective term for the medical conditions ulcerative colitis and Crohn’s disease. Both are chronic relapsing remitting diseases with a major impact on a patient’s quality of life. Symptoms of the diseases include increased bowel frequency, abdominal pain, rectal bleeding, urgency and incontinence, weight loss and reduced appetite. There is no known medical cure for either condition, and surgery often involves stoma formation and, therefore, has major implications for the patient in terms of management and body image.
Ten steps to getting your paper published in a professional journal
Authors: Devitt Patric , Hardicre Jayne , Coad Jane
Published: May 2014

There is an increasing expectation that nurses, whether they work in clinical practice management, education or research, will publish. At the same time there remains a mystique about the best way to go about this. This article provides a simple commentary suggesting ten steps to help you publish in a professional journal.
Consent: the issue of rights and responsibilities for the health worker
Authors: Fullbrook Suzanne
Published: May 2014

The next three articles discuss elements of an important part of health provision. Deciding who has control over health choices is controversial, and many health providers are confused as to the issues. The confusion would appear to arise in two main areas. First, definitions as to who can and cannot make decisions appear to some to be muddled. Second, specific new legislation that applies principles of consent to certain groups of healthcare users, would seem to be poorly understood at present. The three articles will be presented as follows: discussion on the legal definitions and principles of consent; discussion of issues surrounding the capacity of families to give or refuse consent to organ transplantation; discussion on the freedoms and responsibilities of people who are affected by the new incapacity bill.
Urinary elimination: Part 2 - retention, incontinence and catheterization
Authors: Pellatt Glynis Collis
Published: May 2014

In part two of this article, the nursing role in relation to the assessment and management of urinary retention, urinary incontinence and catheterization are considered using recent literature and best practice statements. Retention of urine and incontinence have a major detrimental impact on a person’s life and nurses have an important role to play in supporting patients. Catheterization is often necessary for acute retention of urine but is the last resort for incontinence. However, when catheter use is appropriate, asepsis technique during insertion and continuing management can help to minimize associated problems. Urinary elimination problems are embarrassing and distressing and nurses need to deal with them with sensitivity and empathy