bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationships in nurse prescribing: revealing the processes
Authors: Fisher Richard
Published: May 2014

Nurse prescribing, a relatively recent policy initiative in the NHS, has the potential to initiate long-term changes to the ways in which the various actors in primary care relate to each other. Focusing primarily on the working lives of district nurses, this article explores the ways these practitioners and others interact, using their own words as a source of data. Semi-structured interviews are undertaken with a number of professionals in a purposive sample (17 nurse prescribers, four non-prescribing nurses, two pharmacists and one general practitioner) employing an iterative approach. Data revealed are analysed thematically to produce detailed explanatory accounts of activity centring around prescribing. Concepts generated from the themes (team working, effects on roles, prescribing mechanisms and relationships) are discussed. Findings indicate that working relationships generally operate smoothly, although some staff nurses, pharmacists and GPs appear unclear about some legal aspects of the prescribing role.
Potential pitfalls in adherence to hand washing in the community
Authors: Nazarko Linda
Published: May 2014

Infection control is vitally important in community settings. Community nurses care for people with complex care needs who are extremely vulnerable to infection. The most important thing a nurse can do to prevent the spread of infection is to maintain good hand hygiene. Nurses can face barriers in their efforts to practice good hand hygiene, including lack of education, lack of time, poor facilities and inappropriate clothing and hand adornments. This article outlines evidence-based practice on how to overcome barriers to good hand hygiene and stresses the important role of the community nurse in working with her team to ensure best practice, cut infection rates and save lives.
An evidence-based approach to urinary catheter changes
Authors: Miles Gail , Schroeder Jenny
Published: May 2014

Many people in the community have a urinary catheter that is routinely changed by a community nurse. People with urinary catheters can experience a number of problems including catheter blockages. A blocked catheter causes great distress and inconvenience to the person and places a strain on the resources of community nursing organizations because of the need for unscheduled visits to change the catheter. A procedure that enabled catheter changes to be planned before they blocked would reduce patient distress and better assist community nursing organizations with resource management. The ‘planned catheter change’ approach is a procedure that community nurses can use to better plan urinary catheter changes to minimize complications. In this article the author presents the outcomes from the implementation of a planned approach to catheter care in a home nursing service in Melbourne, Australia.
Old and alone: bereavement and the older person
Authors: Paterson Richard
Published: May 2014

The death of a spouse or partner will, for many of us, be the most catastrophic personal event in our lives. For most of us, this is likely to occur in our latter years, when we are least equipped to adjust successfully to the dislocation and challenges that such a bereavement brings.
Key-worker clinics: the maintenance phase of lymphoedema therapy
Authors: Green Tracy
Published: May 2014

This article describes the development of services for patients with mild and uncomplicated lymphoedema through a network of community-based staff nurses specially trained in the management of mild and uncomplicated lymphoedema in order to deliver an integrated service across the acute foundation and primary care trusts.

Government policies, increasing referral rates and patients with complex co-morbidity requiring intensive treatments had prompted a review of the service provision to examine ways to deliver an efficient and cost-effective service across the local health economy.

Patients with mild and uncomplicated lymphoedema do not necessarily require specialist care but can be managed effectively by key workers with appropriate training and skills (British Lymphology Society, 2001a; b; Lymphoedema Framework, 2006). This development demonstrates the benefit of training existing community staff, using their existing skills. Providing access to clinics within the primary care setting helps to provide a cost-effective, structured and co-ordinated care pathway at all levels of intervention, ultimately improving treatment outcomes and patient satisfaction.

A cohort of community staff nurses were identified and trained in the provision of lymphoedema management to key worker level, providing the opportunity to develop a lymphoedema service based upon health-care need and not disease site as has occurred with other national developments. These clinics offer the same advice, support and monitoring of the patients condition alongside education and information in a more locally accessible setting, avoiding the need for hospital visits.
An interview with Marina Goater
Authors: Goater Marina
Published: May 2014

In 2004 I was working on a busy acute medical and gastrointestinal ward and was given the opportunity to become a nutrition link nurse with my first task of assisting with introducing the Nutrition Screening Tool. The NICE (2006) guidance supported this process and 6 years on it feels like a lifetime involved and managing nutritional care. I seized the opportunity with both hands because I had always been passionate about the importance of my patients receiving adequate nutrition working very closely alongside the dietitians and speech and language therapy team at ward level.
Nutrition in the news
Authors: Smith Rhonda
Published: May 2014

The National Association of Care Catering (NACC) and the Caroline Walker Trust have agreed on one nutrition standard for community meals, making it easier for local authorities to compare services, and ensure consistent nutritional standards for meals that meet the needs of older people living in their own homes.
Spirituality in end-of-life care: attending the person on their journey
Authors: Hayden Deborah
Published: May 2014

Spirituality is a fundamental element to the human experience of health and healing, illness and dying. Spiritual care is an essential component of palliative and end-of-life care provision and is the responsibility of all staff and carers involved in the care of patients and families. As end-of-life care is a significant element of community nursing, this article explores the relevancy of spirituality to end-of-life practice, the challenge of defining spirituality and the attributes and skills required for the practice of spiritual care. The aim of is to encourage self reflection and open dialogue about the subject, thus enhancing community nurses' understanding of spiritual care practice. By reflecting and generating talk about the practice of spiritual care, it may become more normalized, recognized, and practically meaningful, thereby retaining its significance in holistic nursing.
Eczema: causes, symptoms and treatment in the community
Authors: Peate Ian
Published: May 2014

The most common diseases encountered by health professionals are those associated with skin disorders. There are thousands of skin diseases, accurate diagnosis of which is critical to appropriate management and patient outcomes. Diseases of the skin are the most common group of occupational health problems that lead to absence from work in the general population. Eczema describes a variety of inflammatory skin disorders; it is a chronic, widespread, non-infective inflammatory condition that causes severe pruritus, erythema and scaling. The condition can impact at any age; generally it occurs during infancy or early childhood. The cause of atopic eczema is complex and not fully understood. This article describes the pathophysiology associated with eczema focusing upon atopic eczema. Signs and symptoms are described; methods of diagnosis and treatment options are outlined. The most up-to-date clinical evidence is used to inform the community nurse. The active involvement of the informed patient in their therapy is critical to success and this is advocated. The role of the nurse is central to enhancing health and wellbeing of people with atopic eczema.
Advice on safe administration of medications via enteral feeding tubes
Authors: Best Carolyn , Wilson Neil
Published: May 2014

This article provides patients, carers and professional staff in the community with a simple guide to safe practice when administering medication through an enteral feeding tube. For the purpose of this article, enteral feeding tube access relates to nasogastric tubes, gastrostomies, or jejunal feeding tubes.
Mental health issues in primary care: implementing policies in practice
Authors: Currid Thomas J , Turner Anna , Bellefontaine Nerys , Spada Marcantonio M
Published: May 2014

Recent health policies highlight the important role that mental health contributes to our general wellbeing, and call for parity of esteem between physical and mental health. The bidirectional relationship between physical and mental health culminates in high prevalence rates of mental disorders in primary care settings. Despite these prevalence findings being known for some time, evidence would suggest that at times mental disorders are being overlooked. This article, set in context to policy, patient prevalence, practice and professional development, outlines a range of factors that can impede mental health delivery and proposes ways in which primary care nurses can strengthen their activity and involvement at various levels.
An insight into continence management in patients with dementia
Authors: Kyle Gaye
Published: May 2014

This article discuses the prevalence of urinary and faecal incontinence in people with dementia. The content explores the physiological changes affecting the older bladder and bowel together with the psychological and behavioural problems associated with dementia that impact on continence.
ACP conversations in clinical practice: impact of an education initiative
Authors: Colville Elaine , Kennedy Catriona
Published: May 2014

This article reports on participants' experiences of facilitating advanced care planning (ACP) conversations in their clinical practice following an ACP study day. NHS Education for Scotland commissioned an educational package to be delivered by designated facilitators across all health boards in Scotland as part of the implementation of ‘Living and Dying Well in Scotland’ (2008). The reported impact of this programme on the practice of six nurses is the focus of this paper. Six nurses from both community (n=3) and acute care settings (n=3 ) were interviewed on a one-to-one basis 10–12 months after attendance at an ACP study day. Data were transcribed verbatim and analysed using a comparative approach to thematic analysis. The training was found to have increased participants' awareness of ACP, validated their knowledge and skills, and in turn had a positive impact on their clinical practice. However, some barriers to providing this approach were identified, including time, planning and resource constraints. Educational programmes can be beneficial and impact on clinical care. However, education is only one way to encourage ACP in health care. The complex and transactional nature of ACP should be recognised, alongside the need to pace conversations about ACP.
BAPEN: What is it, what does it do, and what can it do for you?
Authors: Bowling Tim
Published: May 2014

Dr Tim Bowling, Chair of BAPEN, introduces the Association's key goals and strategies for the year ahead, and discusses the role of community nurses in meeting these goals.
Improving efficiency and safety for patients who are unable to self-administer insulin
Authors: Livingstone Carina , Wolper Sandra , Rogers Tracy
Published: May 2014

A one-day ‘snapshot’ study was conducted to determine the nature and extent of specific safety issues faced by community nurses who care for patients unable to self-administer insulin. Community teams from 19 NHS trusts reported 607 patients requiring support with insulin administration. In total, 15.1% of insulin administration documents had an abbreviation for the word ‘units’, which is a serious safety hazard where any resulting serious harm would be classed as a ‘never event’. Pens or disposable devices were used for 52.9% of all administrations, with 16.7% using an insulin device without any previous device-specific training. Major differences were discovered between trusts in many aspects of practice and insulin use, and comparative data can be used to benchmark activity and drive safety and cost improvement. For example, 50.9% of patients had insulin administered more than once a day, but individual trusts reported figures ranging from 25.9% to 66.7%. If it were possible for all 19 trusts to manage 60% of patients on once-daily regimens, total annual service costs could be reduced by about £200 000, or by £3.5 million across the UKs.
Changing a urethral or suprapubic catheter: the patient's perspective
Authors: Chapple Alison , Prinjha Suman , Mangnall Joanne
Published: May 2014

Understanding the patient's perspective in any area of health care is now recognised as being crucial to good practice, but little is known about patients’ views on living with an indwelling urinary catheter. In this study, 36 people living with either a urethral or suprapubic catheter across the UK were interviewed. After thematic analysis, the authors interpreted what they learned. Many issues were raised, including the need to know who was responsible for changing the catheter, the importance of continuity of care, 24-hour access to services, and good hygiene. Patients valued nurses with training and experience, with plenty of time, who took care and who listened to what mattered to the patient. The patient's perspective is important at all levels, not only when designing and planning an integrated continence service, but also in delivering services in the community.
Caseload management: an approach to making community needs visible
Authors: McDonald Anne , Frazer Kate , Cowley Dame Sarah
Published: May 2014

Aim:

To explore the process employed in the development of a population health framework and documentation for managing community nursing caseloads.

Background:

No formal structure exists to validate and link local health information collected by Irish public health nurses to a wider epidemiological framework. Neglect of this bottom up information forfeits opportunities to resource and manage public health nursing services.

Design:

Action research methods guided the development of the framework in one geographic area in Dublin and 34 participants engaged in Stringer's (1996) Look, Think and Act cycle.

Results:

The framework identified four patient registers: family health, chronic sick/disability, older adults and acute care, which identify public health outcomes for discussion within the caseload analysis process and can predict risk factors in local populations.

Conclusions:

The use of the developed documentation identified a framework that describes caseloads in primary care and provides nurse managers with an evidence base to allocate resources, match skill mix to need, and estimate future workforce requirements.
Outpatient parenteral antimicrobial therapy: its delivery in the community
Authors: Nazarko Linda
Published: May 2014

Fifteen years ago, only a small minority of hospital inpatients were considered suitable for outpatient parenteral antimicrobial therapy (OPAT) services ( Wiselka and Nicholson, 1997 ). Now almost 70% of those treated with intravenous antibiotics as hospital inpatients are considered suitable ( Hitchcock et al, 2009 ). In total, 38–53% percent of those requiring OPAT are able to self-administer ( Hills et al, 2012 ). The demand for intravenous antimicrobial therapy is increasing and the way it is being delivered is changing. This article examines service models, setting up services and developing staff to enable them to deliver OPAT services.
The nurse's role in closing the diagnostic gap for people with dementia
Authors: Leach Katherine , Hicks Allan
Published: May 2014

Inequalities in health-care access exist for people with dementia (PWD), as reflected in regional, national and international variations in diagnostic rates. This article considers three overlapping themes that emerged from a literature search on the subject: GP competencies, confidence and belief systems; lack of awareness of dementia and different belief systems among carers; and the context of primary health care. These three themes support policy drivers on perceived barriers to achieving a diagnosis of dementia. The context of primary health care, with GPs often regarded as the first point of contact for PWD and their carers, further inhibits inclusive and equitable access to health care for all. Nurses work at the interface between the community and PWD, and are well placed to identify subtle changes during the early stage of dementia. Due to a rising ageing population, the context of primary care needs to change, utilising nurses' roles within public health and secondary prevention.
Preventing malnutrition in home-dwelling elderly individuals
Authors: Burton-Shepherd Alison
Published: May 2014

The aim of this article is to provide an overview of the role of the nurse in the identification and prevention of malnutrition in home dwelling elderly individuals. It will examine the causes and prevalence of malnutrition outlining the factors that may place older home-dwelling people at risk of developing this serious nutritional disorder. The remainder of the article will provide an in-depth focussed discussion on the role of the community nurse in the assessment and prevention of malnutrition, with recommendations for the improvement of clinical practice.
Patient safety at home
Authors: While Alison
Published: May 2014

‘The constant time pressure in hospitals has been blamed for squeezing compassion out of nurses; however, this may also be occurring within community nursing, although the evidence may be less visible.’
Exploring portable negative pressure wound therapy devices in the community
Authors: Ousey Karen J , Milne Jeanette
Published: May 2014

Case studies and clinical reviews support the use of negative pressure wound therapy (NPWT) for managing a range of wound types, yet very few scientific studies fully support its effectiveness. However, it has been argued that NPWT can provide excellent symptom management, reduce the frequency of dressing changes and provide a cost-effective alternative to traditional wound therapies due to faster healing times, leading to a reduction in overall treatment costs. Use of NPWT within community environments is increasing as length of hospital in-patient stay decreases, and many patients who would have traditionally been admitted to an acute setting with a complex or highly exuding wound are now managed by community nurses. This article presents a narrative review of NPWT, identifies safety precautions that require consideration and explores the application of smaller/disposable NPWT systems that are now available.
Principles of preventative foot care
Authors: Bateman Sharon
Published: May 2014

The lower extremities of the body, particularly the heel and ankle, are at risk of ulceration, skin tears and other forms of trauma. This is especially so in today's health-care environment, where society is faced with the challenges of an ageing population, alongside an increased incidence of diabetes, vascular insufficiency, obesity and dermatological conditions, all of which pose both clinical and economic challenges to health-care providers. Once established, damage to the foot can have a detrimental impact on the patient's overall wellbeing, often over extended periods of time, with some patients spending many years within the health-care system. Advanced wound care products tend to have a strong focus upon management of tissue damage, infection, maceration and the promotion of an optimum environment to facilitate the healing process. This clinician–patient collaboration product review challenges traditional ideals and explores the impact of using an adherent soft silicone foam dressing in maintaining skin integrity and preventing tissue damage in those high-risk patient groups.
Care of the feet: common problems and how to treat them
Authors: Nazarko Linda
Published: May 2014

Foot care can be a neglected area of care and health professionals do not always appreciate the importance of helping patients to care for their feet. Patients most likely to need this attention are the over 65s with an estimated 6.5 million older people requiring help to care for their feet (Ellis, 2006). Age related changes and chronic disease can affect the nail beds, nails can become thickened and difficult to cut.

Bunions can develop because of ill-fitting footwear. Arthritis, gout and other long-standing diseases can also affect feet. Neurological diseases such as stroke and Parkinson's disease can alter gait and lead to calluses and the development of foot problems (Nazarko, 2006). This article aims to provide guidance for healthcare assistants and assistant practitioners in the care of the feet.
New skills for HCAs: taking a blood pressure
Authors: Thornett Andrew
Published: May 2014

The NHS is changing, we can see it all around us. Work is moving from the acute sector into community care and, wherever you work as a healthcare assistant (HCA), you will be taking on roles that previously were the remit of nurses or doctors. Much of this change is driven by the desire to improve cost-efficiency in the NHS. This involves increasing the numbers of patients seen and meeting performance targets. This series will look at these new roles and explore what they mean for HCAs in the UK in the 21st Century.
Saying ‘NO’ and when it is appropriate
Authors: Vaughan Paul , Rice Matthew
Published: May 2014

As a healthcare support worker, you will often have a variety of roles to play within the healthcare setting that you work. You will often find that colleagues ask you to help out even when you are really busy. In order to maintain a healthy work-life balance and perform to the best of your abilities without taking short cuts or rushing things, it is important for you to feel comfortable with saying no. It is equally important that you recognize situations when it is important to say yes. This article provides tips and advice on how to do this effectively.
Life's not fair
Authors: Vaughan Paul
Published: May 2014

I don't know about you, but I am an avid fan of the BBC's ‘Strictly Come Dancing’. Following last years series when Spoony went out very unexpectedly the producers, no doubt under pressure from the judges, changed the voting process. This was to ensure that the best celebrity dancers were acknowledged and stayed in the programme long enough to see off the somewhat poor attempts from celebrities like Fiona Phillips or Chris Parker. But low and behold, to my horror, Gabby Logon was eliminated early on in this series despite being one of the best celebrity dancers on the show. It appears all their efforts to improve the system were in vain. Sometimes, life is just not fair!
Understanding and managing hypoglycaemia
Authors: Mulryan Chris
Published: May 2014

Hypoglycaemia is an acute complication of diabetes mellitus that has a disabling effect on the person. Being able to recognize and manage a person with hypoglycaemia is an essential skill for all healthcare assistants and assistant practitioners.
Body fluids: components and disorders of lymph
Authors: Peate Ian
Published: May 2014

The lymphatic system is a complex network of lymphoid organs that produce and transport lymph fluid from tissues to the circulatory system. The lymphatic system runs throughout the body and carries a colourless liquid called lymph. The lymphatic system plays a major part in the immune system; lymph carries a large number of lymphocytes (white blood cells). The lymphatic system drains fluid into the blood stream, lymph nodes filter lymph as it passes through, if cancer cells, for example, break off from a tumour they can become stuck in the nearest lymph node. Swollen lymph nodes can indicate infection. Lymphoedema occurs when there is swelling of a part of the body, for example, in the arm following surgery for breast cancer where the lymph nodes in the axilla (arm pit) are removed. The swelling occurs because of the obstruction to the flow of lymph.

It is important that the healthcare assistant (HCA) or assistant practitioner (AP) understands the function and flow of lymph as this can help to identify in patients potential or actual health problems. Understanding can provide the carer with information that will enable them to offer patients support. HCAs and APs have an important role to pay in assisting those who experience diseases associated with the lymphatic system.
Body fluids: components and disorders of urine
Authors: Peate Ian
Published: May 2014

This article examines the components and disorders of urine - a body fluid which can provide a wealth of information on the health and wellbeing of a patient. A skill expected of many healthcare assistants and assistant practitioners is that of testing and observing urine so it is important to have a good understanding of potential problems which may show up in urine and what to do when they are discovered.
Self-directed learning: communication
Authors: Stephenson Nina
Published: May 2014

There are many demands on the time of a healthcare support worker (HCSW), they must prioritize their workload and sometimes clear and concise communication can become a low priority, when in fact it should be a fundamental priority. Communication is the process of sending and receiving messages between two or more individuals to achieve the desired action or effect. It can be verbal (all aspects of speech) and non-verbal (body signals, including eye contact, facial expressions, posture and gestures) but usually it is not either or it is a mixture of both verbal and non-verbal. However we communicate we should also be aware of individual needs and preferences and remember that communication, both written and verbal/non-verbal, is underpinned by the legal requirement of the Data Protection Act 1998 which has eight basic principles (Office of Public Sector Information, 2008), in essence it covers the confidential storage, retrieval and handling of verbal, written and electronic information to protect the rights of the individual.
What's in a name?
Authors: Hood Adele
Published: May 2014

Support workers such as healthcare assistants (HCAs) and assistant practitioners (APs) provide valuable support to registered practitioners and patients throughout the NHS and private sectors. A myriad of titles is used for support workers and this can leave both patients and registered practitioners confused with regards to the roles of support workers with differing titles. In turn this has the potential for inappropriate tasks to be delegated to support workers because of a lack of clear titles and therefore clear role definitions. This can impact on support workers leaving them feeling demoralized and frustrated. Consolidation of role titles may in turn lead to a clearer picture of roles that are presently not reflected in a vast array of titles. This aim of this article is to explore some of the issues surrounding role titles for support workers.
An innovative approach to the development of HCSWs
Authors: Bland Rachael , Smith-Robbie Alison , Rutherford Kathryn , Kinnell Angie , Hall Sarah , Andrews Christine
Published: May 2014

The Health Care Support Workers Development Programme was implemented within West Sussex in early 2008. The evaluation of the programme has demonstrated the fundamental impact on individual professional development and service provision. This article provides an overview of the programme and includes four examples of presentations delivered by students, evidencing service improvements.
Who do you think you are? A study from Northern Ireland
Authors: Rush Thomas , Cunningham Joseph B
Published: May 2014

This article presents data from a study conducted in Northern Ireland into the titles, tasks, and training of healthcare assistants (HCAs). There is a review of the literature for core skills in ‘nursing’ care. Our findings demonstrate that the HCA role is expanding, and now includes many of the tasks once carried out by nurses, but often in the absence of training, and without regulation that would protect them and their patients. The study provokes discussion about the need for reform and proper regulation.
Who cares for the carer?
Authors: Vaughan Paul
Published: May 2014

I am just back from skiing in Courchevel, France. Sounds extravagant, especially as we are in the middle of a credit crunch but having booked and paid for it in July 2008 it appears that for once my forward planning paid off.
Paediatrics: Caring for children with type 1 diabetes
Authors: Lowes Lesley
Published: May 2014

Children with type1 diabetes receive ongoing care from a multidisciplinary paediatric diabetes team, usually in a secondary care setting. Healthcare support workers have a role in paediatric diabetes care when children attend routine clinic or are admitted to hospital at diagnosis or during periods of acute illness. In this article, the management of childhood diabetes is explored.
Nutrition part 4: anorexia of ageing
Authors: Nazarko Linda
Published: May 2014

Older people who become unwell and are admitted to hospitals are often undernourished. Poor nutrition undermines a person’s health and increases the risks of infection, falls, pressure sores and can really impair a person’s quality of life. This article explains how ageing, medication, depression and illness can lead to poor nutrition. Healthcare assistants can use strategies outlined in the article to enable older people to regain weight and health and enjoy an improved quality of life.
Long-term conditions: innovative education for HCAs
Authors: Hasselder Alison , Forte Denise , Horrex Jane
Published: May 2014

Kingston University and St George's, University of London are running an exciting new Foundation Degree in Long Term Conditions within the framework of the new South West London Academic Network (SWan) Interprofessional Institute. Based at the Faculty of Health and Social Care Sciences, the course is ideal for heath and social care staff working with people who may be living with a long-term condition such as the effects of a stroke, diabetes or heart problems. Colin-Thome (2007) has identified that over 15million people in this country report living with a long-term condition. They are conditions that cannot currently be cured, but can be managed by medication and other therapies; they can limit an individual's ability to cope with everyday activities (Colin-Thome, 2007). This foundation degree aims to educate healthcare support workers (HCSWs) to take on a new associate practitioner role with a unique skills set and specifically to enable them to care effectively for people living with long-term conditions and their carers in a variety of health and social care settings.
Look after yourself: Self-care in a culture of dependency
Authors: Wrixon Sarah
Published: May 2014

As ever greater pressure is brought to bear by the current economic climate, one simple step may yield a significant release of time and money. Leaders from primary care and the non-prescription medicines industry are in agreement that the time has come to break the national culture of dependency on the NHS, estimated to cost every general practice in England an average of £250000 annually, equivalent to an astonishing £2 billion across primary care. It also actively denies people the confidence to take control of their own, and their families' health and therefore ‘the opportunity to set up good behaviours for the longer term’ according to Dr Laurence Buckman. This paper examines the role healthcare assistants can play in helping to change this culture.
Facilitating successful transition: pre-registration adult nursing programmes
Authors: Southgate Andrew , Felstead Ian
Published: May 2014

The National Health Service Executive (1998) has promoted the secondment of healthcare assistants (HCAs) onto pre-registration nursing and midwifery programmes. Local evidence suggested some secondees were successful in practice but struggled academically. An audit was undertaken to investigate whether there was a relationship between seconded students' entry qualifications, their overall secondment interview score and academic success. Academic success within this audit was defined as passing all assignments at the first attempt. The current criteria for secondment were audited against year 1 programme outcomes, and the results demonstrated that particular packages of entry qualifications could indicate academic success. The criteria for selection were subsequently reviewed and amended.
Discrimination against disabilities: A life worth less?
Authors: Megson Denise
Published: May 2014

This article aims to provide a brief understanding of the origins of discrimination against people with disabilities. It will provide definitions of disability and discrimination and cite some examples of how people with disabilities are discriminated against. The changes in legislation from multiple statutes to a single Equality Act 2010 will be explained. The establishment of the Department of Health's Equality and Diversity Council (EDC) in 2009, with its strategic role to help the NHS improve on patient outcomes and legislation compliance, will be examined. The role of healthcare assistants and how they can be involved in making reasonable adjustments to ensure discrimination is prevented are discussed, encompassing how HCAs can help in improving patient outcomes and complying with equality duties.
Using reflective practice to ensure high standards of care
Authors: Stonehouse David
Published: May 2014

Some support workers mistakely believe that reflective practice is difficult to undertake or is only performed by staff members who are engaged in written assignments. This article aims to encourage all support workers to adopt reflective practice as an activity to be undertaken within their everyday working lives. Reflective models are discussed as well as mentoring and the use of reflective diaries and journals.
Coping with Vocally Disruptive Behaviour in Advanced Dementia
Authors: Nazarko Linda
Published: May 2014

Vocally disruptive behaviour (VDB) is a common behavioural problem found in people with dementia. It can take different forms and be provoked by a variety of different causes. It can cause great distress to care givers and others within a person's environment. Causes of VDB, including pain, internal factors and external influences, can be removed or altered to reduce the risk of it occurring. This article provides information on why VDB occurs and how it can be managed.
‘It takes two to Tango!’: communication skills for getting the best out of a consultation
Authors: Lynall Anna
Published: May 2014

A crucial element of the work of healthcare assistants (HCAs) and assistant practitioners (APs) is the ability to relate effectively to patients in a way that improves communication and facilitates an effective consultation. This article uses a Neuro-Linguistic Programming (NLP) approach to look at how we can identify what we bring as individuals to the consultation and how we can use skills to get the best out of it for the patient.
Falls: individual risk factors
Authors: Nazarko Linda
Published: May 2014

Falls and fear of falling can have a major impact on the older person’s quality of life. If we are to reduce the risk of falls and improve quality of life, we need to understand why falls occur. Falls occur because of interactions between the person, the environment and the quality of care the person receives. This article, the second in a series, examines the risk factors relating to the individual.
Continence series, part 1: continence and ageing
Authors: Nazarko Linda
Published: May 2014

Urinary incontinence is a hidden problem that is often exposed when a person requires care in hospital or at home. Staff caring for people with continence problems may not have the skills or knowledge required to help and may resort to providing incontinence aids. This article, the first in a series, aims to enable readers to understand why incontinence can develop and to use a problem-solving approach to promote continence.
Family care-givers: the role of the healthcare assistant
Authors: Barber Chris
Published: May 2014

This second article on family care-givers will focus on how healthcare assistants (HCAs) can support such care-givers within a variety of care settings, including GP practices, healthcare centres, hospital departments, hospital wards and in the care-giver's own home. Suggestions for training of HCAs who are likely to work with family care-givers will be proposed.
Hyper-acute stroke treatment: the first 48 hours
Authors: Nazarko Linda
Published: May 2014

Every year, 150000 people in the UK suffer a stroke. This works out at one every five minutes ( Townsend et al, 2012 ). Stroke is the single largest cause of disability and the third largest cause of deaths in England. Stroke costs the NHS over £2.8 billion and can lead to death or severe disability ( Mant et al, 2004 ).

The National Stroke Strategy launched in 2007 outlined a 10-point strategy to develop stroke services, reduce death and disability and to improve care ( Department of Health (DH), 2007 ; 2008 ). One of the most important aspects of stroke care is ensuring that stroke is recognised and that everyone acts quickly to preserve brain function and minimise disability.

Healthcare professionals and the public need to be able to recognise stroke and to act appropriately when stroke occurs. This article aims to enable readers to recognise acute stroke and to act quickly and appropriately when stroke occurs
Clinical governance: it's all about quality
Authors: Stonehouse David
Published: May 2014

Within this article the author will examine what clinical governance is. It will discuss some of the many different, but interlinked, components, which, when all working together, help to ensure the quality of care that individual support workers deliver, as well as the organisation as a whole.

It will use as a base for its discussion 7 of the components that make up ‘The Temple Model of Clinical Governance’ devised by the Clinical Governance Support Team.

Clinical governance is a mechanism that enables quality to be placed at the heart of everything that we do as support workers. Every patient has the right to know that the care they are receiving is of the highest possible standard and quality. It is therefore every member of staff's responsibility to work towards ensuring that quality care is being delivered.
Should a year as an HCA be compulsory for pre-reg nurses?
Authors: Glasper Alan
Published: May 2014

This article discusses the ramifications of the Government's response to the Francis report, in which secretary of state for health, Jeremy Hunt, argues that every undergraduate nursing student seeking NHS funding should first serve up to a year as a healthcare assistant (HCA). It questions if the role of the nurse mentor is pivotal in the preparation of nursing students.
Everything you wanted to know about learning disability
Authors: Barber Chris
Published: May 2014

This article, which arose out of a presentation that was delivered at the 2013 BJHCA's health care assistant's conference, seeks to give a brief overview of learning disability. Issues that are covered in this article include what learning disability is and is not, its causes and forms, how to work and how not to work with those who have a learning disability. A short list of available resources that will provide more in-depth information about various aspects of learning disability will close this article.
Cushing's syndrome: a problem of excess cortisol
Authors: Peate Ian , Holmes Edward
Published: May 2014

This article provides the healthcare assistant (HCA) and assistant practitioner (AP) with information about and understanding of Cushing's syndrome, which results from prolonged exposure to inappropriately high levels of the hormone cortisol and may bring with it significant morbidity and mortality.

An overview of the endocrine system and the various endocrine and exocrine glands is provided, along with a discussion of the role and function of the adrenal glands. The signs and symptoms of Cushing's syndrome, the investigations required to make a diagnosis, the surgical and/or drug-related treatment options, and the care and management of the person with the condition are described.

Excessive levels of the hormone cortisol (glucocorticoid) in the body cause Cushing's syndrome and there are a number of reasons why this may occur. A variety of tests and investigations will be required to establish the root cause of the excessive production of this hormone.

The HCA and AP can help to support people with the condition in a safe and effective way if they have insight and understanding of the key issues.

A glossary of terms is provided.
Making mental health as important as physical health
Authors: Peate Ian
Published: May 2014

In its January 2014 strategy, Closing the Gap: Priorities for Essential Change in Mental Health, the Government has given a commitment to make mental health as important as physical health. This article considers the many problems associated with poor mental health, including disability and premature death.

Although there are some areas of good practice in the health and social care sectors, many people with a mental illness are being let down by these services with respect to their physical health. A holistic approach, that includes physical and mental health, is necessary.

It helps if the HCA or AP is able to demonstrate an awareness of the issues that people with mental ill health face and the fact that their physical needs are being neglected.

The ambition is to improve the lives of those people with mental health problems and to promote wider mental wellbeing and this concerns all of us: mental health is everyone's business.
Alzheimer's and managers - breaking the communication block
Authors: Bosanquet Nick
Published: May 2014

At present the NHS is offering no or little service to people with mild to moderate Alzheimer's disease; 90 per cent of public spending is on institutional care with very little on prevention. But a recent symposium at the RCP showed that we were frustratingly close to a breakthrough in terms of low cost effective services.
Implementing health and safety systems
Authors: Wilson Jo
Published: May 2014

With the increase in the number of employer liability claims there is a need for all healthcare organizations to demonstrate that they can meet the requirements of NHS health and safety issues (HSG(97)6).
Public health's road to freedom
Authors: Halpern Stephen
Published: May 2014

The improvement of public health has always been at the very core of the NHS. But how to turn this goal into reality has always been fraught with problems. The election of ‘New’ Labour and the creation of a Public Health minister, Tessa Jowell, gave much encouragement to the public health lobby.
Virtual insanity or tomorrow's reality?
Authors: Harvey Trevor
Published: May 2014

Doctors, who needs them? Or at least, who values what they know? The obvious response is that we all do, but recent assertions by the cogniscenti cast doubt on this. Acknowledging the wise judgments of experience, doctor's skills of diagnosis and prescription are falling prey to advancing technology and consumer sophistication.
The crisis of 1999 - managers control pay, but demands symbolise dangerous shift in power
Authors: Bosanquet Nick
Published: May 2014

The NHS starts its ascent towards fine ideals, but is often pulled back to ground level by the realities of pressure within a huge system. The everyday frictions of waiting lists and problems in communication are accompanied by a longer term crisis. Past experience (and many thanks to Stuart Ingham for originating this hypothesis) points to a pattern of ten-fifteen year crisis with past peaks in 1963-4, 1975 and 1987. Are we moving towards the crisis of 1999?
Recent developments in renal surgery
Authors: Brambleby Peter
Published: May 2014

Kidney transplant rejection is a major problem which is distressing for the patient and expensive for the NHS. This article reviews recent developments in this fast-changing field.
Consuming health care
Authors: Cowper Andy
Published: May 2014

Another year winds itself up like a scroll. As the final few days stretch out before the festive season, managers throughout the country will be hoping that the seasonal flu remains as it is at present: mainly of the least virulent strain. The prayer must be that, if not ‘the season to be jolly’, this winter will not be the cause of misery for patients and for all the team of staff throughout the health service.
Book Review
Authors: Hunter David
Published: May 2014

It is generally accepted that Health Improvement Programmes (HImPs) are the strategic glue binding together the various components of the government's NHS reform agenda. Importantly, HImPs are not confined to health care but are intended to embrace wider notions of health and help narrow the health gap between the better off and poorer sections of society. The needs of the local population and not existing pattern of services are the starting point for HImPs.
Clickhaler: the price and the costs of asthma
Authors: Madden Vicky
Published: May 2014

We introduce the first in a new series of cost-benefit analyses. As budgetary constraints, evidence-based medicine and health economics have increasingly come to the fore in managing health care, it was felt that a series examining cost-effective solutions to common health care problems could be valuable. We open this series with a consideration of the increasingly prevalent condition of asthma.
An inspector's call: CHI's year of investigations, reviews and views
Authors: Cowper Andy
Published: May 2014

There is a strong perception that as Chief Executive, you have sought to avoid the ‘name-and-shame’ approach favoured by the Government. What are your future plans to continue developing a constructive (rather than destructive) approach?
Department's jab in the dark on MMR vaccine
Authors: Halpern Stephen
Published: May 2014

If the level of concern in the Department of Health can be measured by the number of press releases it issues, then the penultimate week of January saw the nation facing the greatest peril since the outbreak of the bubonic plague.
The balance of power has shifted against the consultants
Authors: Roth Andrew
Published: May 2014

Perhaps the consultants should take on Arthur Scargill as their consultant. If truthful, he could at least tell them that in a confrontation with the authorities, you can be victorious under certain circumstances; but undergo a calamitous defeat when the balance of power changes. When he struck in 1984, he did not realise how completely the balance of power, including the police preparations, had changed from the time of his previous, victorious challenge.
The prophet motive
Authors: Cowper Andy
Published: May 2014

Now the hurly-burly's done, managers will be looking over the lie of the post-electoral land. They are likely to do so with genuine uncertainty about the next few years. The only sure thing is that the next five years will be full–steam ahead for delivery in terms of concrete, tangible improvements in what the public experience and the media report.
Bristol bombshells will change the landscape for management
Authors: Halpern Stephen
Published: May 2014

Among the mass of recommendations emanating from the Bristol Royal Infirmary Inquiry, there are some which could transform the careers of health service managers.
‘Shape up or ship out': how to get fired (or not)
Authors: Davies Lynn
Published: May 2014

The security of tenure of senior managers has recently become yet more precarious, with various noises from the Secretary of State. This article looks at the legal and practical realities.