bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevention of falls among older patients in the hospital environment
Authors: Hayes Nicky
Published: May 2014

Falls among older inpatients are a significant cause for concern, yet currently there is no national guidance on falls prevention programmes, and little evidence from the research literature on the effectiveness of hospital prevention programmes. This article explores the unique problems associated with falls in hospital, particularly the issues related to observation and supervision of patients with cognitive impairment. The evidence base for falls risk assessment and prevention strategies is examined. An interprofessional, multidimensional approach to falls and injury prevention is suggested as the most likely approach to be effective in hospital, and the contribution of specific strategies such as exercise and hip protection are examined. Ethical issues are considered and the role of restraint in falls management is rejected. The Kings College Hospital inpatient falls prevention programme is described as a practice example of an interprofessional, multidimensional approach. Finally, the nurse's role in implementing falls prevention strategies and leading future practice development is identified.
Traumatic injuries to the head and spine 2: nursing considerations
Authors: McLeod Anne
Published: May 2014

Trauma to the central nervous system can have devastating consequences for both the person who sustained the injury and his/her family/loved ones. This article first discusses pathophysiology in relation to altered cerebral haemodynamics and changes that occur after spinal injury. Following on from the underpinning theoretical perspectives, the article reviews the nursing care and management strategies required by patients who have sustained either a traumatic head injury or acute spinal injury, with the aim of controlling secondary injury, which is preventable. This ensures the patient will have the best possible prognosis and outcome.
Changing practice: the role of the community stoma nurse
Authors: Skingley Sarah
Published: May 2014

Over the past few decades the nursing profession has recognized the need for major reforms to ensure that it meets future challenges and changes. As a community stoma care nurse, the author was given the challenge of improving stoma care education for all community nurses within the local community trust. This article describes how the community stoma care nurse established what areas of stoma care community staff felt needed updating. However, it also demonstrates that not taking time to plan or use a change tool meant that this was not an organized process and outcomes were not measurable. The article also looks at some recommendations for improving future implementation of stoma care teaching sessions.
Patients' perceptions of ߢuncertainty' in nurse practitioner consultations
Authors: Barnes Heather , Crumbie Alison , Carlisle Caroline , Pilling David
Published: May 2014

The aim of this qualitative study was to explore patients' perceptions of consulting with a nurse practitioner in situations of clinical uncertainty. Uncertainty in this context is defined as one where there is no obvious diagnosis, treatment or where the outcome of the consultation is not definite. Three general practice sites were recruited to participate. A sample of 43 patients who consulted with one of three nurse practitioners were interviewed using a semistructured schedule. The nurse practitioners identified uncertainty in 30 of these consultations; only two patients expressed any awareness of uncertainty within the consultation. The results showed that patients appear to accept that there will be a level of uncertainty in some consultations. Recognition of uncertainty within the consultation does not appearto have a negative effect on patients' perception of the nurse practitioner as they feel that the nurse will refer to a doctor if necessary.
Sexuality and sexual health promotion for the older person
Authors: Peate Ian
Published: May 2014

Being a sexual being and having sexual feelings is a part of what it is to be a human being — there are no age limits to enjoying a healthy sex life and having the ability to love and be loved. There are many misconceptions surrounding sexuality and in general these misconceptions become even more problematic as the older person and sexuality are discussed. This article aims to consider misconceptions that nurses may have about sex and sexuality concerning older people. The nurse is ideally placed to encourage the older person to discuss sexual worries and can easily correct any misconceptions. However, in order to do this effectively, he/she needs to have a good knowledge base about the topic. Nurses need to demonstrate empathy and understanding if the patient is to disclose intimate feelings concerning his/her sexual health. Information is offered that may help nurses to ensure that a truly holistic approach to care is provided to older patients. Finally, recommendations are suggested in order to act in the patient's best interests.
A study into nurses' awareness of the National Service Frameworks
Authors: Block Marc , Justham David
Published: May 2014

This study sought to demonstrate nurses' awareness of the National Service Frameworks (NSFs), which began in 1999, and are an important part of the Government's modernization strategy for the NHS. A questionnaire was sent, in 2002, to a systematic random sample of 228 nurses. The results were analysed for descriptive and comparative statistics using the computer software Statistical Package for the Social Sciences (SPSS), and the nurses questioned showed a low to moderate level of awareness. A quarter of nurses had not heard of the NSFs before receiving the questionnaire, and of those who had, only half had tried to find out more information. Despite high readership of nursing journals and good internet use, nurses did not think it was their responsibility to use such sources to find out about the NSFs, considering rather that management should provide study days and workplace teaching. While this outlook may be at odds with the concepts of lifelong learning and professional responsibilities as outlined by the Nursing and Midwifery Council, it is suggested that formal mechanisms of dissemination of reforms need to be implemented if nurses are to participate fully in them.
The management and care of people with stoma complications
Authors: Burch Jennie
Published: May 2014

There are a variety of complications that are associated with stomas. These are described and their causes explained. A number of solutions are presented and advice that the nurse can give is offered. Some of the complications are commonly seen by the nurse, such as sore skin, whereas others are rare, such as an allergy to the stoma appliance. There may be sexual dysfunction after surgery, which may be temporary or permanent. These and many other potential problems are elaborated upon to aid the nurse when caring for people with stomas.
Palliative care in the management of chronic obstructive pulmonary disease
Authors: Blackler Laura , Mooney Caroline , Jones Christine
Published: May 2014

Chronic obstructive pulmonary disease (COPD) is a slow, debilitating, progressive disease and, as symptoms worsen, quality of life is affected and issues surrounding end of life arise. There are known difficulties about the healthcare professional's ability to manage this area and this is reflected in the literature. It is recognized that palliative care services for people with non-malignant diseases are not developed but this needs to be addressed. Within a London teaching hospital the COPD team has been working towards improving the standard of service offered to patients with advanced COPD using various strategies. The team's approach to this area of care focuses on quality of life by recognizing when an individual may need further support, and patients have reported that they feel their needs are being addressed. This article aims to review current evidence on the management of palliative care for patients with COPD and identify what steps have been taken by a London teaching hospital to address this issue.
Caring for patients with hemiplegia in an arm following a stroke
Authors: Goulding Rosie , Thompson Debbie , Beech Chris
Published: May 2014

The patient's arm affected by hemiplegia is a common problem following a stroke. The term hemiplegia is a limited physiological description of the effects of a stroke on a patient's limb. Any nurse involved in the care of stroke patients must possess essential knowledge on the pathophysiology of hemiplegia and its subsequent treatment and care management programmes. This article reviews the stroke literature for patients with arms affected by hemiplegia. It describes common complications that may arise and subsequent preventive care management strategies that need to be considered. Finally it discusses why success in rehabilitation and recovery programmes need to be considered from the patient's perspective and measured in the context of the patient's experiences and feelings of wellbeing.
Evaluation of Urgotul plus K-Four compression for venous leg ulcers
Authors: Smith Jacqueline , Hill Jayne , Barrett Simon , Hayes Wendy , Kirby Pamela , Walsh Sally , Gittins Eleri , Whitehurst Fran , Cooper Robin
Published: May 2014

In this non-comparative clinical evaluation, 36 subjects with venous leg ulcers, 85% of which were indolent or deteriorating, were treated with Urgotul® lipidocolloid wound dressing and the K-Four® multilayer compression bandaging system for 12 weeks or to healing — whichever occurred first. Results show that Urgotul® was an ideal dressing in combination with K-Four®, being easy to apply (98.7%) and remove (98.1%), and largely pain-free (95.6%) and non-adherent (99.7%). In a patient group of ‘hard-to-heal’ ulcers, 50% of the ulcers healed within the treatment period. Ulcers not healed after 12 weeks achieved almost 50% area reduction on average. The treatment combination proved safe, with only one of seven adverse events reported being probably related to the products used. This study supports the use of a combination of Urgotul® dressing and K-Four® compression to provide a ‘matched’ treatment for venous leg ulcers.
Chronic obstructive pulmonary disease: non-pharmacological approaches
Authors: Booker Rachel
Published: May 2014

Chronic obstructive pulmonary disease (COPD) is a progressive, smoking-related, chronic disease that eventually impacts on every area of the lives of the patient and his/her family and carers. The nature of the disease — chronic, irreversible airflow obstruction — limits the impact of drug therapy, particularly as the disease progresses. Increasing breathlessness on exertion saps confidence, reduces self-esteem and produces dependence. In addition, frequent exacerbations utilize health service resources. Non-pharmacological approaches, such as pulmonary rehabilitation, together with lifestyle advice that enables patients to help themselves manage exacerbations, maintain independence and quality of life and make the most of life with COPD can benefit both patients and the health service.
Exploring common deficiencies that occur in record keeping
Authors: Dimond Bridgit
Published: May 2014

This article discusses many of the common mistakes which occur in record keeping including absence of clarity, failure to record action taken to meet an identified problem, missing information, significant spelling mistakes and failures in communication. It also considers some of the lessons on record-keeping standards which can be drawn from reports of the Health Service Commissioner (Ombudsman).
New attempts being made to change doctors' attitudes
Authors: Castledine George
Published: May 2014

It is difficult to change the way in which doctors behave, particularly in Britain. There have been some attempts (Irvine, 2003), but overall many medical professionals still treat patients and other members of the healthcare team in a patronizing manner.
Caring for minority ethnic older people in nursing care homes
Authors: Mold Freda , Fitzpatrick Joanne M , Roberts Julia D
Published: May 2014

This article aims to identify best practice guidance in relation to caring for minority ethnic older people in UK care homes that provide nursing care, highlighting key issues and identifying gaps that require redress. Current best practice guidance focuses on client issues, such as the recognition of cultural preferences, and organizational issues, such as workforce and the environment. However, while there is some best practice guidance regarding the care of minority ethnic older people in care homes, it is not sufficiently explicit. The article concludes by suggesting key strategies to help address the needs of minority ethnic older people in care homes.
Psychological considerations in gastrointestinal nursing
Authors: Williams Julia
Published: May 2014

Body image changes and psychological adaptation are often associated with patients who have gastrointestinal disease due to the potential alteration to physical appearance through the very nature of the disease process or treatment. This article describes some of the psychological issues highlighted by patients with gastro-intestinal disease, including loss of bowel control, withdrawal and concealment. It highlights altered image difficulties and adaptation through the patients' journey and treatment with illustrations from patients' narratives. In doing so, it explores the nurse's role and stresses the necessity for nurses to seek training to become skillful in counselling this group of patients towards exploring and identifying their individual psychological problems.
Exercise: who needs it?
Authors: Blaber Amanda Y
Published: May 2014

Nurses will be involved in delivering the UK Government's Choosing Activity: a physical activity action plan (Department of Health, 2005), so it is important to ensure that nurses benefit from the implementation of this policy. It is accepted that in some areas of nursing, the daily routine can be physically and mentally demanding; all the more reason to examine lifestyle and the benefits of exercise. This article considers some factors that may affect nurses' physical and mental health. The potential value of the Healthy Workplace Award Scheme is discussed and some recommendations are made about future strategies that employers could adopt or develop to give nurses the opportunity to improve their physical and mental well-being within the workplace. These opportunities could improve nurses' health and impact on the care nurses' provide.
The management of ballistic trauma: an infection control perspective
Authors: Lines Laurence D
Published: May 2014

This article discusses the relationship between ballistic trauma, clostridial contamination and potential wound infection and considers the implications for care by nurses and infection control teams. An overview of ballistics is presented followed by an examination of the pathophysiology of wounding and its effects. The philosophy of war surgery is balanced against civilian concepts and the differing management strategies that prevail. It explores the causes of, and relationship between, wound contamination and the seriousness of wound infection. Nurses, inexperienced in dealing and caring for these types of patients, should be aware and understand the beliefs, arguments, and controversies that surround ballistic trauma management. By so doing, nurses and infection control teams will be able to provide an enhanced level of holistic nursing care.
Importance of the appropriate selection and use of continence pads
Authors: Hampton Sylvie
Published: May 2014

Urinary incontinence is becoming an increasingly common problem for older men and women living in the community. It can have a deleterious effect on quality of life and, although advances have been made in treatments and therapies for this condition, there is still confusion over selection of continence products. This article will explore the problems associated with product selection and discuss alternative advice.
Mental capacity and professional advice in a patient with dysphagia
Authors: Dimond Bridgit
Published: May 2014

This article considers the implications of a dispute between a speech therapist and other health professionals over whether a patient suffering from dysphagia should be allowed to take liquids by mouth. The right of the patient to act contrary to professional advice is discussed. The patient cannot insist that a health professional acts contrary to his or her professional judgment. The article also considers the law if the patient were to lack mental capacity.
How successful is the dual diagnosis good practice guide?
Authors: Laker Caroline
Published: May 2014

Evidence from the US shows that integrated treatment programmes for dually diagnosed patients are more successful than parallel treatment programmes. In the UK the Dual Diagnosis Good Practice Guide (DDGPG, 2002a), advocates a move towards an integrated system of care delivery. However, the paucity of evidence in the UK and the entrenched nature of the established mental health and addictions services means that current policy is derived from limited information and is struggling to address the process of change. By definition, dual diagnosis is a complex interaction between a range of mental health and substance misuse problems leading to difficulties in allocating appropriate skill mixes to teams. Ethical and legal issues in the mental health services cause conflict with the treatment concepts for substance misuse. The advent of the DDGPG is positive, but there is a clear need for further work in this area.
Alternative management of complex wounds and fistulae
Authors: Renton Sandra , Robertson Isabell , Spiers Mary
Published: May 2014

The management of complex wounds and fistulae can often prove challenging to even the most skilled clinician. The incidence and complexity of fistulae vary considerably from centre to centre, however they often lead to prolonged hospital stays. Routine admissions for 4–5 days may lead to 4–5 months in the event of fistulae formation. Thus, many patients experience not only compromized physical health, but also complex psychological problems. This article provides a brief overview of the challenges and developments of managing a complex wound with multiple fistulae and a pictorial illustration of an innovative alternative wound management system.
Nurses' perceptions of providing advice via a telephone care line
Authors: Störm Mayvor , Marklund Bertil , Hildingh Cathrine
Published: May 2014

The provision of advice over the telephone in the health service has become more common in the Western world and in Sweden this task is allocated to nurses. There are several million calls a year to the medical care telephone helpline. Nurses answer the calls, provide advice and direct the flow of patients to the most appropriate treatment level. The aim of this study was to describe how nurses perceive their job of providing telephone advice to patients. Interviews with 12 nurses were analyzed using a phenomenographic approach. The nurses perceived their work as stimulating, autonomous and challenging. They also felt exposed because extensive knowledge is required and there is a risk of being criticized, as they are in a front-line position. Nurses who are responsive, determined and not anxious about their prestige can carry out the work well, provided they have a good level of self-awareness. Personal qualities and the confidence of superiors make even an exposed position with considerable requirements manageable.
Irritable bowel syndrome: quality of life and nursing interventions
Authors: Smith Graeme D
Published: May 2014

Irritable bowel syndrome (IBS) is a functional bowel disorder. It is one of the most common gastrointestinal diseases diagnosed in medical practice and can account for up to 50% of referrals to gastroenterology outpatient clinics. IBS remains a poorly understood and mysterious medical condition. Individuals can suffer from abdominal pain and abnormal bowel function for unexplained reasons and the impact of these symptoms can have a detrimental affect on health-related quality of life. In this article the incidence, causes, diagnosis and management of IBS are addressed. Specific attention is given to the nursing role in the management of this chronic condition.
Daniel's story: self-injury and the case study as method
Authors: Lovell Andrew
Published: May 2014

This article explores the value of case study methodology as a means of investigating the relationship between people with learning disabilities and self-injury. One life story might appear to be of limited value in this regard; however, it is argued that it might not only be of use in demonstrating the development of an isolated self-injuring career, but there may also be insights into its entrenchment in the lives of others. The telling of one story might serve as a filter, through which the interventions of medication, mechanical restraint and behaviourism can be observed over time. Furthermore, studying one life in some detail might be used to illustrate broader concerns about the context of the transition from institutional to community care. The restrictions of such an approach are acknowledged, particularly in the telling of a story where the main character's words cannot be heard, but maybe that is also the point of undertaking research about those at the margins of society.
Funding decisions in chronically sick individuals
Authors: Waldron Nicola
Published: May 2014

This article examines current research, literature and government policy that influences how health funding is allocated for treatment and care of the chronically sick. Chronic disease represents a hugeburden of ill health in the UK and a substantial cost to the NHS. With both an increase in the ageing population and advancing technological developments giving doctors the theoretical ability to sustain the most fragile life, the issue of providing unlimited access of care to the chronically sick within financial limitations is clearly untenable. This article explores the issue of funding the needs of the chronically sick while posing a significant challenge both politically and financially to the healthcare system. It examines the controversial policies of rationing implemented by various governments since the conception of the NHS. Some have proved unworkable, all have been controversial, and still the challenge remains to provide a comprehensive care package with limited resources. The issue of how to ration resources to the chronically sick remains unresolved. Social gerontologists predict that living to 120 years of age may become the norm before the end of this century. Exploitation of the genome map and society's unwillingness to accept the inevitability of disability resulting from chronic illness will further increase pressure on healthcare financing and, as a result, demands will be forever increasing despite the most rigorous attempts at rationing.
Anti-embolism stockings: are they used effectively and correctly?
Authors: Cock Karen Anne
Published: May 2014

Anti-embolism stockings are widely advocated in the prevention of deep vein thrombosis. But do they do more harm than good? This article explores the effectiveness of this intervention and the possible link with heel pressure ulceration, an increasing problem which costs the NHS millions of pounds and causes suffering to patients. With the aid of an audit tool the author assesses nursing knowledge and reveals that, although there is a high level of understanding regarding post-application care, the appropriate initiation of the intervention and subsequent documentation of this intervention are severely lacking, leaving the health profession wide open to litigation.
Best interests. An holistic approach: Part 2(b)
Authors: Fullbrook Suzanne
Published: May 2014

In the last article principles and guidelines were discussed that related to the ways in which nurses have to work with the best interests of their patients in mind. Where a person is ordinarily capable of consenting to or refusing to consent to, a proposed course of treatment or care but has temporarily lost that capacity, there are certain legal guidelines to follow to ensure that the minimum interventions occur until the person regains their capacity to act in their own interests. However, also highlighted was that that certain people have never attained capacity, or do not yet have capacity or have lost capacity on a permanent basis. For these people, there are legal principles that are incorporated in the Mental Capacity Act and these have to abided by. This article is dedicated to a review of the situation where, sadly, a person has been assessed as not being legally competent to make their own health decisions. However, where a programme of treatment and care has been clinically proposed, the person refuses to co-operate. The situation of enforced treatment and care is a delicate one. Staff have to be aware of the legal principles that apply, with reference to the Mental Capacity Act.
Advanced breast cancer: aetiology, treatment and psychosocial features
Authors: Banning Maggi
Published: May 2014

Breast cancer is a common form of cancer in women of varying age. Due to the relationship between breasts, sexuality and reproduction, this form of cancer has an interconnected psychological and psychosocial influence on the wellbeing of women. Current understanding of the aetiology and pathogenesis of the disease has evolved as evidence supporting a role for genes such as the HER2 gene has emerged. HER2-positive breast cancer is a particularly progressive form of the disease as a result of its ability to differentiate and spread. Trastuzumab (Herceptin) forms part of the current treatment for this form of breast cancer; albeit costly, it has been shown to improve survival rates in women. For this reason it is now a recommended treatment for early-stage breast cancer. During and after treatment cycles, the breast cancer nurse and medical practitioners should be available to provide emotional support and advice on the manifestations of the disease, coping strategies and how breast cancer patients manage close family relatives
The management of venous thromboembolism in cancer patients
Authors: Dolan Shelley , Fitch Margaret
Published: May 2014

Venous thromboembolism (VTE), encompassing deep venous thrombosis and pulmonary embolism (PE), is a common complication of cancer and an important cause of preventable mortality in people with cancer. Because VTE can be clinically silent, fatal PE generally occurs without warning, and preventive measures are, therefore, necessary in high-risk patients. Clinical guidelines recommend the use of low-molecular-weight heparins in the treatment and prevention of VTE in patients with cancer, in addition to non-pharmacological interventions aimed at reducing thrombotic risk. Nurses have an important role in helping to identify patients at risk of developing VTE, and in the implementation of preventive or therapeutic regimens, and monitoring the development of complications. Furthermore, nurses are in an ideal position to educate patients on the importance of preventive measures and to help ensure compliance with thromboprophylactic interventions.
Nutrition in pregnant teenagers: how can nurses help
Authors: Derbyshire Emma
Published: May 2014

Teenage birth rates in the UK are some of the highest in Europe. This article summarizes how the diet of pregnant British teenagers is currently inadequate and may impact upon maternal and infant health in the short and long term. The review highlights the value of an adequate diet during teenage pregnancies and explains how specific nutrient requirements can be met.
Carbon footprint - is the NHS the corporate Bigfoot?
Authors: Foss Tara D
Published: May 2014

What happens when we wake up to the world around us? Are we scared about what could be coming up to harm us? Do we sit and hope that the ‘bad stuff’ will just pass by? Who among us peeks around the corner with the sheer excitement of a new way of seeing the world?
Advance directives and implications for emergency departments
Authors: Jones Sian , Jones Bridie
Published: May 2014

What are the implications of caring for patients with advance directives in emergency care contexts? This paper examines legal and professional perspectives and highlights the challenges that practitioners face. Emergency care contexts necessitate the need for timely decision making regarding care and treatment options. Fundamental to the decision-making process is the need to take into consideration the wishes and preferences of the patient. Advance directives are expressions of choice. They are also legally binding documents and represent the wishes of a patient, but often with little prior knowledge of the patient, practitioners may be unsure whether to act on an advance directive. This paper makes some attempt to examine key components of this debate.
Nursing management of the person with diabetes mellitus. Part 2
Authors: Nair Muralitharan
Published: May 2014

Diabetes mellitus (DM) is a syndrome of a relative or absolute lack of insulin resulting in hyperglycaemia. Patients with type 1 diabetes need insulin to regulate their blood glucose levels, while for patients with type 2 diabetes, weight loss and dietary management may be sufficient in controlling blood glucose levels (Porth, 2005). People from black and ethnic minority groups are six times more likely to develop the condition than their white counterparts (Department of Health, 2005a). Department of Health guidelines (2005a) give clear guidelines for healthcare workers in caring for patients with diabetes. There is no known cure for diabetes, however management of patients with diabetes include dietary management, physical activity, oral antidiabetic agents and insulin regimen. Care can also be complex as some of the patients may suffer from other long-term conditions, such as coronary artery disease. Part 2 of this article discusses the nurses’ need to adhere to the National Institute for Clinical Excellence guidelines (2002a, 2004) in the management for type 1 and type 2 diabetes.
Clinical skills: cardiac rhythm recognition and monitoring
Authors: Sharman Joanna
Published: May 2014

With technological advances, changes in provision of healthcare services and increasing pressure on critical care services, ward patients’ severity of illness is ever increasing. As such, nurses need to develop their skills and knowledge to care for their client group. Competency in cardiac rhythm monitoring is beneficial to identify changes in cardiac status, assess response to treatment, diagnosis and post-surgical monitoring. This paper describes the basic anatomy and physiology of the heart and its conduction system, and explains a simple and easy to remember process of analysing cardiac rhythms (Resuscitation Council UK, 2000) that can be used in first-line assessment to assist healthcare practitioners in providing care to their patients.
Renal care: six essentials for a haemodialysis patient
Authors: Chamney Melissa
Published: May 2014

Once the filtration rate of the kidney falls below 10ml/minute a patient will require haemodialysis treatment sessions typically three times per week to remove waste products and excess fluids. Due to the obvious change in life circumstances the patient will require clinical intervention and usually quality psychosocial support. Therefore, several areas have to be included in the nursing care plan to provide a complete treatment strategy. Access to the blood is provided through a surgically created access and this must be monitored regularly for adequate function and signs of infection. With little or no renal function fluid will accumulate in the body and there are a number of clinical signs that need to be recognized that are involved in determining the patient’s correct hydration status. The interpretation of routine observations such as weight and blood pressure is vital to the fluid removal strategy and antihypertensive drug therapy. The patient’s diet should also be carefully controlled avoiding foods with high sodium, potassium and phosphate content while ensuring adequate protein intake and vitamin supplement where necessary. Most patients require several or more medications throughout their life on haemodialysis and this requires a well organized care plan for medication administration.
The information needs of men with breast cancer
Authors: Iredale Rachel , Williams Buddug , Brain Kate , France Elizabeth , Gray Jonathon
Published: May 2014

The information needs of men with breast cancer are under-researched. This article uses questionnaire data from 161 men with breast cancer, and in-depth interview data from a sample of 30 of these men, to explore perceptions of information needs and how best to meet these needs. These men typically received verbal information or written information in the form of leaflets or booklets. Generally this information was helpful, was pitched at about the right level and contained the right amount of information, but was of variable relevance given that it had not been developed specifically for men. Men with breast cancer would benefit from receiving gender-specific information, given the limitations of existing information sources. Of all healthcare professionals, breast care nurses were described as being most helpful in terms of providing both information and practical support.
Fundamentals of pain management in wound care
Authors: Coulling Sarah
Published: May 2014

Under treated pain can result in a number of potentially serious sequelae (Australian and New Zealand College of Anaesthetists, 2006), including delayed mobilization and recovery, cardiac complications, thromboses, pulmonary complications, delayed healing, psychosocial problems and chronic pain syndromes. This article considers pain management in the context of painful wounds. An international comparative survey on wound pain (European Wound Management Association, 2002) found that practitioners in the wound care community tend to focus on healing processes rather than the patient’s total pain experience involving an accurate pain assessment and selection of an appropriate pain management strategy. Procedural pain with dressing removal and cleansing caused the greatest concerns. An overview of simple, evidence-based drug and non-drug techniques is offered as potential strategies to help minimize the experience of pain.
A phenomenological hermeneutic study into unseen chronic pain
Authors: Clarke Kathryn A , Iphofen Ron
Published: May 2014

Acute pain is often accompanied by physiological changes, such as increased heart rate, unlike chronic pain, which in sharp contrast is often unaccompanied by any physiological changes other than the patients’ self report of pain. Coupled with the lack of physiological changes, chronic pain will outlive the usual healing period if an injury has been sustained thereby leading to the unseen nature of the chronic pain phenomenon.This study (n = 8) adopted a multi-method approach – a low-structured interview coupled with patients’ diaries – and was analysed hermeneutically. ‘Unseen pain’ was identified as a category with subsequent themes of ‘isolation’, ‘needing to prove the existence of chronic pain’, ‘in their head’ and ‘depression’. The unseen nature of the chronic pain phenomenon caused further distress to patients as they could feel disbelieved by society as well as by healthcare professionals. This has a profound effect on patients who then channel valuable psychological resources into appearing credible to society and healthcare professionals in particular. The lack of clear explanations and a definitive diagnosis or acceptable label also adds to the invisible nature of the chronic pain phenomenon and as healthcare professionals we need to confirm the validity of the expressed pain narrative through means that do not enforce illness behaviour, but empower the patient to accept their chronic pain and live with it rather than be ruled by it.
Interpretation and knowledge of human rights in mental health practice
Authors: Dickens Geoffrey , Sugarman Philip
Published: May 2014

The Human Rights Act is sometimes misunderstood as being an obstruction to the provision of safe and effective mental health care, allowing patients to cry ‘human rights abuse’ too easily. In reality, however, little is known about how human rights are protected and promoted in psychiatric care. This article provides an overview, for nurses, of how human rights are currently understood to be protected in mental health care and steps that could improve the protection of rights. Additionally, an overview of the relevant case law is presented to enable nurses to understand how human rights law is ever-evolving, how cases may be interpreted, and the implications that this has for mental health nursing practice.
Advanced nursing practice and Newton’s three laws of motion
Authors: Sturgeon David
Published: May 2014

This article considers the reasons for the development of advanced practice roles among nurses and other healthcare professions. It explores the implications of financial constraints, consumer preferences and the development of new healthcare services on the reorganization of professional boundaries. It makes use of Sir Isaac Newton’s three laws of motion to demonstrate how professional development in nursing has taken place in response to a number of external influences and demands. It also considers the significance of skill mix for the nursing profession, in particular the development and likely expansion of the physician assistant role. The application of different professionals and grades within a healthcare team or organization is central to the Government’s Agenda for Change proposals and nurses have successfully adopted a number of roles traditionally performed by doctors. Nurses have demonstrated that they are capable of providing high quality care and contributing directly to positive patient outcome. Advanced nursing roles should not only reflect the changing nature of healthcare work, they should also be actively engaged in reconstructing healthcare boundaries.
The art of auscultation: evaluating a patient’s respiratory pathology
Authors: Ferns Terry , West Susan
Published: May 2014

This article considers national policy drivers promoting the development of advanced assessment skills and practical procedures for the safe and effective use of the stethoscope in the clinical area. The evidence base underpinning effective use of the stethoscope in clinical practice is explored, including the preparation of the patient and the environment, applying infection control policies, and placing an emphasis on privacy and dignity. This is followed by a practical guide to auscultation technique of the respiratory system for nurses developing advanced practice skills.
Infant hospitalization and breastfeeding post-caesarean section
Authors: Chertok Ilana R , Shoham-Vardi Ilana
Published: May 2014

Background: Breastfeeding has been shown to protect infants from illness, but there is minimal published research on the relationship between illness and breastfeeding following caesarean delivery. Aim: To examine the association between post-caesarean breastfeeding and infant hospitalization in the first year of life. Study design and methods:A retrospective cohort study of 468 term infants examined the relationship between infant hospitalizations and breastfeeding, using hospital admissions records and surveys from a post-caesarean breastfeeding intervention study in an Israeli hospital. Results: A significantly lower proportion of Jewish infants breastfed for at least 4 months (40%; 42) was hospitalized in the first year, compared with non-breastfed infants (60%; 62) (P= 0.003). Among the Muslim infants who were breastfed, a significantly lower proportion were hospitalized (33%; 35) than those who were not hospitalized (67%; 71) and a greater proportion of non-breastfed infants were hospitalized (80%; 8) than those who were not hospitalized (20%; 2) (P= 0.005, Fisher’s exact test). In the logistic regression models, the significant variables decreasing the likelihood of hospitalization for Jewish infants were being born to a non-immigrant mother, higher maternal education, and being breastfed, and for Muslim infants the only significant variable was being breastfed. Clinical implications: Breastfeeding in post-caesarean women has a protective effect on infant health, as demonstrated by a decrease in illness-related hospitalizations in the first year of life.
Venepuncture practice and the 2008 Nursing and Midwifery Council Code
Authors: Lavery Irene , Smith Emma
Published: May 2014

This article explores the new Nursing and Midwifery Council Code (2008) in relation to venepuncture and, through analysing each clause, will present key considerations for good practice. The skill of venepuncture is discussed and, using a scenario, will review the technique and the impact of the Code on the practitioner. Any clinical skill requires safe and competent practice; it is hoped that this article will aid practitioners involved in undertaking venepuncture to reflect on their skills and knowledge, and to review best practice.
Neurogenic continence. Part 1: pathophysiology and quality of life
Authors: Pellatt Glynis Collis
Published: May 2014

There are a number of neurological conditions that cause bladder and bowel problems in the form of neurogenic bladder and bowel dysfunction. Both have a considerable impact on a person’s quality of life. Nurses have an important role to play in supporting patients when considering the options available to manage their neurogenic bladder and bowel problems. This article is the first of a series of three. Part 1 outlines the physiology of micturition and defecation. It discusses the pathophysiological changes in neurogenic bladder and bowel in spinal cord injury, spina bifida, multiple sclerosis, stroke and acquired brain injury, cerebral palsy, Parkinson’s disease and diabetes mellitus. The psychosocial impact of this neurogenic dysfunction is addressed. Part 2 discusses the physical and psychosocial issues related to the management of neurogenic bowel dysfunction, and part 3 goes on to discuss the physical and psychosocial management of neurogenic bladder dysfunction.
The missing link: paediatric to adult transition in diabetes services
Authors: Jones Susan E , Hamilton Sharon
Published: May 2014

Childhood diabetes is a chronic and life-changing condition requiring careful management by clinicians, the child and family. During childhood, care is provided by the paediatric team, which is then transferred to the adult diabetes team during adolescence. This literature review identified five themes in the literature: adolescence as a time of transition; adolescent needs during transition; barriers; facilitators; and models of transition. Key findings suggest that the transition process remains problematic with a gap between paediatric and adult services being identified, including significant differences in clinical practice and culture. Although there is a growing body of knowledge around the reasons behind this phenomenon, research into effective models of transition to address these problems is still lacking. A period of managed transition between the two services has been recommended, with evidence that the nurse has the potential to develop a coordinating role, to assist in bridging the gap between paediatric and adult services.
The dichotomy of nurse education
Authors: Karstadt Lyn
Published: May 2014

Nursing and midwifery education has evolved over the past few decades, leaving many in the profession — as well as education — slightly confused as to what is going on. In her ongoing column, Lyn Karstadt discusses Lord Darzi’s Next Stage Review report and how it heralds a significant change in the investment in education for newly qualified nursing staff.
Collaboration in developing a protocol for nurse-led seroma aspiration
Authors: Warren Melissa
Published: May 2014

A seroma is a serous fluid collection which may develop in the space between the chest wall and skin flaps following breast cancer surgery with axillary lymph node dissection. Seroma formation following mastectomy is most common. This article aims to produce a protocol for nurse-led seroma aspiration in collaboration with the breast multidisciplinary team and describe the four main steps involved in the development. It was important to develop a protocol for nurse-led seroma aspiration to enable the breast cancer clinical nurse specialist (CNS) to practice confidently and safely in an extended area of practice. The protocol will assist the breast cancer CNS by providing clear and specific guidance. CNSs considering developing a protocol for seroma aspiration should involve all relevant members of the breast multidisciplinary team. Breast cancer CNSs must be trained in seroma aspiration and undergo clinical supervision. Only when deemed competent, should nurse specialists provide a seroma aspiration service independently. Patient satisfaction with the nurse-led seroma aspiration service should be evaluated by clinical audit at an early stage.
Malnutrition and the older adult: care planning and management
Authors: Dunne Annette
Published: May 2014

Malnutrition is a major problem in the UK, which frequently goes unrecognized and untreated. It impacts on patients’ quality of life, increases length of stay in hospital, and overall increases the risk of unsuccessful outcomes in treatment. Effective management of malnutrition and related conditions aims to correctly screen and identify the presence of malnutrition through the use of a validated nutrition screening tool and address underlying deficiencies through adapting food choices, food fortification or initiation of proprietary nutritional supplements. This article discusses the prevalence of malnutrition, the role of screening and practical steps towards improving nutritional management in older people.
Huntington’s disease. Part 2: treatment and management issues in juvenile HD
Authors: Aubeeluck Aimee , Brewer Helen
Published: May 2014

Juvenile Huntington’s disease (JHD) is a rare condition, with only about 5-10% of Huntington’s disease cases occurring in individuals under the age of 20 years. Symptoms of JHD include, for example, rigidity, stiffness, awkawrdness in walking, and speech difficulty. JHD is caused by an inherited gene mutation that is localized to the short arm of chromosome 4. There is no cure for the condition, and it is currently managed through symptomatic treatment and supportive care. Being an inherited condition, those involved in the care of a child with JHD need to be aware of the impact that the disorder will have on the whole family