bluuebunny/crossref_metadata_2025 huggingface dataset:
Contact at the borderline: psychoanalytic psychotherapy with EB patients
Authors: Moss Kate
Published: May 2014

Against expectation, the experience of setting up a psychotherapy service for adult epidermolysis bullosa (EB) patients at St Thomas’ Hospital in London has been that take up is slow and wary. Prior indications from the wider team were that need is high. This may reflect differences in the experience of need on the part of patients and staff. Published research on the psychosocial aspects of EB is minimal. This article proposes a type of genetic trauma particular to this patient group. It then examines some clinical psychodynamics with regard to the capacity of some severely affected patients to experience and acknowledge feelings such as love and need. Some aspects of the psychological significance of the skin as an organ of the body will be discussed, with particular reference to what happens when it goes wrong.
Flatus, odour and the ostomist: coping strategies and interventions
Authors: Williams Julia
Published: May 2014

Both new and established ostomists fear the loss of control over their bodily function that stoma surgery brings about. They often express feelings of embarrassment and isolation as they try and adjust to their new lifestyle. Quality-of-life studies often highlight flatus and odour to be two of the top five fears or worries among ostomists. This article reviews the current literature offering an insight into how flatus and odour impacts on an ostomist’s life and considers interventions to assist the nurse in aiding the ostomist through this period of adaptation.
Managing chronic venous leg ulcers with zinc oxide paste bandages
Authors: Parboteeah Sam , Brown Allyson
Published: May 2014

Chronic venous leg ulcers are a major problem for patients as they affect the quality of life in terms of their ability to work, self-esteem and daily activities of living. It is therefore imperative for practitioners to plan interventions based on the current best evidence available for the treatment of venous leg ulcers. Currently, the best practice recommended for the management of chronic venous leg ulcers is compression bandaging. However, this therapy has not been successful in a minority of patients as they have continued to suffer physical and psychological problems as a result of ulcers that fail to heal. This article discusses the management of patients suffering from recalcitrant venous leg ulcers with the use of zinc impregnated paste bandages as a primary dressing. These case studies have shown that wound healing can be achieved when using zinc oxide paste bandages (Viscopaste PB7) as a primary dressing in the management of difficult to heal venous leg ulcers.
Exploring the concept of moist wound healing and its application in practice
Authors: Benbow Maureen
Published: May 2014

The concept of a moist wound environment for optimal healing has been promoted since the early 1960s. With few exceptions, improved healing rates, less painful dressing changes and better quality scarring result from wounds treated with dressing products that manage exudate effectively. An understanding of how wounds heal is necessary to both predict and anticipate how they will react to different dressing products so knowledge of those dressing products is essential.
Quality of life, exudate management and the Biatain foam dressing range
Authors: Kirby Pam
Published: May 2014

Wound care has become very complicated. For years, wound care practitioners have deliberated over the characteristics of what constitutes the ‘ideal dressing’; more recently, the need to prepare the wound bed before it can begin to heal has become evident, including the importance of biotechnological innovations, such as growth factors and chemical mediators, to alter the composition of the wound in an attempt to produce the ideal wound healing environment. There has also been a shift in focus to try and improve the psychological and social needs of patients; to address the patient holistically rather than separating them from their wound. Many studies have looked at quality of life, most concentrating on pain, although there are other factors to address, such as malodour and leakage leading to loss of sleep, depression and social isolation. This article discusses how the new Biatain range hopes to address some of these issues, matching products to patient symptoms and problems.
RETRACTED: Comparison of three peripherally inserted central catheters: pilot study
Authors: Giacomo Michele Di
Published: May 2014

Peripherally-inserted central catheters (PICCS) are non-tunnelled, central catheters inserted through a peripheral vein of the arm. They are 50–60 cm long and are usually made of either silicone or second-third generation polyurethane. PICCs can be used for prolonged, continuous or intermittent infusion therapies (up to 3 months) both in hospitalized patients and in patients treated as outpatients, in a hospice, or at home. When establishing a vascular service it is key to select a PICC that meets the requirements of safety, cost-effectiveness, high resistance (ability to take increasing fluid volumes with high pressure devices) and durability, and low complications rate. The complications and dwell times of three different PICCs were studied: coated polyurethane, valved silicone and powerinjectable. The study was conducted at the chemotherapy suite at the author’s hospital with the aim of selecting the right PICC based on low incidence of complications, resistance and enhanced dwell time. Results show a low incidence of complications and long dwell time among patients with the power-injectable PICC. Furthermore, this study demonstrated a reduction on the rate of occlusion and rupture with power-injectable PICCs, which makes them safer to use for administration of chemotherapy and other vesicant agents, as well as for the management of patients in critical care.
Variations in aseptic technique and implications for infection control
Authors: Marie Aziz Anne
Published: May 2014

Healthcare-acquired infections (HAIs) are a serious concern, costing the NHS £1 billion a year and causing 5000 deaths annually despite increased funding. A contributing factor is the variety of aseptic techniques in use in different hospitals and even within a single hospital. These cause problems for healthcare workers as well as increasing the risk of HAI. This article examines a number of traditional approaches to aseptic technique, highlighting their differences and the implications for infection control. It concludes that improvement in aseptic technique could be achieved by implementation of a single unified approach to aseptic technique that can be standardized and audited annually, such as the aseptic nontouch technique (ANTT), which has been recommended for adoption throughout the UK. It ends with suggestions for measures that could be introduced and strengthened to improve aseptic technique, and ultimately reduce the rate of HAI.
Experiences of ward-based nurse prescribers in an acute ward setting
Authors: Goswell Natasha , Siefers Rhian
Published: May 2014

A plethora of literature is written about non-medical prescribing, directed towards community nurses, specialist or advanced practice roles. There is a lack of literature, however, regarding the use of non-medical prescribing with the open formulary in the acute ward setting. The experiences of two nurses reveal that non-medical prescribing is a valuable addition to patient care within the acute cardiac ward setting. It ensures that patients receive timely access to medications. This article reveals that the development of nonmedical prescribing develops through clinical experience and with it, professional and clinical competence. Non-medical prescribing has been an invaluable addition to ward-based holistic patient care. It has ensured safety is maintained, and supported multidisciplinary working for the benefit of patients. It also provides the opportunity to develop service provision further.
Unlocking the misery of childhood atopic eczema
Authors: Van Onselen Julie
Published: May 2014

Atopic eczema, even in its mildest form, is not trivial disease. The overall prevalence of childhood atopic eczema in Europe is 15–20% in 7–18 year-olds (Hoare et al, 2000). Incidence of atopic eczema is highest in children under 18 months, with rates of 21% in the first six months of life and 11.2% between 6–18 months (NICE, 2007). These figures represent a two-to-three fold increase in atopic eczema over the past 30 years (Hoare et al, 2000), resulting in more children suffering from this debilitating and largely underestimated skin condition. Children and parents find dealing with eczema on a daily basis challenging and difficult to cope with. This was expressed by a parent in response to a survey by Oilatum® Junior in conjunction with the National Eczema Society (NES) as ‘total despair – the world doesn’t understand we don’t cope – it rules us out’ (NES, 2008).
An evaluation of a competency tool (Niche) to develop nursing assistants
Authors: Whittingham Katrina
Published: May 2014

As UK society changes, with people living longer and with chronic conditions, and less people available of working age to provide nursing care, there is a need to re-think how healthcare is organized and delivered. This is likely to have an affect on the non-registered component of the health-care workforce. However, if patient safety is to be maintained, it is paramount that the competence of individuals taking on roles that were carried out by trained staff must be ensured. This pilot study of a competency tool, National Incremental Competencies in Healthcare Education (Niche), demonstrated that individuals could expand or change their role as a result of completing the educational package. The evaluation aims to examine the usefulness of this competency tool in preparing nursing assistants to take on new roles and meet patients’ needs.
The birth of new professional organisation
Authors: Castledine George
Published: May 2014

Now, more than ever, there is a need to advocate and protect professional nursing practice. This may seem a strange statement given the recent announcement from the Prime Minister, Gordon Brown, of a Commission on Nursing. However, over the past few years I have become more concerned and worried about nursing’s future direction and feel that at the moment no one in particular cares about the subject I have devoted my life to exploring, researching, understanding and implementing.
Stroke research questions: a nursing perspective
Authors: Rowat Anne , Lawrence Maggie , Horsburgh Dorothy , Legg Lynn , Smith Lorraine N
Published: May 2014

Background: stroke is a national research priority. However, in the literature there is still minimal systematic investigation of stroke nursing – especially practice. The aim of this study was to explore stroke nurses’ research priorities through a series of focus groups. Method: the study was qualitative and involved focus groups (n = 7) with registered nurses working in stroke care settings and who were members of the Scottish Stroke Nurses Forum. Data were analysed to identify conceptual categories, which were found to relate to the categories defined by Kirkevold (1997) and Booth (2001). Results: five priority areas for stroke nursing were described: preventive/conserving; supporting/consoling; restorative; integrative; and service structure/systems. Conclusion: by consulting stroke nurses it can be ensured that future research truly reflects the nature of nursing care and is of particular relevance to stroke nursing practice. The development of research evidence-base in stroke nursing will lead to increased knowledge, a better quality of care and ultimately better outcomes for patients.
Impact of childhood chronic illnesses on siblings: a literature review
Authors: O’Brien Irene , Duffy Anita , Nicholl Honor
Published: May 2014

Background: Childhood illness can have a significant impact on families, particularly on the ill child’s siblings. There is a dearth of published literature focusing on the needs of siblings of ill children. Aim: This literature review aims to provide an overview of the current healthcare literature in relation to the impact of childhood chronic illness or disability on siblings. Method: A literature review was undertaken by searching the databases CINAHL, PsycINFO, ProQuest and Cochrane Library for relevant articles in English using the search terms: ‘siblings’, ‘chronic illness’, ‘disability’, ‘cancer’, ‘sibling relations’, ‘sibling adjustment’, ‘coping’, ‘family-centred care’, ‘sibling interventions’, ‘camps’, ‘autism’, ‘Down’s syndrome’. Seventeen research studies in total were reviewed. Results: This review focuses on three sibling groups related to children suffering from autism, cancer and Down’s syndrome, and are discussed under the following headings: sibling adjustment; family functioning and sibling’s coping resources; and intervention programmes. Conclusion: The literature revealed that siblings of children with Down’s syndrome were well adjusted to living with their brother or sister. However, there was conflicting information on the adjustment of siblings of children with cancer and autism. An awareness of the harmful effect that living with childhood illness and disability can have on some siblings is essential to enable healthcare professionals to provide supportive interventions to protect siblings’ physical and emotional wellbeing.
Electroconvulsive therapy and nursing care
Authors: Kavanagh Adam , McLoughlin Declan M
Published: May 2014

Modified electroconvulsive therapy (ECT) is a controlled medical procedure in which a seizure is induced in an anaesthetized patient to produce a therapeutic effect. ECT is the most acutely effective treatment available for affective disorders and is more effective than antidepressant drugs. Although in use for 70 years, ECT continues to attract controversy and there is considerable stigma associated with its use that often overshadows the empirical evidence for its effectiveness. One way to overcome this is for health professionals to be educated about contemporary ECT practice. Patients need to make informed decisions when consenting to ECT and this process can be influenced by preconceived ideas and scientific fact. It is, therefore, essential that nurses possess sufficient information to help patients make rational and informed treatment decisions and be able to care for both the clinical and psychological needs of patients treated with ECT. This review outlines the nursing role in ECT and summarizes the main aspects of contemporary ECT practice relevant to general and psychiatric nursing practice.
Blood transfusion: implications of treating a Jehovah’s Witness patient
Authors: Effa-Heap Gladys
Published: May 2014

Jehovah’s Witnesses believe that an individual’s life is contained within blood, and that accepting transfusion of blood and blood products is sinful. The administration of blood to a Jehovah’s Witness who has refused to accept transfusion may lead to criminal or civil proceedings. From an ethical viewpoint, if a rational adult who has been fully apprised of the consequences of not receiving this treatment persists in a refusal, the decision should be respected. Medical and nursing staff faced with such a problem should explore fully with the patient any transfusion alternatives that the patient might find acceptable, such as cell salvage, volume expanders, antifibrinolytics and pharmaceutical options, such as erythropoietin. This article examines the legal and consent issues around blood transfusion in Jehovah’s Witness patients and their implications for medical and surgical management.
National olicy and sexual health of men who have sex with men
Authors: James Philip
Published: May 2014

Nurses continue to play a crucial role in helping to deliver the Department of Health’s 10-year National Strategy for Sexual Health and HIV (DH, 2001) and the Government’s White Paper, Choosing Health (DH, 2004). Both policies aim to reduce the transmission of sexually transmitted infections (STIs) and the prevalence of undiagnosed cases. However, over the past 10 years the rate of newly diagnosed STIs among men who have sex with men (MSM) has increased by 77% (Health Protection Agency, 2007). Genitourinary medicine (GUM) clinics have long been popular with MSM owing to their provision of non-judgemental services, and are increasingly becoming nurse-led. However, the relative underfunding of GUM clinics and the pressures placed on nursing staff to reach waiting time targets has called in to question the quality of service provided. Concurrently, potential contributors to poor sexual health among MSM, including the deeprooted effects of homophobia and low self-esteem, continue to be overlooked in the fight against rising STIs. Despite the Government’s pledge to transform sexual health services with £300 million extra funding, there has been little significant improvement in the sexual health of MSM. Poor stewardship of resources and poor management of service targets arising from current policy contribute to a negative impact on the sexual health of MSM and the quality and effectiveness of nursing care.
An audit of bedrail use and implications for practice
Authors: Shanahan Denise , Evans Alison
Published: May 2014

Bedrails are used extensively in both the hospital and community care settings to protect vulnerable people from falling out of bed. However, there is evidence of indiscriminate bedrail use and some inadvertent use of bedrails as a form of restraint, which in turn may compromise patient safety, dignity and autonomy. This article describes a night-time bedrail audit undertaken in one integrated NHS trust to determine the numbers and types of bedrails in use, the patient demographic, locations where bedrails were used and, importantly, why staff decided to use them. The information collected was used to inform local policy development and improve practice. The implications of the audit findings for practice are discussed, and a new decision aid for the use of bedrails is presented.
Prevention and management of needlestick injury in Delhi
Authors: Patrick Simon Lucy
Published: May 2014

Needlestick and sharps injuries are the most common cause by which blood borne pathogens are transmitted between patients and health-care workers. A study was conducted to assess the knowledge and existing practices of staff nurses regarding needlestick injuries (NSIs) and evaluate the effectiveness of guidelines developed for the prevention and management of NSIs in a selected government hospital of Delhi. The study revealed that 70% of staff nurses had sustained NSI. The majority 24 (68%) got NSI with a hollow-bore needle. There was lack of awareness among staff nurses regarding prevention and management of NSIs. Among the nurses who sustained NSI, the majority (71%) did not report it. The developed guidelines regarding prevention and management of NSI was found to be effective in enhancing the knowledge and improving the practices of staff nurses. It is useful for British nurses to be able to compare their experience of NSI with that of nurses in Delhi, to see if lessons can be learnt that can be applied British nursing.
The role of nurses in the management of women with pelvic organ prolapse
Authors: Hagen Suzanne , Richardson Karen , Glazener Cathryn , Stark Diane
Published: May 2014

Pelvic organ prolapse is a common female complaint, with 50% of women experiencing some degree of pelvic relaxation, although not all have any symptoms. Prolapse is found most commonly in the anterior vaginal walls. Posterior vaginal wall and apical prolapse are the other, less common, categories. There are a large number of potential risk factors, but increased age, parity and body mass index are most consistently reported. A variety of symptoms may be experienced, including a feeling of something coming down, pelvic heaviness, urinary, bowel and sexual dysfunction. Two main treatment options exist, conservative management (pessary or pelvic floor rehabilitation) or surgical repair, however the evidencebase for treatment is weak. The specialist nurse is well-placed to contribute to the initial assessment, management and ongoing support of women with prolapse.
Who should teach clinical skills to nursing students?
Authors: Mackenzie Katherine M
Published: May 2014

Nurse education has traditionally relied on clinical placements to provide nursing students with the ‘hands-on’ experience that is not possible to teach in a classroom setting. However, with changes to the NHS this is becoming increasingly difficult, with fewer resources available and issues of patient safety to consider. Hennman and Cunningham (2005) recognize there is a significant gulf between the theoretical component taught in the classroom and the complex realities of clinical practice. Cave (2005) has suggested the move into higher education has hindered rather than helped the linking of theory and practice in nurse education, because many nurse teachers are far removed from clinical practice and therefore no longer competent or clinically credible to be able to teach up-to-date clinical skills. In Scotland the Practice Education Facilitator’s role in integrating theory with practice is essential for both the NHS Trusts and higher education institutes. It would appear that these clinicians are the lynchpin between linking university work with the harsh realities of daily practice. If nurse education is to provide effective clinical skill simulation then it must also provide effective teachers who are up to date with current practice. In many cases this will not be the nurse teacher.
Peristomal MRSA: a case study
Authors: Keely Fiona , Williams Julia
Published: May 2014

This article shares clinical skills and knowledge through the use of a case study. Prolonged peristomal soreness had led to the loss of independence in a patient with a newly formed stoma due to the unrecognized bacterial infection of meticillin-resistant Staphylococcus aureus (MRSA). By considering this case scenario, the article will explore the assessment of peristomal MRSA and reflect upon its management.
Issues in irrigation for people with a permanent colostomy: a review
Authors: Varma Sarah
Published: May 2014

Colostomy irrigation is a way of achieving faecal continence and is offered as an alternative method of stoma care management to wearing and emptying a colostomy appliance. This article summarizes an extensive literature review carried out to determine the benefits of irrigation to colostomists and barriers to its uptake. Colostomy irrigation is a method of stoma care management offering ‘control’ over bowel habit thus assisting the colostomist in the adjustment and adaptation towards their new way of life.
Mepilex®> Ag: an antimicrobial, absorbent foam dressing with Safetac®> technology
Authors: Barrett Simon
Published: May 2014

his article examines the role of a unique dressing—Mepilex®> Ag—that incorporates the rapid and sustained antimicrobial action of ionic silver with the benefits of Safetac®> soft silicone adhesive technology. The combined attributes of each component of this dressing allow both the control of pain and infection to be achieved simultaneously. This dual approach to the management of wounds is of significance since the evidence suggests that wound infection and the release of pro-inflammatory modulators result in both local pain and delayed healing. In this respect the control and treatment of pain is as important as the treatment of infection itself. A review of the clinical evidence relating to Safetac technology clearly demonstrates that it can be used to prevent dressing-related trauma, minimize pain at dressing change, and control exudate when used on a wide range of wound types and skin injuries. In combination with silver, this technology has been shown in in-vitro studies to have an almost instant and sustainable antimicrobial effect on a broad range of pathogens associated with delayed healing. Finally, in small clinical and case studies, Mepilex Ag has been shown to control wound bioburden and improve healing rates.
Prevalence of bone loss in a population with cystic fibrosis
Authors: Robertson Julie , Macdonald Kath
Published: May 2014

The adverse effect of an increased life expectancy for people with cystic fibrosis (CF) is the increased risk of complications, such as CF-related low bone mineral density (BMD). Diagnosis of CF-related low BMD is confirmed by a dual-energy X-ray absorptiometry (DXA) scan. This study reports the results of an audit of DXA scans in 108 adults with CF in our clinic. The most common risk factors for bone loss were vitamin D deficiency (89%), CF-related diabetes (53%), low body mass index (39%) and post-lung transplant (25%); half of those with bone loss were genotype homozygous DF508. Overall fracture incidence was 5.5%; low BMD was not associated with high fracture rates. Thus BMD may not be a good predictor of fracture risk. Treatment includes bisphosphonates, which are difficult to take and have uncertain long-term effects. It is unknown whether bisphosphonate therapy is justified in this already overburdened group.
Long-term causal meaning of myocardial infarction
Authors: Baldacchino Donia
Published: May 2014

This descriptive exploratory study conducted between 2000 and 2007 aimed to explore patients’ search for causal meaning of myocardial infarction across the first 5 years of recovery. Qualitative data were collected by audio-taped interviews with 70 patients. This paper discusses patients’ interpretations of the cause of their illness guided by Frankl’s theory of Logotherapy and Existential Analysis. Research demonstrates that the sudden onset of a life-threatening illness appears to trigger a search for causal meaning, in an attempt to find an answer to the question, ‘Why me?’ The three themes found across time were determining the cause, finding fate- or faith-related causal meaning for their illness, and understanding the personal significance of illness. These findings corroborate with Frankl’s Theory, whereby individuals’ beliefs can give meaning to their illness and life. Causal meaning may enable persons to change their attitude to life, including their unavoidable suffering. Recommendations were set in order to increase awareness among nurses and health professionals and bridge the gaps in the current clinical practice in hospitals and community
Venous thromboembolism prophylaxis: the role of the nurse
Authors: Findlay John , Keogh Michael , Cooper Louise
Published: May 2014

Venous thromboembolism is the most common preventable cause of hospital death, with surgical and medical patients at a significantly increased risk. It is estimated that, without prophylaxis, it occurs in 20% of general medical and surgical patients, and 40–60% of orthopaedic patients. It accounts for 25-times greater mortality than meticillin resistant Staphylococcus aureus (MRSA). Despite overwhelming evidence advocating the routine use of thromboprophylaxis, provision is persistently deficient. It has been demonstrated that involvement of the nursing profession in initiatives to improve provision is important and effective. Recent years have seen the nursing profession continue to evolve and take the lead in a number of areas of preventive medicine, and to develop specialist nursing roles. The authors believe that this drive must be harnessed so that the profession can enact the routine provision of thromboprophylaxis to patients
Brief interventions: a useful tool for stroke nurses
Authors: Lawrence Maggie
Published: May 2014

Fear of recurrence is common following stroke, and stroke patients are keen to identify the cause of their stroke (Townend et al, 2006; Lawrence, 2010). If patients can identify a cause, they can be empowered to take appropriate action that may help to prevent stroke recurrence. A recent, large-scale, international case-control study has identified five risk factors that account for more than 80% of the global risk of all stroke (ischaemic and intracerebral haemorrhagic), namely hypertension, current smoking, abdominal obesity, diet, and physical activity (O’Donnell et al, 2010). Stroke nurses have a key role to play in the identification and assessment of risk factors, including lifestyle risk factors, following stroke, and they are ideally placed to initiate early health promotion strategies, in the form of brief interventions (Lawrence et al, 2009).
Thromboprophylaxis awareness among hospital staff
Authors: Gao Fangfei , Kause Juliane
Published: May 2014

Aim: Following the introduction of thromboprophylaxis risk assessment tools at Southampton University Hospitals Trust in April 2008, this audit aimed to assess the level of understanding for correct thromboprophylaxis use for patients among hospital staff within the trust. Methodology: 50 members of staff, including doctors, nurses and pharmacists, chosen at random, were surveyed using a questionnaire. They were asked whether they thought venous thromboembolism was a problem among hospital patients; their awareness of the current prevention tools in the trust; whether they complete the assessment labels in patients’ admission notes; and whether they have seen incorrect use of thromboprophylaxis and had they taken appropriate action to correct the errors. Outcomes/Results: The authors found that while the general level of awareness for thromboprophylaxis is good within the organization, compliance with the Trust guidelines was inadequate at 32%, resulting in high levels of inappropriate thromboprophylaxis use which is poorly recognized by staff. In particular, there is a lack of participation from nursing staff owing to a lack of motivation and confidence. Only half of the doctors surveyed completed thromboprophylaxis assessment labels on patients’ admission notes; all were junior doctors. Pharmacists were generally better at recognizing and correcting errors in thromboprophylaxis prescription compared with doctors. Conclusions: It is clear from this audit that staff knowledge and attitudes to thromboprophylaxis must be improved further by reinforcing educational programmes for both medical and non-medical health professionals. A thromboprophylaxis lead should be appointed for each professional group to ensure efficient monitoring. Teaching should be extended to patients to ensure individualized care for all.
Promoting excellence in children’s nursing practice
Authors: Horsley Angela , Battrick Cath
Published: May 2014

The Association of Chief Children’s Nurses (ACCN) welcomes the decision by the BJN to publish regular articles of interest to children’s nurses. The ACCN is a group of senior nurses representing children’s and young people’s services across the four countries of the UK. The principle aim of the Association is to help inform decision-making with regard to children’s and young people’s nursing. In this regard, the ACCN seeks to influence national policy concerning the care of children and young people. The ACCN operates a philosophy whereby the whole is greater than the sum of its parts. It is designed, particularly, to be helpful to colleagues who may be lone voices for sick children and young people in their organization.
Self-management is key for long-term conditions
Authors: H Wilson Jo
Published: May 2014

The increase in the prevalence of long-term conditions (LTCs) represents a growing challenge to healthcare systems worldwide, with LTCs now accounting for more than half of the global disease burden. The World Health Organisation (WHO) predicts that LTCs will become the main worldwide cause of death and disability by the year 2020. More than 3 in 10 people in England suffer from at least one LTC. Long-term conditions are illnesses such as diabetes, asthma, heart failure, dementia, schizophrenia, rheumatoid arthritis, COPD, asthma, multiple sclerosis and motor neurone diseases.
Using competences and competence tools in workforce development
Authors: Green Tess , Dickerson Claire , Blass Eddie
Published: May 2014

The NHS Knowledge and Skills Framework (KSF) has been a driving force in the move to competence-based workforce development in the NHS. Skills for Health has developed national workforce competences that aim to improve behavioural performance, and in turn increase productivity. This article describes five projects established to test Skills for Health national workforce competences, electronic tools and products in different settings in the NHS. Competences and competence tools were used to redesign services, develop job roles, identify skills gaps and develop learning programmes. Reported benefits of the projects included increased clarity and a structured, consistent and standardized approach to workforce development. Findings from the evaluation of the tools were positive in terms of their overall usefulness and provision of related training/support. Reported constraints of using the competences and tools included issues relating to their availability, content and organization. It is recognized that a highly skilled and flexible workforce is important to the delivery of high-quality health care. These projects suggest that Skills for Health competences can be used as a ‘common currency’ in workforce development in the UK health sector. This would support the need to adapt rapidly to changing service needs.
The NHS needs to listen harder and learn more from complaints
Authors: Tingle John
Published: May 2014

John Tingle discusses the Parliamentary and Health Service Ombudsman’s (HSO) first annual report on complaint handling in the NHS in England
Restraining children for clinical procedures: a review of the issues
Authors: Hull Ken , Clarke Dave
Published: May 2014

The aim of this discussion is to explore the issue’s procedural restraint of children raises for nursing staff caring for children, from both a policy and a research perspective. Specifically the discussion defines the various terms that describe the process of restraint and proceeds to examine the issues that continue to challenge nursing practice in this area: the professional and policy context; professional considerations; parental perceptions; and involvement. Whilst recognizing the difficulties faced by student nurses when involved in restraint. The pivotal role played by the child’s nurse will determine the quality of the service experienced; whilst acting as the child’s advocate they are the health professional most directly involved in care. The discussion closes by highlighting the main issues nurses face when deciding to restrain and child and thoughts for future practice.
Does patient experience correlate to the experiences of NHS staff?
Authors: Glasper Alan
Published: May 2014

Professor Alan Glasper looks at the recent Institute for Health Services Effectiveness report, which gives much evidence to support the claim that positive patient experiences do not mean an overstretched and unhappy workforce, quite the contrary.
Signposting the road to quality nursing care delivery
Authors: Glasper Alan
Published: May 2014

Professor Alan Glasper looks at Department of Health’s new ‘Nursing Roadmap for Quality’ document, which highlights the vital contribution that nurses make to healthcare.
Clinical update on hormone replacement therapy
Authors: Holloway Debra
Published: May 2014

There has been much change concerning the menopause in clinical practice, research and prescribing since the 1990s, with conflicting information and uncertainties. The use of hormone replacement therapy (HRT) has declined and women have often stopped taking it with no discussion with healthcare professionals. The uncertainties have led to confusion for healthcare professionals and women alike, with some women being denied HRT when it would be appropriate for them to take it, and others taking alternative or complementary therapies when there is little or no information on their efficacy. This article aims to give an update on HRT, what it is, why women take it and alternatives to HRT, including lifestyle advice.
A pilot study to test an intervention for dealing with verbal aggression
Authors: McLaughlin Sue , Bonner Gwen , Mboche Catherine , Fairlie Trish
Published: May 2014

Verbal aggression has been defined as communication with an intention to harm an individual through words, tone or manner, regardless of whether harm occurs. It includes verbal threat to harm, ridicule, openly hostile remarks, unjust persistent criticism, shouting or yelling insults, as well as more covert actions such as spreading hurtful rumours (Cox, 1987; Farrell et al, 2006). Receiving verbal aggression from a patient has been closely associated with psychological distress which may negatively affect work performance. A verbal aggression work book was developed to help nursing staff to deal with verbal aggression from patients in clinical practice. This was piloted over a six-week period with 18 nurses working on one acute psychiatric inpatient ward. Findings revealed that the intervention had some promising effects. However, much more attention needs to be paid to changing attitudes towards verbal aggression.
A pilot intravenous cannulation team: an Irish perspective
Authors: Carr Peter J , Glynn Ronan W , Dineen Brendan , Kropmans Thomas JB
Published: May 2014

Peripheral intravenous cannulation (PIVC) is a potentially painful and distressing procedure for patients, and is traditionally carried out by medical personnel. A university hospital in Ireland was chosen to initiate a pilot intravenous (IV) cannulation team, to ascertain whether this procedure could be performed effectively by a team of nurses. The team was introduced to support the implementation of the European working time directive (EWTD). A team of four registered general nurses, led by a senior phlebotomist, provided PIVC. Request books were placed on each ward and data was recorded before and after each insertion. A constantly increasing percentage of first-time cannulation success is displayed from the first five months of the study. In-depth analysis on an orthopaedic ward reveal a preference for distal site insertion and routine change at 72 hours. IV teams performing IV cannulation can effectively reduce insertion rate attempts, and potentially offer a solution to the manpower issues arising as a result of implementation of the EWTD.
The pathogenesis of infection and immune response
Authors: Weston Debbie
Published: May 2014

An understanding of the pathogenesis of infection, and the complex and fascinating ‘relationship’, or interaction, between the infecting organism and the host are advantageous when caring for patients with infections/infectious diseases, particularly as many of the clinical features of infection are as a consequence of the defence mechanisms mounted by the immune system. This article aims to provide a brief overview of the pathogenesis of infection, explaining how the two branches of the immune system, the innate/natural immune response, and the adaptive/acquired immune response, mount an attack against invading bacteria. Reference is made to bacteria such as Staphylococcus aureus, Clostridium difficile, Streptococcus pyogenes, Neisseria meningitidesand Mycobacterium tuberculosis, and their effect on the human host and the immune response, through the processes of attachment/entry, evasion of host defences, replication, and damage to the host.
Urinary tract infection: diabetic women's strategies for prevention
Authors: Litherland Anne Torine
Published: May 2014

Urinary tract infection (UTI) is a common problem in the female population. Women with diabetes mellitus are possibly at a higher risk. The usual medical therapy for UTI is antibiotic treatment. The aim of this study is to explore strategies employed by diabetic women for prevention and self-treatment of UTI. Forty-two women with diabetes mellitus who had experienced at least one episode of UTI in the last six months were included. Data collection included background information, questions about prevention and self-treatment strategies and a clinical examination to measure maximal urine flow, residual urine, a blood test evaluating diabetic control (HbA1c) and a urine test strip for determination of glucose, leucocytes, nitrite, blood, protein and pH. Thirty-five participants (83.3%) reported changes in daily routines like ‘always keeping warm’, ‘increased fluid intake’, ‘good personal hygiene' as prevention strategies. Different herb and plant extracts were used for prevention by twenty-three participants (54.5%). Among the twenty-three (54.5%) participants who used self-treatment strategies when they noticed symptoms of UTI, intake of cranberry tablets or capsules was most common. Better knowledge of strategies for prevention and self-treatment of UTI may reduce distress and discomfort for women at risk.
The Capsaicin 8% Patch For Peripheral Neuropathic Pain
Authors: England Janice , Wagner Till , Kern Kai-Uwe , Roth-Daniek Andrea , Sell Angela
Published: May 2014

Neuropathic pain is thought to affect up to 8% of the adult population in the UK. The condition can severely impact on patients' quality of life and can be difficult to treat. The capsaicin 8% patch has been developed to directly target the source of peripheral neuropathic pain and has been shown to provide pain relief for up to 3 months from a single 30- or 60-minute application. Adherence to the capsaicin 8% patch application procedure is important to achieve effective treatment. The authors are a group of health professionals experienced in using the capsaicin 8% patch. In this article the authors describe the optimal patch application procedure from their real-world clinical experience and provide recommendations on how to optimize the therapeutic benefit of the patch. Other key aspects of the application procedure are also addressed, including the importance of patient management, the ideal treatment setting, the best way to manage application-associated discomfort and post-treatment care. The observations and learning that the authors have gained from their clinical experience with the capsaicin 8% patch will help others to maximize the benefit gained with this novel treatment option.
The role of the clinical nurse specialist in MS: a literature review
Authors: Corry Margarita , McKenna Martina , Duggan Marguerite
Published: May 2014

The purpose of this review was to determine the role of nurse specialists in multiple sclerosis (NSMS) in providing care for carers of people with multiple sclerosis (PwMS). The databases searched from inception to April 2010 include: CINAHL, PsycINFO, British Nursing Index, PubMed, AMED, Nursing and Allied Health Source, Academic Search Complete, Cochrane Library Database, Web of Knowledge, Ovid Nursing Database, Social Science Index, and Joanna Briggs Institute. Eighteen articles were included in the review. However, only three research-based articles were found that evaluated the role of the NSMS. The remaining articles were discussion-based and provided insight into the contribution of the NSMS to service provision. The review highlights the continuing lack of research evaluating the impact of the role of the nurse specialist in multiple sclerosis and in particular, the lack of recognition of the support role that nurse specialists provide for carers of PwMS.
Osteoporosis among young adults with complex physical disabilities
Authors: Grainger Michelle , Dilley Carol , Wood Neil , Castledine George
Published: May 2014

This study set out to explore the possible link between osteoporosis in people under 40 years of age, who have complex physical disabilities and live in long-term care facilities. A range of information was obtained from the participants including their bone mineral density (BMD). The results confirmed that immobility is associated with low BMD, and those who are fed using a percutaneous endoscopic gastrostomy (PEG) tube are particularly at a higher risk of low BMD. The study findings helped to change the evidence-based care pathway for patients with complex physical disabilities, and the physiotherapy and manual handling they receive.
Comorbidity in modern nursing: a closer look at heart failure
Authors: Rushton Claire A , Satchithananda Duwarakan K , Kadam Umesh T
Published: May 2014

Comorbidity, which is the experience of other disorders or diseases in addition to an index condition, is common in older patients and is set to increase as the population ages. Comorbidity impacts on both clinical management and patient self-care, resulting in poorer patient outcomes in terms of mortality and morbidity. This article explores these issues in the context of heart failure, a condition that falls disproportionately on older people and where comorbidity is the norm rather than the exception. In heart failure comorbidity impacts on the diagnosis and management of patients and adversely impacts on their self-care activities, including symptom recognition, lifestyle modifications, drug adherence and contact with health professionals. Over the past decade health care has become preoccupied with national, standardized guidelines and single disease pathologies. Nursing as a profession has developed along this trajectory with increasingly disease-targeted specialist roles. It is time for health care to broaden its focus onto the patient as a whole, and for nursing to reestablish its professional roots in a holistic approach.
Developing leadership in nursing: the impact of education and training
Authors: Curtis Elizabeth A. , Sheerin Fintan K. , de Vries Jan
Published: May 2014

This is the second of two articles on developing leadership in nursing; this article explores the role and impact of training and education on nursing leadership. Nursing leadership education has been identified as much needed, and can be provided by universities (at Masters, diploma and certificate levels), healthcare organizations or hospitals. Research demonstrates that where leadership has been effectively taught and integrated into nursing, it has a positive impact on nurses' leadership skills and practice. It is suggested that healthcare organizations continue to develop and support leadership training, while also seeking ways of maintaining and promoting leadership development in practice.
Vesicant chemotherapy extravasation management
Authors: Schulmeister Lisa
Published: May 2014

Extravasation is a potentially harmful complication of vesicant chemotherapy administration. Although nurses strive to prevent extravasations from occurring, they cannot always be prevented. Vesicant chemotherapy extravasations must be promptly detected and appropriately treated in order to reduce the severity of tissue destruction that occurs when vesicants inadvertently enter the tissue. Recently approved treatments have demonstrated safety and efficacy, and have enabled patients to maintain their skin integrity and adhere to their planned chemotherapy treatment schedules. Nurses need to be knowledgeable about advances in extravasation management so that they can provide optimal care to patients receiving vesicant chemotherapy.
Incidence and predisposing factors of phlebitis in a surgery department
Authors: Furtado Luís Carlos do Rego
Published: May 2014

This paper reports on a study conducted to determine the incidence of phlebitis related to peripheral cannulae, and its predisposing factors in a general surgery department. Phlebitis is a serious health problem that affects a large proportion of hospitalized patients receiving intravenous therapy. A data collection tool was developed based on the previous literature and was completed between 15 October and 30 November 2010 in a general surgery department. All patients with peripheral cannulae who fulfilled the inclusion criteria, and who agreed to participate in the study where monitored. This was a quantitative study, which used descriptive, inferential, and correlational analysis. A total of 171 patients and 286 peripheral cannulae were monitored. The average incidence of phlebitis was 61.5%, and factors such as diabetes and tobacco consumption were identified as relevant to the development of phlebitis. Other elements identified as predisposing to the development of phlebitis include administration of potassium chloride, the dwell time of the peripheral cannula, and the anatomical location of the cannula. Phlebitis associated with peripheral cannulae is still a current problem requiring knowledgeable staff who can prevent, recognize and act appropriately in a timely manner to minimize its severity.