bluuebunny/crossref_metadata_2025 huggingface dataset:
Issues surrounding professional portfolio development for nurses
Authors: Bowers Susan J , Jinks Annette M
Published: May 2014

This article discusses issues that underpin professional portfolio development for registered nurses. The findings were informed by a review of the pertinent literature. The literature was obtained by undertaking searches of a number of electronic databases and hand searches of key journals. It was found that portfolio development has been a requirement for reregistration for a number of years. However, there appears to remain confusion and uncertainty among professionals regarding the meaning and implications of portfolio development for nurses. For example, in the review conducted, the terminology used was often found to be confusing and expectations of how a portfolio should look are unclear. Conclusions can be drawn that practitioners may be in a quandary of how to develop and present evidence in what is now a mandatory requirement for reregistration, the maintenance of a professional portfolio.
Nursing Record/British Journal of Nursing archives, 1888–1956
Authors: Lorentzon Maria
Published: May 2014

This article centres on the experience of using a new database comprising a digitized historical journal — the Nursing Record/British Journal of Nursing from 1888 to 1956, when the journal ceased publication. The project was initiated by the UK Centre for the History of Nursing, a collaboration between a number of academic bodies, including the Wellcome Trust and the Royal College of Nursing (RCN). The database was launched at Oxford in September 2003 and is freely available via the RCN website. The database was searched for material concerning emotion, as there has been increasing interest in this topic among service professionals, including nurses, during the past few decades (Hochschild, 1983; Smith, 1992; James et al, 2003). It seemed interesting to explore the same topic, as discussed in the late 19th and first half of the 20th centuries. Search terms used were ‘emotion’, ‘feeling’, ‘sympathy’, ‘comfort’ and ‘compassion’. Most hits were achieved with ‘sympathy’ and ‘feeling’, but the majority of these were not strictly relevant to the discussion. This pilot search indicates that hand searching of paper copies still represents the ‘gold standard’, in terms of identifying relevant material and interesting context data, not necessarily found when feeding specific search terms into a computer. The main advantages of the digitized journal are much wider access to this source and protection of fragile archival material.
Using bladder instillations to manage indwelling catheters
Authors: Pomfret Ian , Bayait Frances , Mackenzie Rona , Wells Mandy , Winder Ann
Published: May 2014

Indwelling urinary catheters are commonly used in both acute and primary care settings but patients often experience problems with blockage of the catheter as a result of encrustation. Bladder instillations of differing solutions are used in at attempt to prevent and treat this problem of encrustation. This article looks at some of the issues surrounding the use and methods of use of these solutions. Based on an audit performed by a group of continence clinical nurse specialists in five areas of the UK, results of a questionnaire sent to acute and primary care nursing staff in 2003 are presented and discussed. The questionnaire covered a variety of clinical issues involved in performing bladder instillations and the results show that there is a wide variation of practice across the UK. The authors conclude that there are issues pertaining to bladder instillations which warrant further work.
Intra- and extracranial causes of alteration in level of consciousness
Authors: McLeod Anne
Published: May 2014

Acutely ill patients often demonstrate an altered level of consciousness. However, there are a variety of different reasons that may cause this alteration and nurses caring for patients without a defined cerebral event need to be aware of situations that can alter a patient's level of consciousness so that care strategies can be implemented. This article explains the concepts of consciousness and intracranial pressure and what is meant by an ‘altered level of consciousness’. Assessment strategies are identified and a simple alternative to the Glasgow Coma Scale is identified that can be used as an initial assessment tool. This then allows the nurse caring for the patient with an altered level of consciousness to rationalize his/her interventions in relation to that patient.
Clinical skills: practical guide for managing adults with epilepsy
Authors: Hayes Christine
Published: May 2014

This article concentrates on the practical management of those with seizures by general nurses. It focuses on the role of the hospital nurse in secondary care and the practice nurse in primary care. Both need to be conversant and practically competent to deal with the first-aid management of a seizure. They also need to know when medical assistance is required and how to act in an emergency. Epilepsy is a chronic long-term condition in adults and the main function of the nurse is advisory and educational. It is to act as a facilitator, and to assist adults to self-manage their epilepsy. Where the nurse is unable to provide this advice, appropriate referrals or contacts should be given.
Are nurses nurses, doctors or a mixture of both?
Authors: Fullbrook Suzanne
Published: May 2014

There has been increasing debate within the nursing profession recently in relation to the future of nursing and whether the changes occurring within nursing are for better or worse. Underlying the current debate is an attempt to understand what is happening to nursing in the context of government policies and underlying trends in societal thinking. My perspective is to highlight why some of the changes to the nursing role have occurred, and expose some of the difficulties these changes have brought to those currently working as nurses.
Nurses must learn methods to deal with difficult doctors
Authors: Castledine George
Published: May 2014

In the past, doctors have been overly criticized for exerting too much professional dominance in the health service. For example, it has been claimed that some doctors are too concerned about themselves and their status, rather than showing humanistic concern for their patients and the rest of the healthcare team, particularly nurses. Observers such as Ley and Spelman (1967) have exposed how poor doctors have been in terms of communication and in developing their relationships with patients and colleagues. It is no wonder that modernization of the health service has been geared to changing this situation.
When nurses take on doctors' roles are they just gap-filling?
Authors: Fulbrook Suzanne
Published: May 2014

The current climate of working practices for some nurses envisages an assumption of roles previously undertaken by doctors. These roles possess certain attributes: autonomy, responsibility, accountability and authority. In some areas of the country, pilot studies have resulted in the ‘rolling out’ of such roles, e.g. nurse consultants, emergency nurse practitioners, and site managers. However, there are certain questions that I believe need to be asked: why have such roles been devised? Who benefits? What are the costs associated with such changes and how can the future of nurses not ‘awarded’ with such roles be defined?
We must act to move tissue viability forward
Authors: Finnie Alison
Published: May 2014

As the new consultant editor of the BJN Tissue Viability Supplement I would like to thank David Gray, the past consultant editor, for all his hard work and dedication over the past 3 years. The supplement now holds a key position as an information resource for all tissue viability nurse specialists (TVNS). In the short life of the supplement there have been significant changes in the world of tissue viability. One of these has been the launch of the Tissue Viability Nurses' Association (TVNA). The creation of the TVNA has added to the plethora of tissue viability organizations, each of which offer differing perspectives and agendas for individual practitioners, but all draw upon a relatively small specialist market.
Evaluation of a wound dressing using different research methods
Authors: Reynolds Tim , Russell Linda
Published: May 2014

This article examines different methods of assessing wound progress in order to better inform future research designs and thus produce a more credible and valid bank of knowledge. Data collected in a study of Vacutex, a capillary action dressing, were reassessed using four different mechanisms: non-blind assessment by a research nurse; two different scoring systems based on wound size and appearance; and a blind randomized assessment using initial and final images of wounds. Non-blind assessment indicated that the Vacutex dressing was superior to standard dressings by +40.8% (P=0.022); assessment by wound area and overall appearance indicated +11.2% superiority (P is not significant); and the blind randomized image-based assessment indicated a +20.6% difference (P is not significant). Assessment by wound area and description did not allow a percentage superiority to be identified and the conclusion of this method was that there was no significant difference by rank sum testing. The different assessment techniques resulted in significantly different conclusions about the effectiveness of Vacutex. On balance, the blind, randomized, image-based assessment may miss some finer nuances of wound progress but is probably the most unbiased option because those assessing the wounds are not aware of which images are taken before or after wounds have been treated.
A tool to aid nurses' decision making in relation to dressing selection
Authors: Keen Delia , James Jane
Published: May 2014

A multidisciplinary formulary group was established to create a standardized approach to wound management throughout Carmarthenshire. It was felt that a tool to aid nurses' decision making in dressing selection might enhance the process of formulary implementation. This article outlines the development of the tool. An action-research approach was chosen to investigate the idea. The project followed a series of cycles consisting of planning, action, data collection and reflection. The first cycle confirmed the need for such a tool. A reference card was produced. As a result of data collected in the second cycle, the card was reproduced with suggested improvements. The improved tool was then evaluated in the third cycle. Minor adjustments and incorporation of the completed Carmarthenshire formulary took place during the fourth cycle. The Carmarthenshire formulary is now in use and accompanied by the reference card.
The analgesic effect of odour and music upon dressing change
Authors: Kane Fiona MA , Brodie Eric E , Coull Alison , Coyne Lynne , Howd Alison , Milne Alan , Niven Catherine C , Robbins Ruth
Published: May 2014

Vascular wounds may require frequent dressing changes over a long period of time, often involving pain, which may not be adequately controlled with conventional analgesia. Complementary analgesia may be beneficial as an adjunctive therapy. This pilot study presented eight patients with two odour therapies, lavender and lemon, two music therapies, relaxing and preferred music and a control condition, during vascular wound dressing changes. Although the therapies did not reduce the pain intensity during the dressing change there was a significant reduction in pain intensity for the lavender therapy and a reduction in pain intensity for the relaxing music therapy after the dressing change. This supports the use of these complementary therapies, which are inexpensive, easy to administer and have no known side-effects, as adjunctive analgesia in this patient population. Earlier administration before dressing change may enhance these effects. Further research is required to ascertain why certain complementary therapies are more effective than others at relieving pain.
The relationship between pain and leg ulcers: a critical review
Authors: McMullen Marie
Published: May 2014

Leg ulceration may have a profound impact on the individual: in some cases activities of living become subservient to the degree of pain experienced. Pain control, which is viewed as a key function in health care, appears marginalized in leg ulcer management. Pain can be intense, bringing psychological implications for the patient. Knowledge deficiency in practitioners' management of venous and arterial leg ulcers was identified in the literature. This may lead to unnecessary pain caused by inappropriate dressings, misdiagnosis, or poor technique in the use of compression therepy. A holistic approach to the patient using evidence-based standardized practice may improve the patient's experience.
Assessing community nurses' level of knowledge of lymphoedema
Authors: Morgan Philip A , Moody Marion , Franks Peter J , Moffatt Christine J , Doherty Debra C
Published: May 2014

As part of a major project to develop a primary care trust-based framework of lymphoedema management, the educational needs of community nurses regarding the care of patients with lymphoedema were assessed using focus groups and questionnaires. Community nurses assessed their current knowledge and skill in the care and management of patients with lymphoedema as adequate or poor. They were concerned about their lack of knowledge and skill and were uncertain regarding their role relative to other professions involved in the care of this patient group. At the same time they understood the importance of their role in providing ongoing care, recognizing problems, offering sound advice and referring on to a specialist practitioner when necessary. Any educational provision that prepares community nurses for their role within a framework of lymphoedema management should emphasize the important place they occupy in providing long-term care for this patient group.
Law concerning organ transplants and dead donors in the UK
Authors: Dimond Bridgit
Published: May 2014

Mike, aged 18 years, was severely injured in a road accident. He was admitted to intensive care and placed on a ventilator. The consultant anaesthetist notified his parents that he was unlikely to survive and he would be tested to ascertain if he was brain dead. The parents were told that Mike was carrying a donor card and were asked about organ donation. They said that they did not agree with it, and were surprised that Mike was carrying a donor card. They did not wish the donation to proceed. What is the law?
Transmission and epidemiology of MRSA: current perspectives
Authors: Banning Maggi
Published: May 2014

Staphylococcus aureus is a Gram-positive bacterium that developed resistance to the penicillin derivative methicillin. Subsequently, methicillin-resistant S. aureus (MRSA) emerged as a bacterium that became less susceptible to the actions of methicillin and thus developed the ability to colonize and cause life-threatening infections. Globally, MRSA continues to cause hospital-acquired infections which are becoming difficult to treat owing to increasing glycopeptide resistance and the increasing development of community-associated MRSA. Nurses caring for patients in both hospital and community settings should be able to acknowledge the importance of MRSA, the difficulties of treating the bacterium and the need to comprehend and adhere to universal precautions that are important in the prevention of transmission of MRSA.
The aetiology, management and complications of alcoholic hepatitis
Authors: Sargent Suzanne
Published: May 2014

First described over 40years ago, alcoholic hepatitis (AH) (an acute inflammation of the liver) is a common condition seen in 10–35% of heavy drinkers. In its severest form acute AH carries a high short-term mortality of up to 60%. Although the current treatment options are limited, many of the complications associated with increased mortality, such as hepatorenal syndrome, are preventable. The incidence of AH in the UK is set to rise as a result of the increase in heavy drinking. This article aims to increase awareness of the disease aetiology and to review current management strategies and nursing care.
Managing exacerbations of chronic obstructive pulmonary disease
Authors: Cross Sue
Published: May 2014

The worldwide incidence of chronic obstructive pulmonary disease (COPD) is increasing and, in parallel, so is the social and economic burden. Mortality data underestimate COPD as a cause of death because the disease is more likely to be cited as a contributory rather than as an underlying cause of death, or may not be cited at all. By 2020, COPD is expected to be the third most common cause of death worldwide yet it receives less funding, publicity and fewer resources than is deemed necessary. The major burden of COPD falls on the patient and carer, and it is difficult to quantify. The quality of life of patients is evident and depends on the severity of their disease and their ability to adapt physically, socially and emotionally to the resulting disability. COPD leads to 30000 deaths per year in the UK. It is a considerable load to the NHS, particularly in the winter months when exacerbations occur most commonly; it results in 13% of all acute medical admissions.
Exploring supportive care needs and experiences of facial surgery patients
Authors: Furness Penny J
Published: May 2014

Research suggests that an important determinant of psychosocial outcomes following disfiguring surgery is social support. Healthcare professionals are in a position to offer emotional support to patients undergoing surgery, but evidence regarding the experience of supportive care among facial surgery patients is sparse. This study explored the experiences of facial surgery patients and their friends or family with regard to support from healthcare professionals. Twenty-nine facial surgery patients and nine significant others (eight marital partners and one close family member) participated in indepth interviews and focus groups, and the data were analysed using a grounded theory form of coding. Analysis identified three main categories of support: informational, practical and emotional. Findings also showed discrepancies between patients' need for emotional support and provision by healthcare staff.
Facilitating the implementation of lifelong learning in nursing
Authors: Gopee Neil
Published: May 2014

Lifelong learning in nursing comprises an essential conceptual shift from the notion of the registered nurse (RN) being merely a competent health service incumbent to one who engages in professional learning continuously throughout their career in order to keep their knowledge and skills up to date. Since the 1990s, lifelong learning has appeared as a rhetoric within nursing literature in the UK, with a seemingly general assumption that there is a shared understanding and acceptance of the concept among all nurses.

A literature review on lifelong learning shows that the concept comprises a number of components. However, because the literature does not seem to address the application of the concept to nursing, a study that aimed to ascertain RNs' perceptions of lifelong learning, and their views on the mechanisms that would enable effective implementation of the concept, was conducted. This qualitative study entailed individual interviews with 26 RNs and two focus groups with another 12 RNs. The findings suggest that there are positive perceptions as well as certain reservations about lifelong learning among RNs, and that structural mechanisms could be more firmly and equitably anchored. Additionally, profession-based and informal personal networks tend to play a key role in encouraging and supporting learning. The results of the study are configured into a conceptual framework for the implementation of lifelong learning in nursing and possibly in other health professions.
Education in practice: a colorectal link-nurse programme
Authors: Perry-Woodford Zarah , Whayman Kathy
Published: May 2014

This article illustrates the planning, implementation, evaluation and personal implications of a link-nurse programme for colorectal cancer nursing. The programme was designed to maintain a patient-centred support service and continue the provision of bowel cancer education and support to nurses in the clinical environment. Literature on previous link-nurse schemes, and the recent legislation on education and cancer nursing provides the background on which this programme is based. The use of educational theory supplies the theoretical underpinnings for this approach to learning, and evaluation findings are reported from both the group's and the individual's viewpoints. The programme increased the link nurses' awareness of the patient's pathway, support and information needs and the role of the multidisciplinary team in managing care. Sufficient time, support and encouragement from ward teams and clinical managers were seen as vital to the success of the programme, and specific benefits and challenges when establishing this type of practice based education for nurses are explored.
Chronic leg ulcers, part 1: do they affect a patient's social life?
Authors: Brown Annmarie
Published: May 2014

This article describes a qualitative study into how chronic venous leg ulceration impacts on the social dimension of a patient's life and is presented in two parts. Part one will discuss the background to the study, give an overview of the existing literature and briefly describe the methodology used for the study. Part two will follow in the next issue and will present the findings of the study, which will be discussed in relation to the literature. The limitations of the study will be described, together with conclusions and recommendations for practice and further research.
Delivering wound management in a social setting
Authors: Dalzell Louise
Published: May 2014

As a District Nursing Sister based at a small village surgery, this is a personal account of the author's experiences introducing a new approach for delivering holistic wound management to patients. It deals with the practical and emotional challenges of overcoming barriers to change and forging new working relationships, both within the nursing team and with the patients and wider community. With the encouragement and support of Ellie Lindsay, originator of the Lindsay Leg Club model, Combs Ford Leg Club was set up in 2000 to provide leg ulcer management in an empowered and stigma-free environment. Through the commitment and efforts of nurses, volunteers and patients working together, difficulties and resistance have been confronted and overcome, and Combs Ford Leg Club today is a thriving and vibrant resource, treating, supporting and educating those experiencing leg ulcers or other leg related conditions.
Clinical nursing rounds part 3: patient comfort rounds
Authors: Castledine George , Grainger Michelle , Close Ann
Published: May 2014

Clinical rounds are being introduced in the Dudley Group of Hospitals to improve patient care, involve patients and improve communication. There are four types of rounds, matrons' rounds, nurse management rounds, patient comfort rounds and teaching rounds. This article is the third in the series and describes patient comfort rounds (PCRs). PCRs are an important part of maintaining and monitoring the fundamental aspects of individual patient care. They should be carried out at 2-hour intervals whenever possible, commencing after lunchtime and continuing for the rest of the day. At night time, PCRs should be carried out before patients go to sleep and again in the early morning. It may be necessary to carry out more regular care to some patients. This approach should not be confused with the old system of ‘back rounds’ which were often restricted to pressure area care. The purpose of PCRs is to maintain a regular review of the patient nursing needs, support the nursing process and evaluate nursing care.
American nurses' work autonomy on patient care and unit operations
Authors: Mrayyan Majd T
Published: May 2014

Work autonomy is an essential aspect of nurses' professional lives. The aim of this research was to study American nurses' work autonomy and, in particular, autonomy over patient care and unit operations decisions. Data were collected electronically during July of 2004. A total of 300 American nurses were recruited from two clinical listserves in which nurses communicate electronically as a group. Nurses were more autonomous about decisions relating to patient care than unit operations, and their total work autonomy was moderate. Correlations and stepwise regression analyses revealed that nurses' experience, education, and time commitments influenced their work autonomy. Findings suggest that nurses' work autonomy should be enhanced to reach its full potential and that nurse administrators should promote their nurses' work autonomy.
What is a good death? Issues to examine in critical care
Authors: Cardozo Margaret
Published: May 2014

The decision to limit care for critically ill intensive care patients is not uncommon, and most deaths in the intensive care unit are now preceded by do not resuscitate (DNR) orders, which are regarded by some as a way to make death more humane and respect patient autonomy. When a patient receives a poor diagnosis the family needs to discuss the medical care and respect the patient's wishes. Many relatives hesitate to discuss these issues, because they wish to avoid discussing the idea of death or any serious change to the patient's condition. This article aims to address DNR orders and discuss the mechanisms available to achieve a good death for patients and their relatives, instead of enduring a distressing and undignified end.
Patients' satisfaction with a nurse-led oncology service
Authors: Egan Mary , Dowling Maura
Published: May 2014

This study reports the findings of a quantitative study determining the satisfaction levels of patients attending a nurse-led oncology day ward. A random sample of 100 patients was surveyed using an adapted version of the Leeds Satisfaction Questionnaire (Hill, 1997) to ascertain the satisfaction levels of patients attending the unit. Satisfaction levels were found to be favorable in general. However, the study did highlight that some aspects of patient information required attention. Moreover, issues with the use of the questionnaire emerged as the inclusion of both positive and negative statements in the Likert-style questionnaire presented contradictory findings.
Using the 12-lead ECG to assess acute coronary patients
Authors: Gregory Joanne
Published: May 2014

Acute coronary syndromes (ACS) are characterized by the rupture of unstable plaque within coronary arteries. Depending on the extent of the ensuing occlusion and myocardial damage, ACS can be classified as unstable angina, non-ST elevation myocardial infarction (MI) and ST elevation MI. The electrocardiogram (ECG) is an invaluable tool in the assessment of patients with ACS. It provides evidence for the location of myocardial ischaemia, injury and infarction and is a crucial factor in the decision to administer thrombolytic agents and other management strategies. The 12-lead ECG is limited to a view of the left ventricle, however it can be extended to provide additional information about the right ventricular and posterior walls. Critical care nurses with ECG skills can contribute to the early detection and management of patients with ACS.
Combination Model of Care for community nurse practitioners
Authors: MacDonald Janet M
Published: May 2014

Twenty-two community nurse practitioners were researched, primarily to establish whether or not they were able to achieve a ‘higher level of practice’. Grounded theory, the qualitative research methodology developed by Glaser and Strauss, was used as a framework for the research. Data was gathered using primary observation with some participation (581 consultations being observed in the process), and by interviewing the community nurse practitioners and their clinical managers. From the overall theoretical framework that emerged from the research, a category, the ‘combination model of care’, was developed as a theoretical model, together with a conceptual framework for the process of nursing, ‘HADPIPE’. This model of care/nursing and the HADPIPE framework provide a basis from which nurse practitioners can practice with a holistic nursing focus. The article analyses and discusses the combination model, and provides a detailed example of it in action.
Critical care outreach: creating a safe culture
Authors: Heaps Nicola , Thorley Katharine , Langley Susan
Published: May 2014

Critical care ‘outreach’ and early warning scoring tools have become fundamental in identifying patients at risk of clinical deterioration and promoting their optimization within the ward environment. Outreach has been implemented in various ways, ranging from the ‘flying squad’ (staff attending to a patient at risk of deterioration on the ward) approach to an educational model. This article describes the unique approach taken within the cardiothoracic directorate at South Manchester University Hospital Trust. The authors' approach focused on linking critical care outreach to the clinical governance agenda through incident reporting. This enabled the authors to demonstrate the effectiveness of the critical care outreach service by producing both quantitative and qualitative data in respect of patients who had deteriorated following cardiothoracic surgery, and required intervention from the outreach service.
Measuring blood pressure using the mercury sphygmomanometer
Authors: Valler-Jones Tracey , Wedgbury Kirsty
Published: May 2014

Automated blood pressure devices have been embraced by clinicians for their convenience and ease of use. However, the pressure to remove mercury-containing medical devices is leading to the demise of the mercury sphygmomanometer and the loss of manual blood pressure measurement skills. This article argues that there is still a place for the mercury sphygmomanometer, particularly when a clinical decision is based on the blood pressure readings. It presents a review of the available literature to explain the rationale for the use of manual sphygmomanometry and gives a step-by-step guide to the procedure with current supporting evidence. There is a brief discussion of special considerations when dealing with certain client groups. Normal blood pressure ranges for adults and children have been included along with a definition of hypertension for both groups.
All preregistration students should develop skills in learning disabilities
Authors: Barriball K Louise , Clark Louise L
Published: May 2014

In the light of ongoing service developments and government legislation it is important that preregistration nurses from all branches have the opportunity to develop their confidence and skills in the care of people who have learning disabilities. This article outlines the development of strategies employed by one institute of higher education in order to reflect the principles of Valuing People from a health perspective in non-learning disability nursing programmes. The particular challenges that have been encountered in the implementation of these strategies over the last 3 years are discussed, as are issues faced in the evaluation of the effectiveness of such strategies.
Nurses' attitudes to evidence-based practice: impact of a national policy
Authors: Upton Dominic , Upton Penney
Published: May 2014

Clinical effectiveness and evidence-based practice should be key cornerstones of current nursing practice. This study used postal questionnaires to explore the impact of a national initiative on nurses' attitudes, knowledge and practice relating to these twin concepts. Results indicated that attitudes can be influenced by national policy initiatives. Influencing behaviour, however, appears to be more difficult; no change was seen in reported application of evidence-based practice. Nurses did, however, report a desire to increase their implementation of evidence-based practice; reasons for not doing so included lack of the necessary skills and time in the working day. It is recommended that these education and training needs must be addressed by allocating sufficient protected learning time and funds. A more difficult issue relates to the burden of clinical work, which may also be preventing greater uptake of evidence-based practice.
More thought should be given to the team approach
Authors: Castledine George
Published: May 2014

The way we deliver nursing care to patients in the UK is undergoing profound changes. In the past the emphasis was on total patient care and individual nurse/patient allocation. Today, such nursing care delivery systems are considered inappropriate for the demands of the new NHS. Many hospitals are therefore returning to a team approach which emphasizes a task-allocation system.
Nurse leadership, interprofessionalism and the modernization agenda
Authors: Pollard Katherine C , Ross Kathryn , Means Robin
Published: May 2014

As part of the drive to deliver effective health and social care, the Government's modernization agenda focuses on strengthening nursing leadership and developing interprofessional collaboration. Senior nurses are well placed to promote the latter by supporting substantive change in NHS culture. Findings from a research study, conducted by the Faculty of Health and Social Care, University of the West of England, Bristol, as part of a research programme evaluating its interprofessional curriculum, have highlighted senior nurses' potential contribution to implementing and maintaining effective interprofessional collaboration. The authors argue that senior nurses are particularly well placed to help students across disciplines gain the experience needed to develop the requisite skills for delivering care within interprofessional services; and that the implementation of roles and initiatives which support senior nurses in developing appropriate leadership skills is a key component underpinning the modernization agenda.
Prostate cancer and the principles of hormone therapy treatment
Authors: Drudge-Coates Lawrence
Published: May 2014

This article discusses the use of hormone therapy for the treatment of prostate cancer, the most common male cancer. Key to managing this disease is understanding the processes responsible for maintaining prostate growth and hormonal homeostasis in male development. The individual mechanisms of action are outlined and demonstrated for each type of treatment, alongside the effects of these treatments. Each therapeutic option is discussed in conjunction with current key research findings and implications for practice are outlined.
Health professionals need to be able to identify depression in older people
Authors: Béphage Gaëtan
Published: May 2014

Healthcare literature shows that depression in older people, as a mental health problem, is often under-recognized and under-managed. This may partly be the result of multiple pathology, a common feature in later life, masking the features of depressive illness. It may also be the consequence of inadequate use of mental health specialists' skills. As the population is ageing rapidly, healthcare professionals will encounter more cases of depression among the older population. Some therapeutic approaches have been suggested for nurses to adopt. More importantly, nurses and other care workers have to recognize that sensitivity must be exercised in the utilization of these tools and that one approach may require complementing with another. A person-centred strategy is recommended in accordance with the National Service Framework for Older People. In implementing care, consideration of the person and the effects of the environment on the personality should be acknowledged.
An examination of the blood-brain barrier in health and disease
Authors: Khan Ehsan
Published: May 2014

The brain is protected from bloodborne toxins by the walls of the brain capillaries. The capillaries make up the primary part of the so-called blood–brain barrier (BBB). This is an exclusive barrier that precludes a large number of substances from entering the brain. This is because of its specific structural and biochemical properties that arise from interactions of a number of cell types. This review introduces the concept of the BBB to the practitioner. It examines the elements that are presently understood to be necessary for its formation. Finally, the influence of the BBB on disease is examined. This will enable the practitioner to have a comprehensive understanding of the effect the presence or absence of the BBB has on central nervous system health.
Clinical variance in assessing risk of pressure ulcer development
Authors: Sharp Catherine , Burr Gayle , Broadbent Margaret , Cummins Marianne , Casey Hellen , Merriman Amelia
Published: May 2014

Nurses working in one area health service (AHS) in Sydney, Australia, expressed concern about the development of pressure ulcers in hospitalized patients. Anecdotal evidence suggested that a variety of approaches were being used to assess patients to identify those at risk of pressure ulcer development. A questionnaire was distributed to all registered nurses (n=2113) in clinical settings within the AHS. Data were analysed using frequency distribution. The response rate was 40% (n=850), of which 444 were useable. Nurses generally do not use a tool to assess pressure ulcer risk potential, but rely on a range of practice procedures and risk indicators. It is recommended that a pressure ulcer project group be established to evaluate existing tools or, if necessary, develop a tool for the assessment of patients to identify those at risk of developing pressure ulcers.
The management of malodour and exudate in fungating wounds
Authors: Draper Charlotte
Published: May 2014

The topic of malodour and exudate in fungating wounds is of particular interest and relevance for community nurses who care for patients with fungating wounds in the community setting. Community nurses can work together with community oncology and palliative care services to manage patients with fungating wounds at home, where once hospital admission would have been needed to provide the level of support and care these patients require. Fungating wounds present unique challenges and can be problematic as a result of the levels of exudate and malodour which they produce. This review sought to establish whether recent advances in wound care products and/or techniques, could be of value in the control of these symptoms. The review established that there is little clinical research into the care of fungating wounds, and that the development of new dressings and techniques for controlling malodour and exudate is badly needed.
Urgosorb (TM) dressing: management of acute and chronic wounds
Authors: Stevens Jenny , Chaloner Donna
Published: May 2014

This article illustrates the outcomes of a 10-patient prospective case study series. The aim of the study was to evaluate the use of UrgosorbTM in the management of acute and chronic wounds. (UrgosorbTM is a dressing comprising calcium alginate fibres and hydrocolloid, and is recommended for sloughy and granulating wounds with moderate to high levels of exudate.) Parameters assessed were the effectiveness of exudate management and integrity of surrounding tissue, ease of removal, patient comfort, effectiveness of odour control and observation for any adverse reactions. Data were collected over a period of 6weeks with weekly evaluations. Healing was not included in the study objectives as it was recognized this would be difficult on a range of highly variable wounds. Although healing was not assessed, 50% of the wounds did heal during the study period. Dressing removal was considered easy in the majority of cases, and patients experienced none, or only mild discomfort. Levels of exudate were well managed and there were no reports of any adverse events.
Hospital to home: smoothing the journey for the new ostomist
Authors: Readding Linda A
Published: May 2014

For most patients, being discharged from hospital is an important milestone in their recovery. Having come through surgery, they have completed their early recovery, are well enough to leave the safe confines of the hospital and have reached the natural end point of what should be a well coordinated episode of care with a satisfactory outcome, where the discharge is as important as the admission. However, although most are naturally pleased to be going home, patients will have many fears and anxieties about how they are actually going to manage. This includes not only coping with their recovery, but also managing their lives, returning to their usual activities and life style and coping with their new stoma. Knowledge information and support, nursing interventions and experiences in hospital are valuable and will be put to good use at home. This article identifies the key issues that may arise during this time, the level of knowledge and skill required for a successful transition home and the support required by the patient to adapt to their changed circumstances.
Development of a nurse-led ileo-anal pouch clinic
Authors: Perrin Angie
Published: May 2014

The ileo-anal pouch procedure is now seen as the operation of choice for individuals suffering with ulcerative colitis or familial adenomatous polyposis (Fazio, 1999); however, patient follow-up after this surgery remains variable. This article highlights the effectiveness of running a nurse-led follow-up service. A patient satisfaction survey has shown that having a familiar face at each follow-up visit is hugely beneficial, providing continuity and reassurance for patients and their relatives. This nurse-led clinic provides adequate time for patients to discuss a variety of issues including management of sore perianal skin and pouch dysfunction. The growth and development in clinical skills, knowledge and nursing autonomy has seen the emergence of many nurse-led clinics, where nurses are utilizing their advanced skills. Within the nurse-led ileo-anal pouch clinic in Oxford, physical and/or internal examination, and investigations, such as rigid or flexible pouchoscopy, are performed. Such procedures were positively evaluated by patients.
Implementation and clinical audit of alcohol detoxification guidelines
Authors: Taylor Bob
Published: May 2014

This article describes the implementation and clinical audit of alcohol detoxification guidelines at the Royal Cornwall Hospital. The progress in developing a hospital alcohol strategy as recommended by the Royal College of Physicians (2001) is also reviewed. The Clinical Institute Withdrawal Assessment for Alcohol (revised) (Sullivan et al, 1989) is used to assess the alcohol-dependent patient's baseline requirement for their detoxification regimen in the first 24hours of their care. The prevention and treatment of Wernicke's encephalopathy by parenteral and oral vitamin supplementation is also given a high priority in the guidelines. The clinical audit demonstrates high levels of compliance with the guidelines that were used effectively by the nursing and medical staff in their care of patients with alcohol withdrawal, with high levels of referral to the psychiatric liaison nurse service for brief intervention alcohol counselling and referral to community alcohol services.
Collaboration in practice - assessment of an RAF CCAST
Authors: Lamb Di
Published: May 2014

Aeromedical evacuation of critically ill patients by the Royal Air Force is undertaken in a complex healthcare environment – one which demands effective teamwork to achieve the best possible outcome for the patient. A military team cannot rely purely on rank structure to guarantee a disciplined and efficient working unit. Furthermore, personnel must acknowledge the many potential hindrances of a Critical Care Air Support Team (CCAST) working environment that can affect optimal performance. These include: fatigue as a result of extended hours of duty; effects of altitude; isolation; and entering war zones, all of which may negatively affect motivation, stress and communication. This article reviews and discusses adaptation strategies utilised by a CCAST to overcome these obstacles. The importance of role equality within a team and the subsequent feeling of value this promotes, effective communication and positive ‘can do’ attitudes contribute to making the team work.
Respiratory syncytial virus: disease, development and treatment
Authors: Banning Maggi
Published: May 2014

Respiratory syncytial virus (RSV) is spread by droplets and causes infections of the upper and lower respiratory tract. It is most common in infants, children under the age of five years and the elderly. Due to the nature of the transmission, infections with RSV are contagious but usually short lived. Pharmacological treatment involves the use of antiviral medication. Nurses caring for older people, infants or young children should be aware of the risk of transmission of RSV, pathogenesis and treatment options available to effectively manage the care of patients.
Exploring the evidence base of the use of non-invasive ventilation
Authors: Jarvis Helen
Published: May 2014

Chronic obstructive pulmonary disease (COPD) has a prevalence rate of between 4–10% in the UK (Halbert et al, 2003) and as such accounts for a large number of hospital admissions each year. Non-invasive ventilation (NIV) is now increasingly used to treat exacerbations of this condition and therefore nurses caring for these patients need an understanding of the rationale behind its instigation. This article reviews the literature pertaining to the use of NIV in the patient with COPD and provides a critique of the research available. The implications for practice have been highlighted through a discussion regarding the nursing management of the patient on NIV.
Autoimmune connective tissue disease: scleroderma
Authors: Wilson Helen , Vincent Rachel
Published: May 2014

Scleroderma is an umbrella term for a spectrum of rare and complex autoimmune connective tissue diseases, the cause and pathogenesis of which is only partially defined. Scleroderma can be divided into two main subgroups – systemic and localized – but the hallmark of both is skin fibrosis. As yet no drug has been found to be effective in reversing the disease process, however early intervention has been shown to give maximum benefit. Due to the chronic nature of the condition a multidisciplinary approach is essential and the nurse's input from an early stage is vital in supporting the patient to manage both their medical treatment and their activities of daily living.
A personal and ethical perspective on chronic wound pain
Authors: Leighton-Bellichach Amanda
Published: May 2014

Pain is a rarely acknowledged complication of chronic wounds, yet for those who live with it, it is often the over-riding preoccupation. In this article, the author — who herself has suffered for many years with wound pain — discusses why pain is not widely acknowledged by health professionals caring for wounds, and highlights why awareness of it is central to holistic care.
From spirituality to coping strategy: making sense of chronic illness
Authors: Greenstreet Wendy
Published: May 2014

This article explores how individuals might make sense of chronic illness. The spiritual aspect of self is described both as being central to finding meaning in suffering with a chronic illness and also the source of hope in meeting the challenges faced. Culture as the template for interpreting the significance of chronic ill health at a personal, familial and societal level is also considered. A conceptual model for understanding life transitions is modified to incorporate the spiritual and cultural perspectives of making sense of chronic illness in relation to coping skills. In understanding how patients make sense of their circumstances nurses are more likely to be able to offer appropriate support to effect coping.