bluuebunny/crossref_metadata_2025 huggingface dataset:
Neuropathic pain: could nurses become more involved?
Authors: Mann Eileen
Published: May 2014

Neuropathic pain can take a heavy toll on quality of life, impacting negatively on emotions, disrupting sleep, and impairing energy and mobility. It can destroy the enjoyment of life and the opportunity to continue in employment. In some cases, it can lead to suicidal thoughts and intentions. Nurses are well placed to become more effective in identifying and treating this challenging condition. This article outlines what we currently understand are the causes or ‘generators’ of neuropathic pain and the mechanisms that maintain pain. It explores strategies for the diagnosis of neuropathic pain and reviews a couple of typical case studies from clinical practice. Using these case studies, this article discusses assessment, patient expectation, treatment options and realistic outcomes. Finally, it is intended to stimulate debate as to why, when, how and where nurses could become key practitioners in identifying the development of neuropathic pain, assessing its impact on patients and encouraging the initiation of treatment.
The personal tutor’s role in pre-registration nursing education
Authors: Por Jitna , Barriball Louise
Published: May 2014

Providing support for students has always been an inherent part of the lecturer’s role. Widening access to students from backgrounds not traditionally associated with higher education has necessitated a review of the personal tutor system, as potential students may not be equipped with the academic skills to meet the demands of higher education. Ten randomly selected lecturers in one institute of higher education were interviewed to elicit their views and experiences of the personal tutor’s role. The findings showed that the role of the personal tutor was considered both demanding, as students have increasingly different needs, but also fulfilling. The provision of pastoral care was viewed as integral to the role of the personal tutor, although most lecturers reported that they adopted an all-encompassing model of support that ranged from providing academic, professional, psychological and financial advice. Time factors and workload were identified as important structural constraints
Needle anxiety in the clinic: a needs assessment
Authors: Royle Jane , Wright Lissa
Published: May 2014

Background: A needs assessment for needle anxiety was carried out across people with either spinal cord injury (SCI) or spina bifida (SB). Aims: to identify the numbers of people reporting anxiety when having blood taken and being given injections; to explore individual beliefs; and to identify appropriate action. Method: A self-report questionnaire was developed for clinical use, piloted and administered across a 6-month period. Two-hundred and thirty-one questionnaires were returned (188 SCI group and 43 SB group). Data were analysed using SPSS. Results: There was a significant report of anxiety for both areas in both groups: 10–12% for SCI and 16–19% for SB. Eleven per cent of the SCI group and 19% of the SB group believed it was a problem for them; however, only 4% of each group identified they would want help. Conclusion: There is a clinical responsibility to address the level of need identified by this project. Six proposals are made to highlight awareness of this issue and provide guidance on strategies and interventions for patients and staff.
Changing of the guard at the NMC
Authors: Karstadt Lyn
Published: May 2014

Nursing and midwifery education has evolved over the past few decades, leaving many in the profession — as well as education — slightly confused as to what is going on. In her ongoing column, Lyn Karstadt reflects upon the changes to the Nursing and Midwifery Council, and how these changes will impact on the representation of different nursing groups at council level
Therapeutic use of arteriovenous fistula in children with haemophilia
Authors: Khair Kate , Baker Kerry
Published: May 2014

Haemophilia is an X-linked inherited bleeding disorder, which only affects males. Contemporary treatment of children with haemophilia requires adequate venous access for the administration of prophylactic therapy which commences as a relatively early age. In the majority of children this treatment is administered at home, usually by the parents and then, once competent, by the boys themselves. As venous access in young children is fraught with difficulty, central venous access devices have become the mainstay of haemophilia care. However, these devices come with their own difficulties, with infection and thrombosis causing significant side-effects in some children. Small but substantial cohorts of boys with haemophilia develop antibodies (or inhibitors) to coagulation factors, rendering them both more likely to experience bleeding and more complex to treat. These boys are, for reasons not yet fully understood, more likely to experience central line infections, which also affect overall treatment outcomes. Arteriovenous fistulae were used in four such boys in an attempt to eliminate central line infection and to enable continued treatment administration. The experience and outcomes of these four boys is discussed along with considerations and implications for nurses caring for them.
Dementia care. Part 3: end-of-life care for people with advanced dementia
Authors: Ouldred Emma , Bryant Catherine
Published: May 2014

End-of-life care issues for people with advanced dementia have only recently been addressed in guidance. There appear to be barriers to accessing good palliative care for people in the terminal phase of the disease. The reasons for this are multifactorial, but may be attributed to factors such as dementia not being recognized as a terminal disease like cancer, problems in recognizing the symptoms of terminal dementia, and decision-making conflicts between family caregivers and other health and social care providers. This article highlights common symptoms of advanced dementia, and the need for a palliative care approach. It also addresses specific issues in both caring for people with dementia at the end of their lives and in supporting carers.
Huntington’s disease. Part 3: family aspects of HD
Authors: Aubeeluck Aimee , Moskowitz Carol Brown
Published: May 2014

Research into the experience of the Huntington’s disease (HD) family caregiver has established that HD carers experience a number of unique obstacles within their caregiving role. This appears to be due to the chronic nature of the disease, both in terms of genetic inheritance and the prolonged disease process itself. Moreover, due to the complex, physical, neurological, psychiatric and genetic elements of HD, service provision may often be unsuitable leaving family members burdened with the main responsibility of care. The complex nature of HD requires service providers, researchers and policy makers to consider each case on an individual basis, thus tailoring service provision to the user and their family’s unique requirements.
Guided reflection: a discussion of the essential components
Authors: Duffy Anita
Published: May 2014

Guided reflection offers practitioners the confidence to analyse and confront their practice with a critical companion in a safe environment. It is well documented that this process has the potential to liberate practitioners from oppressive constraints of practice. When guided reflection works well the consequences are manifold; however, in the author’s experience the practice has raised some critical questions for novice guides willing to supervise students’ clinically based reflections. Questions from guides have emerged, such as: Where do we start? How do reflectors choose their guide? What happens if things go wrong? In this article, four practical steps for guides beginning guided reflection are suggested.
A life unlike any other; human rights for some?
Authors: Scullion Philip
Published: May 2014

Diversity and difference, along with individuality, are characteristics said to be highly prized by health professionals. Indeed the uniqueness of each human being is something that nurses are taught to value from day one of their education and throughout their life-long learning careers. This has not been the case in all societies nor at all times as I was forcefully reminded on a recent visit to Poland, where among many ‘delightful’ experiences, I visited what remain of the Auschwitz camps. Whilst this cannot be described as ‘delightful’, I felt, like many, that it was an educational visit that should be made. I have also been reading Laurence Rees’ 2005 bestseller Auschwitz: The Nazis and the ‘Final Solution’. Both of these experiences leave a profound discomfort.
Dialysis access and the impact on body image: role of the nephrology nurse
Authors: Muringai Tarisai , Noble Helen , McGowan Amanda , Chamney Melissa
Published: May 2014

End-stage renal disease is a chronic condition, without cure, requiring dialysis therapy to maintain life or transplantation for those fortunate enough to receive a kidney. To commence dialysis (peritoneal dialysis or haemodialysis), access is required in the form of a fistula, vascular catheter or peritoneal catheter, and changes in body image will ensue, no matter what treatment option is selected. Renal transplantation, the treatment of choice for many patients, is also associated with body image issues. Despite these problems, the role of the nurse in managing body image problems in the renal population is rarely discussed. The aim of this article is to outline the concepts of dialysis and body image, and discuss the role of the nephrology nurse at the authors’ current place of work. It highlights suggestions on how renal nurses can prepare and educate patients regarding changes in body image following a diagnosis of end-stage renal disease, and emphasizes the need for future research in this area.
The healing power of prayer and its implications for nursing
Authors: Narayanasamy Aru , Narayanasamy Mani
Published: May 2014

Prayer is widely acknowledged in both ancient and modern times as an intervention for alleviating illnesses and promoting good health. There is increasing attention on prayer in health care, in both popular and serious discourse. Advocates exalt the healing power of prayer in health care, while critics are sceptical about this claim and its healing potential is put down to coincidences or its placebo effect. Consequently, a variety of empirical studies have attempted to test its effect scientifically with no conclusive results. There is evidence to suggest that some patients and healthcare practitioners believe in the healing power of prayer. Nurses may be called upon to pray with or for patients as part of holistic care. This article sets out to explore the role of prayer in healing and its implications for nursing. To achieve this aim, this article provides a review of discourses and evidence on the power of prayer in healing. Its implications for nursing are highlighted with some suggestions on how to respond to patients’ spiritual needs. It is concluded that, although the evidence on the healing power of spirituality is inconclusive, there are indications that it has potential for the health and wellbeing of both patients and nurses.
One wound seen through two pairs of eyes: a case study
Authors: Pagnamenta Fania , Cordell Peter
Published: May 2014

The relationship between the clinical nurse specialist (CNS) (tissue viability) and patient with regard to wound care has not been discussed in the literature. Patients view their wounds in a very different way from the CNS: some patients refuse to acknowledge that there is a problem with their wounds, display unrealistic optimism for their condition, and do not perceive themselves to be at risk of developing diabetic foot ulcers. This article presents a case study in which the wound is viewed through two pairs of eyes – those of the patient and those of the tissue viability CNS – to illustrate the disparity in their perceptions of the wound as it progresses from highly necrotic and infected to healthy and granulating.
Managing wound exudate: role of Versiva® XC™ gelling foam dressing
Authors: Dowsett Caroline
Published: May 2014

Effective management of wound exduate is a considerable challenge for clinicians. Treatment of the patients underlying condition, accurate assessment of the wound and exudate, as well as selection of an appropriate dressing are all important factors for success. A variety of dressings are available to the clinician for the management of exudate, but not all handle fluid in the same way. A gelling foam dressing combining foam with Hydrofiber® technology is described and the supporting evidence for its use reviewed. Versiva® XC™ dressing has some good evidence to support its use in the management of wound exudate and performs well in clinical practice.
A comparison of inferface pressures of three compression bandage systems
Authors: Hanna Richard , Bohbot Serge , Connolly Nicki
Published: May 2014

Objective: To measure and compare the interface pressures achieved with two compression bandage systems – a four-layer system (4LB) and a two-layer short-stretch system (SSB) – with a new two-layer system (2LB), which uses an etalonnage (performance indicator) to help achieve the correct therapeutic pressure for healing venous leg ulcers – recommended as 40 mmHg. Method: 32 nurses with experience of using compression bandages applied each of the three systems to a healthy female volunteer in a sitting position. The interface pressures and time taken to apply the systems were measured. A questionnaire regarding the concept of the new system and its application in comparison to the existing two systems was then completed by the nurses. Results: The interface pressures achieved show that many nurses applied very high pressures with the 4LB (25% achieving pressures > 50 mmHg) whereas the majority of the nurses (75%) achieved a pressure of < 30 mmHg when using the SSB. A pressure of 30–50 mmHg was achieved with the new 2LB. The SSB took the least time to be applied (mean: 1 minute 50 seconds) with the 4LB the slowest (mean: 3 minutes 46 seconds). A mean time of 2 minutes 35 seconds was taken to apply the 2LB. Over 63% of the nurses felt the 2LB was very easy to apply. Conclusion: These results suggest that the 2LB achieves the required therapeutic pressure necessary for the management of venous leg ulcers, is easy to apply and may provide a suitable alternative to other multi-layer bandage systems.
Improving accuracy and efficiency of early warning scores in acute care
Authors: Mohammed Mohammed A , Hayton Ruth , Clements Gill , Smith Gary , Prytherch David
Published: May 2014

Background: Early warning scores (EWS) are an integral part of the care of acutely ill patients. Unfortunately, in the few studies where the accuracy of EWS has been tested it has been found to be lacking, with serious implications for quality of care. Aim: to determine if the provision of computer-aided scoring could increase the accuracy and efficiency of EWS calculations, when compared with the traditional pen-and-paper method, and to determine if it was acceptable to users. Design: 26 nurses from two surgical assessment wards in two hospitals were studied. The study was conducted in three phases. Phase 1 – a classroom-based exercise where nurses were given ten patient vignettes and asked to derive EWS using traditional pen-andpaper methods; Phase 2 – the same as phase 1, but using a hand-held computer to derive EWS; Phase 3 – the same as phase 2, but was a follow-up exercise undertaken in the ward environment, 4 weeks after computer-aided scoring was implemented in the two wards. Each phase closed with a user perception/attitudes questionnaire. Results: Accuracy and efficiency – phase 1 was associated with a significantly lower overall accuracy (152/260, 58%) compared with phase 2 (96%; difference in proportions 38%, 95% confidence interval 31–44%, P<0.0001). There was a small but significant reduction in accuracy from phase 2 (96%) to phase 3 (88%) (8% difference, P=0.006). The mean time to derive an EWS reduced from 37.9 seconds in phase 1 to 35.1 seconds in phase 2 (P=0.016), down to 24.0 seconds in phase 3 (P<0.0001). User acceptability: in phase 1, nurses favoured the pen-and-paper method in all respects except accuracy. In phase 2, nurses’ views shifted significantly in favour of the handheld computer, with little deterioration in the follow-up phase 3. Conclusions: a hand-held computer helps to improve the accuracy and efficiency of EWS in acute hospital care and is acceptable to nurses.
The effective management of catheter-related UTIs
Authors: Nazarko Linda
Published: May 2014

The majority of patients currently residing in Britain’s hospitals are older people, many of whom have continence problems that may result in catheterization. Older people are also particularly vulnerable to infection and the consequences of suboptimal care. Urinary tract infection is the most common health-care-acquired infection and most urinary tract infections are a result of urinary catheterization. This extended case study illustrates how ritualistic catheter care can increase the risks of an older person developing an infection as well as a host of other problems as a result of that infection. It then examines how evidence-based catheter care can reduce the risk of infection and adverse events as well as providing successful patient outcomes.
A sexual health time bomb that needs to be defused
Authors: Shah Shandip , Shah Ketan
Published: May 2014

There is a sexual health time bomb ticking among Britain’s young people, the reasons for which could keep people arguing for weeks – too little sex education, too much sex education, peer pressure, changing moral and religious values, lack of employment opportunities, binge drinking, a celebrity culture obsessed with sex – these are just a few of many suggestions.
Greener nurses are vital for a healthy future
Authors: Castledine George
Published: May 2014

Nursing has always been associated with caring and the future health of the nation. But if nurses really care about people’s health, then they should be at the vanguard of the green revolution that is urgently needed in the world today. In a recent article in The Times, Muir Gray (Gray, 2009) points out that the Victorian revolution in public health was the reaction of the time to the dangers of cholera. ‘Fear of cholera ensured that vast sums of money were spent on building sewers and ensuring that everyone had clean water. Climate change is the cholera of our era – fear of the havoc that climate change will wreak should stimulate a new public health revolution.’
Financing the future cost of nursing care
Authors: Castledine George
Published: May 2014

Ever since the world went into a financial crisis and Britain’s economy crashed, there have been many questions asked about how our financial institutions can move back into the black. While the recession has pushed many private sector companies into making tough choices around personnel costs, those working in the public sector have remained largely immune to the downturn. That was until recently, when the annual conference for senior NHS health-care managers declared that by 2011 the NHS would be in financial trouble.
Growing swine flu fatalities demand serious attention
Authors: Beckford-Ball Jason
Published: May 2014

Back in May, when word of the swine flu outbreak in Mexico had started to spread around the globe and the newspapers were full of stories about potential pandemics, I wrote on these pages that ‘there was a need for perspective – after all, swine flu has yet to kill anybody here’.
Current standards for infection control: audit assures compliance
Authors: Flanagan Pauline
Published: May 2014

Having robust policies and procedures in place for infection control is fundamentally important. However, each organization has to go a step beyond this; evidence has to be provided that these policies and procedures are followed. As of 1 April 2009, with the introduction of the Care Quality Commission and The Health and Social Care Act 2008 Code of Practice for the NHS on the Prevention and Control of Healthcare-Associated Infections and Related Guidance, the assurance of robust infection control measures within any UK provider of health care became an even higher priority. Also, the commissioning of any service by the NHS must provide evidence that the provider has in place robust procedures for infection control. This article demonstrates how the clinical audit team at the Douglas Macmillan Hospice in North Staffordshire, UK, have used audit to assure high rates of compliance with the current national standards for infection control. Prior to the audit, hospice staff had assumed that the rates of compliance for infection control approached 100%. This article shows that a good quality audit tool can be used to identify areas of shortfall in infection control and the effectiveness of putting in place an action plan followed by re-audit.
The role of community nurses in providing a seamless patient pathway
Authors: Bowers Ben
Published: May 2014

Every day, community nursing teams deliver evidence-based practice and use their expertise to oversee complex care pathways. However, much of the valuable work community nurses undertake remains invisible or tacit as practitioners concentrate on managing their patients’ needs rather than raising the profile of the service they offer. This case study demonstrates the crucial role a community nursing team played in coordinating services, risk management and delivering evidence-based care. This enabled an individual to heal his problematic abdominal wound and quickly regain his former quality of life. When community nursing teams apply their experience and clinical expertise, they can facilitate dramatic improvements in patients’ health and recovery times. Nursing teams need to highlight and promote the valuable role they play in care pathways to the commissioners of community services. Patients can then continue to be supported by professionals with the experience and skills to assist them in managing complex clinical situations.
Management of malnutrition in older people within the hospital setting
Authors: Dunne Annette
Published: May 2014

Malnutrition is a major problem among older people in the UK, and one that frequently goes unrecognized and untreated. It impacts on the individual’s quality of life and increases both length of stay in hospital and the risk of unsuccessful outcomes to treatment. This article discusses the prevalence of malnutrition, the role of screening and practical steps that can be taken to improve the nutritional management of older people within the hospital environment.
Marketing disease: is osteoporosis an example of ‘disease mongering’?
Authors: Wright Jane
Published: May 2014

Osteoporosis is often described as a disease, yet the symptoms are imperceptible and reliable diagnostic criteria have not been formulated. It is probably better described as a potential risk factor in patients with underlying illness. However, the marketing of osteoporosis has created the impression that all women (and many men) are at risk of suffering fragile bones, hip fracture and death. Large sums of money have been spent on raising awareness, diagnosing and treating osteoporosis, yet its link to hip fracture is not strong and the drug therapies used may be of little benefit or cause actual harm. This article draws parallels in the development of such pseudo-illness with the medicalization of the menopause and the pathologizing of a number of phenomena, including blood pressure, unhappiness, cholesterol levels, sexual and social function. Similarly, in these cases, the manufacture of ‘lifestyle’ drugs has been costly without significant improvement in mortality or morbidity. Indeed, as was the case with hormone replacement therapy, which resulted in the unnecessary deaths of thousands of women, there may be significant risks attached to treating non-existent diseases. The influence of the medical profession and large drug manufacturers is evaluated and their vested interest in the manufacture of illness is explained. Finally, the crucial role of nursing in challenging these shibboleths is discussed.
Type 1 diabetes: identifying and evaluating patient injection technique
Authors: Spray Jennifer
Published: May 2014

A diagnosis of type 1 diabetes is life changing, both physically and psychologically. This transformation requires a solid rapport between the patient and the diabetic specialist team to ensure the condition is managed successfully. Nevertheless, all general ward nurses should be aware of issues surrounding insulin administration, and thus participate in opportunistic identification, evaluation and empowerment of such patients when hospitalized. Patients that may be mismanaging their condition, irrespective of the length of diagnosis, would then be identified and referred appropriately to the specialist nurse before unnecessary complications arise. It is, however, evident that such measures are overlooked as a result of other constraints. This article explores how the ward is an ideal environment for identifying and evaluating the practical, physical and psychological components of patient insulin administration, through a direct observational approach. Discussion surrounding contributory barriers pertaining to its neglect, proactive implications for practice that potentially could overcome such issues, along with the underpinning pathophysiology, are addressed. Nurses will thus gain a greater perspective concerning the significance of routinely evaluating the competencies of patients’ insulin administration within the ward environment.
A local response to implementing Saving Lives in a large acute Trust
Authors: Charlotte Edden Anna , Willan Johanna Louise
Published: May 2014

Healthcare-associated infections (HCAIs) are a high priority for health professionals. Under the Health and Social Care Act (2008), NHS organizations that fail to comply with the duties in the act could, in extreme cases, be liable for prosecution. Saving Lives (2007) is a national strategy to prevent and control HCAIs which incorporates seven high-impact interventions or care bundles. These relate to clinical procedures that must be performed correctly and in the same order for each patient, every time, to reduce the risk of a patient contracting an HCAI. Within a large Trust in the north east of England, five practice improvement facilitators were employed to assist with the implementation of the Department of Health’s Saving Lives programme. A steering group consisting of senior multidisciplinary team members was set up. One of the aims of the group was to reduce variations in practice and to standardize documentation and clinical practice. This article describes how phase I of the programme was implemented across the Trust and discusses the standardized documentation developed.
The provision of information for patients prior to cataract surgery
Authors: Lockey John
Published: May 2014

This clinical audit evaluates the provision of patient information. It also establishes patients’ views on satisfaction regarding the information provided at nurse-led preoperative assessment prior to giving informed consent for cataract surgery. A quantitative descriptive audit was conducted using a questionnaire, by which the questions reflected the baseline standards. A convenience sample of 75 postcataract patients took part in this retrospective audit. All 75 patients stated that they were either ‘very satisfied’ or ‘satisfied’ with both the verbal explanation and written information received, and identified the preoperative assessment nurse as the main source of information.
Size does matter
Authors: Bailey Asa
Published: May 2014

Big is beautiful. If that is the case, however, then beauty kills. As proven by international healthcare consensus and numerous research studies, being too big (obese) is highly dangerous to your health, increasing the risk of type 2 diabetes mellitus (and associated medical complications), hypertension, coronary heart disease and stroke, cancer, osteoarthritis, infertility and liver disease. And at a projected cost to the NHS of £6.3 billion a year by 2015 (Foresight, 2007), overweight and obesity is not a cost that the Government nor the Department of Health are willing to pay – and rightly so.
Professional conduct for students
Authors: Karstadt Lyn
Published: May 2014

The Nursing and Midwifery Council recently published new guidelines on professional conduct for student nurses. Lyn Karstadt welcomes the move, which will help students understand what is expected of them, and give educators clarity on just what makes a student nurse unfit to practice.
Too clever to care?
Authors: Glasper Alan
Published: May 2014

Alan Glasper assesses the controversy surrounding the Chief Nursing Officer’s BBC Radio 4 interview on graduate entry to nursing on 12 November 2009.
Undergoing enucleation of the eye. Part 1: preoperative considerations
Authors: Cooper John
Published: May 2014

Enucleation or evisceration of the eye is an uncommon but hugely life-changing surgical procedure for any patient. It may be necessary to remove the eye urgently due to trauma or tumour, or for some patients it may be the end of a long period of treatment and other surgical interventions that leads to removal of a blind, painful eye. No matter what the indications for surgery the care required to support and counsel these patients needs to start well before any surgical intervention. The author will outline and discuss some of the care implications associated with patients who undergo enucleation or evisceration surgery. Being an extensive topic the author has divided the subject into two articles. In this, the first of these articles, the author will discuss the preoperative considerations and in the second part the author will outline the postoperative care. The author works as an oculoplastic specialist nurse and has gained considerable experience in planning and facilitating the care for patients who have to undergo this surgery within a multidisciplinary team setting.
How much education does a nurse really need?
Authors: Castledine George
Published: May 2014

Ever since the formal training of nurses began during the latter part of the 19th century, there has been controversy. How much, what type, and what level of education does a nurse need?
Do nurses really care? Confirming the stereotype with a case control study
Authors: Williams Geraint , Dean Phil , Williams Elisabeth
Published: May 2014

In their definition of modern nursing, the Royal College of Nursing emphasizes the importance of caring. However, there is little other than anecdotal evidence that female qualified staff nurses are more caring and compassionate than average individuals. A study was carried out to test, under scientific conditions with a case control study, the hypothesis that staff nurses are no more caring than average female individuals. Using the ten-item personality inventory (TIPI) questionnaire, a statistical comparison was made between 174 volunteer female staff nurses and data for 760 adult female controls extracted from the TIPI instrument’s original validation study. The questionnaire measures each of the five major facets of personality: openness, extroversion, conscientiousness, agreeableness and neuroticism. Agreeableness, which is a tendency to be compassionate, considerate and cooperative, was used as a proxy measure for ‘caring’. Data were analysed using unpaired Student’s t-tests. Female staff nurses recorded significantly higher scores than female controls concerning the personality traits extroversion, agreeableness, conscientiousness and emotional stability (P<0.05). The analysis demonstrates that in direct comparison to normal adult females, staff nurses are significantly more caring, conscientious and resilient individuals. The personality traits found in female staff nurses complement their profession and to some extent justify the caring, compassionate nurse stereotype. Whether career nursing self-selects these qualities or to what extent nursing staff develop aspects of their personality as a product of experience is a subject for debate.
The stigma of mental health still runs deep
Authors: Beckford-Ball Jason
Published: May 2014

Iwould first like to say what a pleasure it is to be back at the BJN after nearly 10 years away. I was lucky to serve my publishing apprenticeship on the journal and learnt firsthand what it means to its readers. I am delighted to be back and able to contribute once again to the BJN’s tradition of providing excellent clinical information to a dedicated and loyal nursing readership.
Reviewing the efficacy of infection control isolation
Authors: Cole Mark , Lai Louise
Published: May 2014

As part of a package of measures aimed at preventing crossinfection the isolation of patients in single rooms or through cohort nursing is a well-documented policy. However, the evidence base for an isolation policy is unclear – it can cause logistical problems through inadequate resources and may result in physical, psychological and social harm to patients. Notwithstanding these problems, isolation can be said to have a practical utility in that it may impact on a nurses’ behaviour as they enact compliance as part of their infection control duties. It is nevertheless important for policymakers to note that it is not the location of the patient per se that is of primary importance in the transmission of contact spread organisms, but the behaviour of staff within the isolated environment.
Assessing the pain of people with a learning disability
Authors: Kingston Karen , Bailey Carol
Published: May 2014

This article highlights the inequalities in health-care provision experienced by people with a learning disability, particularly the issue of pain and the barriers people with a learning disability face when trying to have their pain properly recognized and managed. The authors describe the process followed by their learning disability service in producing a pain protocol that attempted to overcome these barriers. They also examine the pain assessment tool that is now used in the author’s learning disability service. Lastly, the article considers why a specially designed pain assessment tool was deemed more appropriate than any of the standardized assessment tools available and looks at the reasons why assessment tools should be presented in an accessible format that enables people with a learning disability to alert healthcare professionals to their pain and receive appropriate treatment.
Learning lessons from abroad
Authors: Karstadt Lyn
Published: May 2014

Australia and New Zealand changed to an all-graduate nursing profession round 20 years ago. When considering such a change in the UK, it is important to look at the impact on students and nursing in places where it has already been introduced. Lyn Karstadt considers the examples set by Australia and New Zealand, discussing both nursing as an all-graduate profession, and new immigration rules.
A practical guide to reducing pain in patients with wounds
Authors: Benbow Maureen
Published: May 2014

Pain in patients with wounds is a largely underestimated problem in spite of it being highlighted as a significant factor that adversely influences patients’ biopsychosocial wellbeing; it also adversely affects wound healing. This article considers the impact of wound pain on patients’ quality of life, and how quality of life may be measured. The article explores the pathophysiology of pain, its manifestation and how an assessment of a patient’s pain may be carried out using a variety of tools. Finally, it provides practical guidance for reducing pain associated with wounds, including consideration of the method and frequency of dressing changes, and the types of dressing used
The use of MelMax®> in the healing of chronic wounds
Authors: Jones Menna Lloyd
Published: May 2014

Chronic wounds can have detrimental consequences for the quality of life of patients as well as presenting a huge financial burden to the NHS. An imbalance in the level of matrix metalloproteinases (MMPs) and the tissue inhibitors of MMPs (TIMPs) in chronic wounds impedes the healing process. In addition, high levels of bacteria in the wound bed are a common feature of chronic wounds and also cited as a major cause of delayed healing. The aim of this article is to look in more detail at the role of MMPs in wound healing as well as the antimicrobial properties of honey when combined with a dressing to combat wound infection. The article also introduces a new dressing, MelMax®> (distributed by CliniMed), which utilizes protease regulation and the antimicrobial properties of honey when addressing chronic wound infection. Short-term case studies are used to demonstrate how the dressing was successfully incorporated into the author’s practice.
Outpatients: them and us
Authors: Castledine George
Published: May 2014

I have been taking a friend of mine for treatment as an outpatient recently and it has given me the opportunity to observe life from the other side. Many years ago, people attending as outpatients sat on long benches waiting nearly half a day to be seen and receive treatment. When they were called in to see the doctor they would rarely say a word, or question what the doctor had to prescribe. Today, however, things have changed and patients now attend on an appointment basis. Information is shared between the doctor and the patient, and the patient is encouraged to ask questions and participate in a discussion about their treatment and care. Of course, it does not always run as smoothly as that and there is always the likelihood that you can come across a difficult receptionist, doctor or nurse.
Posterior tibial nerve stimulation for faecal incontinence
Authors: Findlay John , Maxwell-Armstrong Charles
Published: May 2014

Faecal incontinence is a common multifactorial condition with a range of invasive treatment options, all of which may be associated with significant complications. Posterior tibial stimulation by continence nurses is an established treatment for urinary incontinence; however, its use in faecal incontinence, while rapidly evolving, is limited to eight small and differing studies. In this article, the background of current management options for faecal incontinence is discussed, as are the physiology and evidence underlying neuromodulation. The evidence base for posterior tibial nerve stimulation in faecal incontinence is reviewed, as well as the implications for practice and further research. While this early evidence base is encouraging, it has yet to be established whether this novel approach may be the minimally invasive, effective and cheap treatment hoped for, for this common and debilitating condition
Assisted suicide and the law: what every nurse should know
Authors: Smith Stephen.W
Published: May 2014

The Director for Public Prosecutions published a final policy for prosecutors in cases of encouraging and assisting a suicide in February of 2010. This policy follows an interim policy and consultation exercise which the Director had engaged in as required by the House of Lords decision in R (on the application of Purdy) vs Director of Public Prosecution. This article explores the changes between the interim policy and the final policy. It provides an analysis of the factors in favour of and against prosecution in the final policy, as well as considering the implications of the final policy for nurses and healthcare workers
Blowing the whistle on bad press
Authors: Hill Rosalind
Published: May 2014

Blowing the whistle on malpractice in the NHS seems to have been given a bad reputation among some NHS staff; this is despite many initiatives in place to show that the majority of (if not all) NHS trusts actively support the practice of whistleblowing
Peripheral IV cannulation in chemotherapy administration
Authors: McGowan Donna
Published: May 2014

It is well recognized that chemotherapy treatments can result in toxic side effects, some of which can be life threatening, such as bone marrow suppression causing neutropenia, thrombocytopaenia, and/or anaemia. These effects place patients at an increased risk of infection when having peripheral cannula placed for intravenous (IV) therapies. The issues surrounding infection control are therefore of particular significance when caring for this patient group
Creative nursing: art or science?
Authors: Castledine George
Published: May 2014

The Government’s commitment to reducing bureaucracy in the public sector and the latest White Paper on the health service may have some interesting implications and opportunities for nurses. In particular, we must push forward the importance of allocating time for nurses to develop their creative skills and holistic approach in establishing quality patient care outcomes. With the end of the ‘target driven culture’ and the emphasis on patient?centredness, this is the time for the ‘art’ of nursing to re-establish itself
Short back and sides
Authors: Hill Rosalind
Published: May 2014

The recently published NHS White Paper,Equity and Excellence: Liberating the NHS (Department of Health (DH), 2010), sets out one of the biggest shake-ups of the country’s health system since the NHS was established over 60 years ago. It introduces four main topics to enact this change
Progress in making the NHS safer and dealing with complaints
Authors: Tingle John
Published: May 2014

Two national organizations concerned with patient safety—the National Patient Safety Agency and the Parliamentary and Health Service Ombudsman—have recently published their annual reports. The publications reveal important insights into how the NHS is currently dealing with the issue of patient safety, and complaints brought against the NHS by patients
‘Have a nice day’: consumerism, compassion and health care
Authors: Sturgeon David
Published: May 2014

Plans to implement a quality measurement framework that will rate nurses according to the level of care and compassion they demonstrate have been proposed and discussed in a number of Department of Health documents. From September 2010 degree?level nursing students in Wales will receive regular feedback on their communication skills and whether they are exhibiting sufficient levels of compassion. This article examines the reasons why there have been such moves by both politicians and health professionals to demonstrate, in quantifiable terms, that they are able to measure something that is frequently contextual and subject to individual interpretation. It explores how these moves have been influenced by the disclosure of unacceptable standards of care by the Patients Association report and the enquiry into Mid-Staffordshire NHS Foundation Trust. It also discusses how the adoption of targets to evaluate care and compassion seems to reflect a market-driven and bureaucratic approach to health care that has resulted in a system in which measurability and outcome are considered the most important indicator of quality
Writing for professional publication. Part 1: Motivation
Authors: Fowler John
Published: May 2014

Dr John Fowler wrote his first article for publication as a staff nurse 30 years ago. Since then he has published over 50 articles in a variety of publications, edited seven nursing text books and is the series editor for 20 books in the Quay Book’s ‘Fundamental Aspects of Nursing Care’ series. He has supported over 40 nurses in their early writing for successful publications

Writing for professional publication can be a daunting prospect, but, with a little effort and the right motivation, it can be a rewarding and career-enhancing experience. And the good news is, it’s not as difficult as it may sound. In this first part of a series of articles on writing for professional publication, John Fowler, an experienced nursing lecturer and author, discusses perhaps the most important factor in seeing your work published: motivation. Forthcoming issues will explore different aspects of publication and include advice and practical tips
Prostate cancer: how assessment of QoL can improve delivery of care
Authors: Brown Michelle
Published: May 2014

Prostate cancer treatments often affect quality of life and problems may present at any point during treatment. Measuring and identifying issues of quality of life (QoL) may create an opportunity for the patient to discuss problems and induce information transfer from health professional to patient and vice versa. Many practitioners already assess QoL in patients with prostate cancer because treatment for the disease can have a dramatic impact on lifestyle. QoL may facilitate a more holistic approach to patient care. Using a QoL assessment tool may promote and enhance the current service provision and aid identification of bothersome side-effects, for example loss of libido, gynaecomastia (i.e. abnormal over-development of the breasts in a man), and hot flushes. The Functional Assessment of Cancer Therapy-Prostate scale (FACT-P) (Cella et al, 1993) is a prostate-specific QoL assessment tool, which can be self-administered and takes little time to complete. This may be a useful tool in the ongoing management of patients with advanced prostate cancer. With the emphasis on quality of service for cancer patients (Department of Health (DH), 2000; DH, 2007a; National Health Service Improvement, 2009), it is paramount that health professionals continually examine practice and the quality of the service delivered. Addressing QoL issues for the patient with cancer should be a priority. This article will outline the significant side-effects that a patient with advanced prostate cancer may sustain and attempts to indicate how QoL assessment tools may contribute to care management and delivery.
The benefits to nurse-led telephone follow-up for prostate cancer
Authors: Anderson Beverley
Published: May 2014

Prostate cancer is an important and increasing health problem for urologists, and one which places significant demands on healthcare establishments for improvements in service provision and maintaining quality. Guidelines for diagnosing and managing prostate cancer in the UK are set out by the National Institute for Health and Clinical Excellence (2008). Diagnosis includes a number of elements, of which the Prostatic Specific Antigen (PSA) test is highly significant both in the diagnosis process and in monitoring patients following treatment. Ongoing monitoring of service provision within the outpatients’ department highlighted an urgent need for improvements in the care received by prostate cancer patients. There is evidence (Department of Health (DH), 2007) to suggest that in undertaking initiatives aimed at improving service delivery and patient satisfaction, the skills of the multidisciplinary team are paramount (specifically the specialist nurse) in the provision of a nurse-led service. Over time, demands for nurse-led services have increased. In particular, telephone consultations have been shown to provide significant improvements in service delivery. A nurse-led PSA telephone follow-up clinic was developed and implemented in 2005 to increase efficiency within the uro-oncology outpatient clinic. Between August 2005 and March, 2009, a total of 67 patients were recruited into the clinic, 46 of which are still being followed-up at the time of writing. To evaluate patient satisfaction with this nurse-led initiative, a questionnaire was developed and a telephone interview conducted. Results indicate an overall satisfaction with the telephone follow-up service with 39 (90%) patients stating that they are very satisfied with the service provided.