bluuebunny/crossref_metadata_2025 huggingface dataset:
Bed occupancy, turnover interval and MRSA rates in Northern Ireland
Authors: Cunningham Joseph B , Kernohan W George , Rush Thomas
Published: May 2014

The data describe bed turnover intervals (TI), bed percentage occupancy (PO) and methicillin-resistant Staphylococcus aureus (MRSA) rates per 1000 bed days of patient episodes. It was collected from annual hospital statistics in Northern Ireland (NI) and from the Communicable Diseases Surveillance Centre (CDSC) NI. The descriptive data show 6 of the general 11 surgical Trusts, out of a total of 12 Trusts examined, had PO greater than 85%; and all 11 medical facilities in these Trusts had occupancy rates greater than 85%. A significant correlation was established between turnover interval and MRSA per 1000 bed days of patient episodes in acute services beds. The correlation of PO with MRSA rates was 0.49 (ns). The conclusions drawn from the study are that in many Trusts the rates of bed occupancy for general surgery and general medicine is in excess of national guidelines and rapid turnover of patients is related to rates of MRSA infection. The implications for nurses and managers are discussed.
The role of mentors in supporting pre-registration nursing students
Authors: Pellatt Glynis Collis
Published: May 2014

Students' practice experience is one of the most important aspects of their preparation for registration. There is currently considerable emphasis on improving this practice experience with adequate support and supervision. Mentors play a vital role in supporting, teaching and assessing students in practice. This article offers a literature-based discussion of the development and current practice of the mentor role in the support and assessment of students undertaking pre-registration programmes. The development of the mentor role is discussed. Issues relating to the role in nurse education today are addressed in relation to supporting, teaching and assessing students in practice and mentor accountability. This article discusses how Higher Education Institutions and universities and service managers might support mentors in their role. The implications for practice are outlined and include the NMC standards to support learning and assessment in practice due for publication in 2006.
Evaluating the evidence for administering phosphate enemas
Authors: Bowers Ben
Published: May 2014

This article analyses the existing evidence surrounding the use of phosphate enemas in practice. Phosphate enemas are routinely used in a variety of clinical areas to relieve constipation or as a diagnostic bowel preparation. Yet, there is increasing uncertainty about both the medication's clinical effectiveness and its safety. There is limited evidence to suggest the product is more effective than other medications in the management of chronic constipation. However, phosphate enemas are an effective preparation for some diagnostic bowel investigations. There are also a variety of infrequently seen, but detrimental, complications specifically associated with the administration of phosphate enemas. The administration of phosphate enemas should be avoided if clients have certain underlying conditions.
Managing long-term conditions: non-cancer-related lymphoedema
Authors: Hardy Denise
Published: May 2014

This article outlines the assessment and management of this under-publicized condition using three cases as examples. It also highlights the requirement for healthcare services to be responsive and personalized to the needs of individuals suffering from lymphoedema, thus improving their quality of life and reducing the impact of those needs on health- and social-care services.
Treating a pressure ulcer with bio-electric stimulation therapy
Authors: Hampton Sylvie , Collins Fiona
Published: May 2014

Mr Jones lived independently until he developed necrotic pressure ulcers over his heels and could no longer mobilize to care for himself. He was transferred to a nursing home where he lived for 18months and where the nurses could care for his wounds.The wound had been on his right heel without changing over the 18months and, although attempts to hydrate the eschar had been somewhat successful, the necrotic tissue proved stubborn creating large quantity of fibrous slough. Mr Jones was initially assessed by the tissue viability consultant on 14 March 2005 and agreed to the application of bio-electric stimulation therapy (POSiFECT™). The wound change was immediate and was fully healed by 16 June 2005, 12weeks after his initial assessment. This article outlines his care and the background to bio-electrical stimulation in wounds.
Depression in patients with chronic venous ulceration
Authors: Jones June , Barr Wally , Robinson Jude , Carlisle Caroline
Published: May 2014

As leg ulcer research has generally focused on aspects of treatment, the psychosocial impact of leg ulceration remains understudied. This article reports the findings of a study exploring the prevalence of anxiety and depression in 190 patients with chronic venous ulceration across 9 Trusts in the northwest of England. The hospital anxiety and depression scale (HADS) was used to screen patients for the presence of anxiety and depression using a cut-off point of 9 for level of ‘caseness’. A total of 52 (27%) people scored as depressed while 50 (26%) scored as anxious. The two symptoms which appeared to be associated with anxiety and depression were pain and odour while there was no association found between living alone, mobility and exudate. These findings suggest that the focus of care needs to be redirected for many patients for whom cure is not an option, but who are left to live with a chronic wound. Furthermore, psychosocial factors, including depression, should be a focus in assessment and ongoing review of patients with leg ulceration.
Work discussion groups in clinical supervision in mental health nursing
Authors: Ho Danny
Published: May 2014

This study aims to explore the value and meaning of a psychodynamic work discussion for mental health nurses, and its potential as an approach in staff clinical supervision. Data were generated by using a focus group with a purposive sample of six mental health nurses, and analysed by the ‘collapsing of data’ from labels to form categories and formulate themes. The findings suggest that staff emotion generated from clinical work is dealt with in many personal ways though rarely in clinical supervision. Although the idea of a work discussion group is not readily known among the focus group, staff appear to be open to its potential to provide a helpful emotional perspective. Education in the form of an introduction and exposure to some basic psychodynamic ideas could provide the first step towards unlocking its potential. Sharing personal experiences of an emotional nature within a safe, secure environment seems significant in this education process
Management of intestinal failure and high-output stomas
Authors: Sica Jo , Burch Jennie
Published: May 2014

Intestinal failure and a high faecal output from a stoma or fistula are rare gastrointestinal complications. Intestinal failure occurs when the intestine fails to absorb sufficient fluids and nutrients to maintain life, and can result from bowel resection or malabsorption. The management of these conditions raises many issues which nurses caring for affected patients need to consider. This article will discuss those relating to feeding, appliances and medication. Two methods of feeding that can be useful in patients with intestinal failure, namely parenteral nutrition (intravenous feeding) and fistuloclysis (feeding via an intestinal fistula), will be explored. Finally, a short case study will be presented to highlight the effects of some of these interventions and the problems that they can cause for patients.
Back to basics: finding an optimal cerumenolytic (earwax solvent)
Authors: Chalishazar Urmil , Williams Huw
Published: May 2014

An in vitro study was conducted to assess the effectiveness of the commonly used aqueous and organic cerumenolytic (earwax solvent). Three agents were included in the study: olive oil, sodium bicarbonate and urea-hydrogen peroxide complex 5% in glycerol. Distilled water was used as a control. The disintegration of preformed wax plug was noted at specific intervals. The test tube containing distilled water as a control was found to be most effective and fastest in completely disintegrating the wax. This was closely followed by sodium bicarbonate. In contrast, the organic products, namely urea-hydrogen peroxide complex 5% in glycerol showed very little cerumenolytic effect. Olive oil, the most commonly used solution, was ineffective in disintegrating the wax plug even after 24 hours. The study shows aqueous cerumenolytics are more effective than organic agents.
Moral dilemmas associated with the withdrawal of artificial hydration
Authors: Blakely Gillian , Millward Jennifer
Published: May 2014

Withholding artificial hydration from unconscious terminally ill patients is a complex phenomenon identified as terminal dehydration. Towards the end of a terminal illness it is acknowledged that a patient’s desire for fluid and food diminishes, followed by a period of unconsciousness (McAulay, 2001). Inconsistent care philosophies produce divergent opinions and often diametrically conflicting treatments (Craig, 1994). Additionally, literature disputes the detrimental effects of dehydration, therefore, decisions pivot on legal and ethical considerations. Consequently, the viewpoints of the medical and nursing staff can vary; furthermore, recognition must be made to the psychological impact of the relatives. As terminal illness is boundless, all areas of healthcare can be affected. Further investigation into this dilemma is required to identify the most appropriate care management plan.
Abuse by care professionals. Part 2: a behavioural assessment
Authors: Barber Christopher
Published: May 2014

The behaviours that give rise to abuse are many, varied and complex. Because definitions of abuse are hampered by a lack of both inter-professional and international consensus, identifying abuse and the causative factors for such behaviour can be problematic. This article will focus on the various types of abuse and possible reasons for such behaviour.
Assessing patient preference for two types of elastomeric infusion device
Authors: Dodd Susan
Published: May 2014

Home administration of antibiotic therapy to cystic fibrosis patients is one of many applications for the use of elastomeric infusion devices. Patient acceptability can significantly affect adherence to complex drug regimens with concordance being a concern in this patient population. While patient acceptance is often cited as a factor in pump selection, patient preference has not been assessed within a particular class of infusion device. The objective of this study was to assess patient preference for one type of elastomeric infusion device (Baxter Intermate® – hardshelled design) or another (Fresenius Kabi Eclipse® – soft-shelled design). Twentyfour patients entered the study. 20/24 (83%) patients expressed a preference for the Eclipse®, while 4/24 (17%) stated no preference for either device. The Eclipse® device was found to be much more favourable in terms of comfort and discreetness. Patient preference should therefore be given significant consideration in order to maximize concordance with drug regimens.
A global perspective on cancer prevention
Authors: Coughlin Kate
Published: May 2014

Many cases of cancer are preventable, is the main message of Food, Nutrition, Physical Activity and the Prevention of Cancer: A Global Perspective, a report from the World Cancer Research Fund and the American Institute for Cancer Research (WCRF/AICR). This report, which updates the first report in 1997, evaluates the relevant evidence. On the basis of this work the international expert panel developed ten recommendations for cancer prevention.
Home intravenous therapy training for carers of children and young people
Authors: Mighten Janice
Published: May 2014

Modernization of the health service has provided patients with an element of choice with health care, which has enabled parents and carers to carry out treatments such as home intravenous therapy (HIVT). Current literature has highlighted the importance of educational programmes for caregivers when undertaking HIVT. This article provides an overview of a training package, developed at Nottingham City Hospital by the children’s respiratory nurses. The package is used to assist parents and carers with HIVT for children and young people with respiratory conditions, in particular, cystic fibrosis. The stages of a training programme are discussed, including details of an audit that demonstrated a good response rate in relation to how useful the training pack was for HIVT.
Tighter controls of student mentors may be problematic
Authors: Castledine George
Published: May 2014

The mentorship of students on approved preregistration nursing education programmes has long been a source of concern for everyone involved with the quality of student supervision and completion of learning outcomes. There are severe critics of the system, which is believed to have led to shoddy practice where students pass practice placement objectives without any proper control or checks to see if they have achieved them. In some instances, students have hardly worked with their mentors and have been faced with the prospect of failing their placements because no-one can verify what they have accomplished.
Comparative study on the effect of enteral feeding on blood glucose
Authors: Campbell Johan , McDowell Joan RS
Published: May 2014

Stress hyperglycaemia is common in intensive care patients. There is recent evidence to suggest that maintaining the blood glucose of a patient in intensive care between 4 mmol/litre and 6.1 mmol/litre reduces morbidity and mortality. The aim of this comparative study was to determine if blood glucose control improves with abolishing feeding breaks and introducing continuous enteral feeding. Twenty ventilated patients admitted to a combined medical and surgical intensive care unit were sampled. Ten patients received standard care (enteral feeding for 18 hours with an 8-hour break). The interventional group received continuous enteral feeding over the 24 hours. Analysis of the data revealed that continuous enteral feeding reduced blood glucose levels significantly, improved blood glucose control and reduced insulin requirements. Research should continue to determine if the results of this study can be replicated within a larger group of intensive care patients.
Testing nasogastric tube positioning in the critically ill: exploring the evidence
Authors: May Sarah
Published: May 2014

Nutritional support in the critically ill is commonly delivered via a nasogastric tube. Correct positioning in the stomach must first be confirmed as inadvertent feeding into the lungs carries a high risk of mortality. The National Patient Safety Agency (2005) recommends the method of pH testing nasogastric tube aspirates to verify tube position. This article critically analyses the research supporting this method, and questions its reliability in critically ill patients whose gastric pH may well be altered due to prophylactic stress ulcer medications and continuous feeding regimens. There is a lack of quality research testing this method in the critically ill population. The theory–practice gap is addressed, and preliminary research behind use of techniques such as capnography and capnometry is also examined.
Venous leg ulcers and the VULCAN trial
Authors: Palfreyman Simon , Walker Nicola
Published: May 2014

Venous leg ulcers are often colonised by microorganisms and, this can have an adverse effect on wound healing (Eriksson, 1984; Halbert et al, 1992). During the last 5 years many dressings that purport to have antimicrobial effects have become available (Chambers et al, 2007). These dressings have been promoted for use in the prevention and treatment of infection in wounds (Alcaraz and Kelly, 2003; Lansdown et al, 2003; Vanscheidt et al, 2003; Dowsett 2004). One type of antimicrobial dressing is those that donate silver to the wound bed. These are based on the ability of silver to kill or limit the growth of a wide variety of microbial organisms (Thomas and McCubbin, 2003).
Women’s help-seeking behaviour at the onset of myocardial infarction
Authors: Higginson Ray
Published: May 2014

Few studies have explored the factors affecting women’s decisions to seek medical assistance at the onset of cardiac symptoms. Although some studies have shown that there are gender differences between men and women in terms of how they cope with having a myocardial infarction (MI) and heart disease, few have explored how women actually experience MI and what influences their help-seeking behaviour. Those studies that have, suggest that women often fail to recognize the signs of MI and delay seeking treatment for symptoms of MI longer than men do. This qualitative study explores the female experience of MI, focusing on some of the thought processes and coping strategies used by women when having an MI. Using a grounded theory research approach, 25 post-MI female patients were interviewed about their experiences during acute MI. Through analysing and coding data, a number of categories emerged that provide insight into the health seeking behaviour of women at the onset of MI. Emergent categories were: a delay in seeking help (main category); an engendered perception of heart disease (sub-category); not recognizing symptoms (sub-category); maintaining control through self-medication (sub-category). Analysis of the data suggests that when experiencing an MI, women delay seeking help for a number of reasons, including not recognizing symptoms, perceiving heart disease as a ‘male’ problem and preferring to self-medicate.
Acute nursing care and management of patients with sickle cell
Authors: De Diana
Published: May 2014

The information provided in this article has been developed to coincide with the recent findings from a National Confidential Enquiry into Patient Outcome and Death (2008) report, ‘A Sickle Cell Crisis’, which calls for nurses to learn more about the disorder in order to better support patients in their care. This article reiterates much of the previous written literature, which has made reference to compromised patient care due to the ongoing unfamiliarity surrounding sickle cell disorders among healthcare professionals in Western societies. Readers will be given an overview of the condition and general clinical guidance on the management of care for patients when they are experiencing a state of ‘crisis’. Readers should note that the term ‘painful episodes’ is sometimes used in preference to sickle cell ‘crises’.
Pressure ulcer prevention and pressure-relieving surfaces
Authors: Benbow Maureen
Published: May 2014

Although rarely subject to media attention, political interest or research funding, pressure ulcers, and their almost inevitable increase in incidence, detrimentally affect the quality of life of thousands of patients, both in the hospital and community setting. In addition, the costs to the NHS of pressure-ulcer-related care in hospitals is estimated to be £1.8–£2.5 billion annually. Many pressure ulcers that develop could have been prevented, and there are several up-todate, easily-accessible sources of evidence to guide decision-making regarding appropriate interventions in pressure care. Consideration and assessment of the patient holistically, followed by appropriate intervention and evaluation, is the key to any prevention strategy.
Neurogenic continence. Part 3: bowel management strategies
Authors: Coggrave Maureen
Published: May 2014

Neurogenic bowel dysfunction has a significant impact on quality of life of individuals with chronic neurological injuries and diseases, and management of this problem presents many challenges for both patients and healthcare professionals. These challenges include the limited evidence available to assist with the development of a satisfactory bowel management programme for individuals, and the small range of available options where conservative approaches are unsuccessful. This is the third article in a series of three on neurogenic bladder and bowel dysfunction. The prevalence and pathophysiology of these conditions, along with psychosocial impact they have on patients’ quality of life, were discussed in part one, and part two discussed management options in neurogenic bladder. This article examines conservative care in neurogenic bowel management, the other options and the evidence to support them in this client group.
Professional regulation. Part 5: Bristol Inquiry and the Kennedy Report
Authors: Fullbrook Suzanne
Published: May 2014

The connection was previously made between Government-sponsored reports (JM Consulting) and a theoretical model of regulation (National Consumer Council). The proximity of several events has been alluded to and a central event in the sequence of debate is the subject of this article: the Bristol Inquiry. It is intended that, although the focus of the article is on the Bristol events, the consequences will be presented as leading into the next article, where the current collection of legislation is now revealed and in the public domain. In addition, the connection will be made (in preparation for later articles) between the events that were the subject of Bristol (the behaviours of a few doctors) and the emergence of the overarching body: the Centre of Regulation for Healthcare Excellence (CHRE). This will be explored in the context of connections with, and the dominance of, the CHRE over the Nursing and Midwifery Council (NMC), where the issue of regulation and NMC status as a professional regulator will be explored.
Leading by example: caring for the vulnerable patient
Authors: OBE Alan Parrish
Published: May 2014

Good leadership is an integral part of management. If it is lacking or weak it has an impact and a divisive effect on services in whatever business you are in. It is so important in nursing for senior managers to set both clinical and moral standards that are clear to all staff as well as being evident in their own practice. This is particularly crucial at ward level and in other areas of practice where contact with individuals is occurring regularly.
Professional regulation. Part 9: politics and ideology in nursing
Authors: Fullbrook Suzanne
Published: May 2014

This article aims to continue the debate that surrounds nurse education and possible career structures. By reviewing two documents produced by the Department of Health and the Nursing and Midwifery Council, this article is concerned with one question: should nurses be free to decide their own career progression, or should they be compelled into the areas that the Government deem necessary to meet the demands of the populace? The answer this article produces is that no clear picture emerges. It becomes apparent that other, more powerful evidence may be in play, and that reference to other documents and political influences is needed; a review of this literature will be undertaken in the next article.
Nursing management of chronic obstructive pulmonary disease
Authors: Barnett Margaret
Published: May 2014

Chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and mortality, which imposes a major burden on both society and the health service. It is a common condition that is on the increase and predominantly caused by smoking. Progressive damage to the lung tissue renders the patient increasingly breathless resulting in a frightening existence causing varying degrees of disability and handicap. It is therefore essential that healthcare professionals understand how this condition affects patients not only from a physical perspective, but also from a psychological and social perspective to provide effective nursing management. Nursing management of patients suffering from this disease is aimed at helping to control individual patient’s symptoms and improve their quality of life.
Professional boundaries in a person-centred paradigm
Authors: Parkes Neville , Jukes Mark
Published: May 2014

Since Valuing People (Department of Health, 2001), there has been a marked change in landscape for housing support and service provision for people with a learning disability. Care and supported living options are now provided by a myriad of providers across the healthcare, social-care and independent sectors. Due to the complexity of such individualized care arrangements, and the non-traditional roles of such service professionals and providers, examination of professional role boundaries with service users is essential; traditional role boundaries are not easily transferable or considered within such professional supports and services. This article discusses important facets of professional boundaries that impact directly on such contemporary, learning disability, person-centred services.
Dementia care. Part 2: understanding and managing behavioural challenges
Authors: Ouldred Emma , Bryant Catherine
Published: May 2014

Management of dementia should focus on the maintenance of function and independence for the person with the disease. Non-pharmacological interventions to manage dementia include reality orientation, aromatherapy and validation therapy. Non-pharmacological ways of managing challenging behaviour are recommended in current guidance. Drug treatments, which may stabilize the symptoms of Alzheimer’s disease or slow down further progression for a time, have been available in the United Kingdom since 1997 and may help some people with dementia. There are high levels of stress, distress and psychological illness in family caregivers of individuals with dementia, and practitioners are well placed to signpost carers to appropriate support organizations
Caring for transgendered people: opportunities and challenges
Authors: Peate Ian
Published: May 2014

In contemporary society there is a need to ensure that care provision is both of a high quality and that it is also based on equality. Nurses need to understand what their role is when caring for transgendered people. In attempting to provide high quality care to the transgendered population it is necessary to examine the complexities and challenges associated with gender identity. This article provides some insight into the complexities that are associated with gender identity, as well as some aspects of treatment available for the transgendered person.
Impact of a clinical nurse specialist on the treatment of chronic hepatitis C
Authors: Shutt James D , Robathan Julia , Vyas Samir K
Published: May 2014

Hepatitis C virus is a common cause of liver disease and a major health problem worldwide. Modern treatment strategies can be successful in up to 50% of cases, with patients treated in specialist and more general hospital settings. Guidelines issued by the Department of Health and the then National Institute for Health and Clinical Excellence made it obligatory for a clinical nurse specialist (CNS) to be involved with assessing and treating patients with chronic hepatitis C. The aim of this retrospective case study was to assess the impact on referral, assessment and treatment of patients with chronic hepatitis C before and after the introduction of a CNS to Salisbury District Hospital. There was a significant improvement in patient follow-up and intention to treat, with a doubling in treatment rates. This was achieved by improving clinic attendance after the patient’s initial outpatient assessment, allowing improved biopsy rates and subsequent selection for antiviral therapy. However, over half the cases with chronic hepatitis C identified in primary care each year were not referred to secondary care for assessment.
Common peristomal skin problems and potential treatment options
Authors: Burch Jennie , Sica Jo
Published: May 2014

Stomas are encountered by nurses in many different fields and may be newly formed or many years old. Caring for ostomists can be problematic, particularly if complications occur. One of the more common problems for ostomists is excoriated peristomal skin. Sore skin can occur for a number of reasons and the cause can be an indicator for the therapy required. At times the treatment can be simple but often the skills of a stoma specialist nurse are required. This article focuses on some of the more commonly encountered ostomy problems that nurses may be faced with. The potential problems are described and potential treatment options are offered.
Thirty years of the ileal-anal pouch and beyond
Authors: Williams Julia
Published: May 2014

Still referred to as a new surgical procedure, the ileal-anal pouch or restorative proctocolectomy is now in its 30th year. Over this time the procedure has become the standard of care for patients with ulcerative colitis and familial adenomatous polyposis who require surgery. For many patients it not only eradicates disease, but also preserves the anal sphincter, therefore enabling the patient to defecate in the normal way. Much research over the years has explored optimum surgical techniques, pouch function/capacity, pouch failure and pouch satisfaction and its long-term follow-up. This article reviews literature relating to the ileal-anal pouch and traces its journey through the past three decades, providing an overview of how the pouch has evolved and considers its future development.
Staff perceptions of psychological care on a stroke rehabilitation unit
Authors: Gurr Birgit
Published: May 2014

This article describes the general principles of a psychological care model and the outcomes of a questionnaire survey with members of a multidisciplinary stroke rehabilitation team. Twenty-eight staff members’ responses concerning their understanding and attitudes about the presented model were analysed. The responses revealed that rehabilitation staff had good knowledge about possible psychological reactions of patients following a stroke. They were supportive of the idea that it is important to understand and address patients’ psychological needs to improve recovery. The survey revealed differing opinions regarding the way such a service could be implemented. Furthermore, the outcomes described personal requirements of rehabilitation staff in addressing the psychological care needs of patients. The results of the survey will have implications for staff training programmes and service developments.
Hypertension – a contemporary approach to nursing care
Authors: Chummun Harry
Published: May 2014

The incidence of hypertension is increasing as the number of patients with obesity and diabetes mellitus increases. Hypertension results when the peripheral vascular resistance is increased, the blood viscosity is elevated and/or the flow of blood through the main arteries is impeded. Chronic hypertension results in an enlarged heart, myocardial damage and lung and renal abnormalities. While some causative factors, such as obesity, can be controlled, others, for example genetics, are more difficult to treat because often there is more than one factor involved. This article explores how essential and secondary factors contribute to the incidence of hypertension and the physiological changes resulting from raised blood pressure. It proposes that although traditional treatment has some success, nurse-led clinics are having better success not only in controlling raised blood pressure but also in reducing cardiac, pulmonary and renal morbidity. Nurse-led clinics are more costeffective, staff are more productive and clients are more compliant with treatment.
Prevalence rates and comparisons of obesity levels in Ireland
Authors: Barron Carol , Comiskey Catherine , Saris Jamie
Published: May 2014

This article compares the prevalence of the overweight and obesity levels in Irish school children aged 4–13 years from data collected by one of the authors in 2007, with data collected from a previous Irish study in 2002 by Whelton et al (2007). Both data sets were analyzedusing the International Obesity Taskforse (IOTF) international cut-off points for body mass index (BMI). From the data collected in 2007 the overall prevalence of the overweight was 17.8% and the rate of obesity was 6.8%. The prevalence of the overweight and obese was 24.6%. No correlation was found between gender and BMI, however a positive and significant correlation was observed between age and BMI, indicating that as age increased so too did BMI (R = 0.35, p < 0.001). Comparing results with data from 2002 (Whelton et al, 2007), no statistically significant changes in the proportions of overweight and obese children were observed within this age group in the 5-year period from 2002 to 2007. While the results of our data suggest that rates of being overweight or obese among Irish children in this age group may be stabilizing, larger and preferably longitudinal Irish studies are required if this assertion is to be fully validated in the Irish context.
Interprofessional capacity building in diabetic foot management
Authors: Hayes Catherine
Published: May 2014

The need to build capacity between allied health practitioners in the management of the diabetic foot is becoming increasingly important as the number of people diagnosed with diabetes mellitus rises globally each year. This rise in newly diagnosed patients, who often present asymptomatically, highlights the need for a significant shift in emphasis from simply treating those with long-term complications of the condition. Incorporation of public health initiatives to promote awareness and prevention of the potential decline in functional and emotional health, and the subsequent decreased quality of life in later years, must become the responsibility of health professionals, who are able to break down interdisciplinary barriers at the level of patient interaction. Traditionally, long-term macrovascular and microvascular manifestations of diabetes mellitus have led to a convenient division of care for people with diabetes between the health professions. As the evidence base increases to suggest a more holistic impact of the condition on general health, the need to build capacity within and between professions in the management and prevention of future disease processes has never been clearer. This article highlights key issues in the management of the diabetic foot, which are of paramount significance in the emergence, development and maintenance of interdisciplinary professional relationships.
Piloting a nurse-led ultrasound cannulation scheme
Authors: Walker Esme
Published: May 2014

Intravenous therapy has evolved to form a fundamental cornerstone of modern health care, but there are significant groups of patients in whom obtaining peripheral venous access is a difficult and drawn out process. An ultrasound guided peripheral venous access service could potentially stop multiple ‘blind’ attempts, and subsequent damage. A pilot scheme to look at nurse-led ultrasound cannulation was established, and its early results are presented in this article. In addition, a oneoperator technique of peripheral ultrasound guided cannulation is described. A total of 28 different patients were referred on 34 occasions for ultrasound guided peripheral cannulation. A total of 33 cannulae were inserted with an overall success rate of 97%. An average of 6.4 attempts at cannulation were undertaken prior to referral and an average of 1.3 attempts were needed to place a cannula under ultrasound guidance. Sixty-nine percent of the cannulae were inserted into the veins of the anterior forearm and 12% into the basilic veins. Overall, 2D ultrasound guided peripheral cannulation is a reliable technique for obtaining vascular access on any adult patients who have already undergone multiple cannulation attempts or in those who it is thought cannulation may be difficult.
Patient confidentiality and mental health. Part 2: dilemmas of disclosure
Authors: McHale Jean
Published: May 2014

The article is the second in the series examining some of the issues relating to patient confidentiality and mental health. It explores the situations in which confidential patient information may be disclosed by nurses. First, disclosure with consent is considered. Second, disclosure where it is in ‘the public interest’ is explored. Third, those situations in which disclosure may be required by statute are discussed. The article concludes by suggesting that the whole area of confidentiality is ripe for reconsideration and perhaps statutory reform.
Prevention of inadvertent perioperative hypothermia
Authors: Burger Leona , Fitzpatrick Jane
Published: May 2014

All patients undergoing surgery are at risk of developing hypothermia; up to 70% develop hypothermia perioperatively. Inadvertent hypothermia is associated with complications such as impaired wound healing, increased blood loss, cardiac arrest and increased risk of wound infection. Anaesthesia increases the risk as the normal protective shivering reflex is absent. Ambient temperature also has a major effect on the patient’s body temperature. Prevention of hypothermia not only reduces the incidence of complications, but patients also experience a greater level of comfort, and avoid postoperative shivering and the unpleasant sensation of feeling cold. Nurses should be aware of the risks of hypothermia so that preventative interventions can be employed to minimize the risk of hypothermia. Preoperative assessment is essential to enable identification of at-risk patients. Simple precautionary measures initiated by nurses can considerably reduce the amount of heat lost, minimize the risk of associated complications and ultimately improve patients’ short- and long-term recovery. Minimizing skin exposure, providing adequate bed linen for the transfer to theatre and educating patients about the importance of keeping warm perioperatively are all extremely important. It is also worth considering using forcedair warmers preoperatively as research suggests that initiating active warming preoperatively may be successful in preventing hypothermia during the perioperative period.
The introduction of the human papillomavirus vaccine – key issues
Authors: Peate Ian
Published: May 2014

The human papillomavirus (HPV) vaccine was introduced in to the national immunization programme at the beginning of the 2008/2009 school year, being offered routinely to all 12–13-year-old girls with the aim of protecting them against cervical cancer. There are two particularly high risk HPV types for which there are now highly effective vaccines available. It is estimated that with the introduction of the HPV vaccination programme the lives of over 400 women per year will be saved in the UK. This article provides insight into some of the issues surrounding the introduction of the HPV vaccine into the national immunization programme. HPV is discussed and its relation to cancer outlined. Genital warts, associated HPV transmission and treatment options are summarized. Issues associated with the vaccine, its safety, and some practical aspects are discussed.
Cervical cancer: physiology, risk factors, vaccination and treatment
Authors: Bedford Simone
Published: May 2014

Cervical cancer is the second most common female cancer after breast cancer. Unlike many other cancers, however, it is largely preventable through screening and vaccination. Therefore, it is necessary for nurses to educate women about cervical cancer, to have an awareness of the mortality rates associated with cervical cancer, and to promote the NHS cervical cancer screening programme. This article discusses the need for cervical screening and methods of prevention, identifies risk factors, treatment and the role of the nurse in preventing and managing cervical cancer.
Classification of schizophrenia. Part 2: the nonsense of mental health illness
Authors: Snowden Austyn
Published: May 2014

The classification of schizophrenia is currently under review in a coordinated worldwide consultation for the Diagnostic and Statistical Manual of Mental Disorders (DSM V) and the International Classification of Diseases (ICD 11) – the standard manuals for psychiatric classification. Classification can seem remote from nurses by appearing to be the antithesis of person-centred approaches to recovery. This should not be the case. Nurses need to critically engage with methods of classification in order to better understand the biological, psychological, social and political assumptions underpinning them. It will be shown that these assumptions often compete, and some common objections to the construct of schizophrenia can be viewed as a function of this. However, it is argued here that a truly holistic approach to care needs to engage with all these factors. The alternative is to simply reject the process as irrelevant to mental health nursing. It will be shown that a corollary of this latter approach is the invention of nonsense terms such as ‘mental health illness’ as a function of trying to simultaneously deny yet acknowledge the existence of mental illness.
Reducing the incidence of back pain: student nurses’ recommendations
Authors: Franklin Barnes Abbie
Published: May 2014

National Back Care week (3–9 October 2009) embraced the promotion of back care. However, over a decade has pasted since the RCN Safer Patient Handling campaign (1996), and reports continue to highlight the high incidence of back pain within the nursing profession. This article reveals student nurses’ experiences of back pain and their recommendations to reduce the incidence of back pain in the workplace. Statistics by the Department of Health (2002) report 24% of NHS staff experience back pain, reflecting the high prevalence of this study, where 34% of student nurses experience back pain during their clinical placement. The student nurses’ recommendations clearly underpin the evidence-based research previously published, and as our future workforce the student nurses’ voices need to be heard.
Inter-branch initiative to improve children’s mental health
Authors: Terry Julia , Maunder Eryl Zac , Bowler Nic , Williams Deborah
Published: May 2014

Pre-registration nursing programmes have been criticized for not adequately preparing nurses to work with children and young people with mental health issues. This article highlights the importance of developing strategies across traditional branch boundaries to remedy this curricula deficit. In 2007, the School of Health Science at Swansea University began an interprofessional initiative between mental health and child branches and designed a 2-day child and adolescent mental health services (CAMHS) workshop in collaboration with a local specialist CAMHS nurse. The purpose of the workshop was to raise students’ awareness of child and adolescent mental health issues, to provide the opportunity for students to meet local CAMHS providers and to promote interprofessional practice. This workshop has been delivered successfully for the past 2 years, has been favourably evaluated by students, and is now a regular part of the curriculum. The authors believe that the inter-branch workshop may provide a template for other higher education institutions with large undergraduate populations to promote learning around child and adolescent mental health issues in a unique way.
The effective treatment of basal cell carcinoma
Authors: Anne Skelton Lucy
Published: May 2014

Basal cell carcinoma (BCC) accounts for 75% of all skin cancers and its incidence is rising by between 3-8% each year (Szeimies and Karrer, 2006). As a result, the development of new therapeutic strategies and treatment methods for the removal of BCC is crucial in combating what is a growing problem. Surgical techniques, such as Mohs micrographic surgery, cryotherapy/ cryosurgery, curettage and carbon dioxide laser therapy, as well as nonsurgical techniques, such as radiotherapy, are reconized as potential options. The aim of this article is to critically review some of the current literature in order to substantiate the efficacy of destructive and non-surgical techniques as reliable alternatives to surgery for the management/removal of BCCs. The success rate, cosmetic outcome, pain and discomfort, recurrence rates, and the cost associated with each method are explored and discussed. Results of the review indicate that no one treatment is completely superior. According to the research, simple excision and Mohs micrographic surgery provide the lowest recurrence rates. However, in relation to success rates, patients’ tolerance of the treatment and cosmetic outcomes, and depending on the type of BCC involved, other treatment methods do offer reliable alternatives.
Predicting patient aggression against nurses in all hospital areas
Authors: Chapman Rose , Perry Laura , Styles Irene , Combs Shane
Published: May 2014

Workplace violence directed at nurses is an alarming phenomenon across the world. To intervene and manage these episodes as quickly as possible, nurses need to identify those factors that can alert them to the possibility that a violent event may occur. However, frameworks to help nurses predict episodes of workplace violence are limited. This article presents the findings of a study of nurses’ experience of workplace violence and identifies those factors and behaviours that nurses reported as indicating that an episode of workplace violence is likely to occur. A case study approach was used involving quantitative and qualitative data. One hundred and thirteen questionnaires were completed and 20 interviews were conducted in 2006. Nurses identified nine behaviours and factors that assist them to predict workplace violence. The first five factors comprising staring, tone of voice, anxiety, mumbling and pacing (STAMP) matched those identified in a previous study. However, the last four factors, comprising emotions, disease process, assertive/non-assertive behaviour and resources (EDAR) expand upon that study. Therefore, the acronym STAMPEDAR was used to classify the nine components. Being alert to these behaviours and factors may help nurses predict that an episode of workplace violence is likely to occur.
Using evidence-based practice to address gaps in nursing knowledge
Authors: Tagney Jenny , Haines Caroline
Published: May 2014

Implementing evidence based-practice and research findings into nursing care has been identified as a challenge to nursing staff. This article identifies key barriers to the use of research in the international literature, however, there are limited suggestions as to how to improve this in the clinical arena. This article aims to identify how nurses could optimize the implementation of evidence and research into their clinical care and reviews barriers to implementing and undertaking nursing research, suggesting a framework for improvement. It considers the widely varied levels of knowledge of research and equally varied critical appraisal skills present both at a pre and post-registration nursing level. The authors discuss an innovative, collaborative approach that considers the role of the nurse consultant, clinical academic and research facilitator posts. To ensure quality evidence-based practice is implemented into clinical nursing care a realistic and practical structure must be applied. With the appropriate framework, clinical structure and organizational support, promotion of evidence-based practice and research for patient benefit can be optimized. The implications for practice are also discussed. The implementation of a realistic research framework into clinical nursing practice has the potential to influence and develop a more active nursing research culture and promote evidence-based care within the workplace.
Choosing the correct stoma appliance
Authors: Black Pat
Published: May 2014

Surgery to the bowel or bladder that results in a stoma, whether temporary or permanent, is designed to improve the patient’s current situation in removing disease, reducing pain and improving health. Adaptation to a stoma is assisted by selection of the most appropriate appliance. Today there is an extensive array of stoma appliances available in the Drug Tariff, but many health-care professionals will have little knowledge of what to prescribe for the stoma patient. This article will look at choosing the correct appliance for the patient with a bowel or bladder stoma.