bluuebunny/crossref_metadata_2025 huggingface dataset:
Nursing aspects of pressure sore prevention and therapy
Authors: Culley Fiona
Published: May 2014

Pressure sores remain a significant problem in hospitals and domestic settings, affecting people of all ages, social class and race. Associated complications may be life threatening, e.g. sepsis and osteomyelitis. Other less dangerous, but nevertheless compromising outcomes such as pain, discomfort and low self-esteem and body image can cause personal suffering, and may add extra demand for limited resources. The exact state of pressure sore occurrence remains difficult to determine, particularly in the community. Recent trends in pressure area management present a multidisciplinary approach, eroding traditional perceptions of pressure sores as a solely nursing problem. Written from a nursing perspective, this article summarizes principles of good practice relating to pressure sore prevention and therapy, emphasizing the importance of documenting observed events, rather than assumptions or opinions, and the need for healthcare professionals to approach problems and needs from a collaborative stance. Pressure sore risk assessment and classification are discussed, and an overview of nutrition, moving and handling, selecting support surfaces, principles of wound management, and skin care are considered.
Interventions for confusion and dementia 2: reality orientation
Authors: Woodrow Philip
Published: May 2014

This article, the second of a five-part series exploring interventions for confusional states, discusses reality orientation (RO). For many decades, this form of intervention has been widely used and accepted as a way of reducing symptoms of confusion. However, an argument against RO is that it makes the person a passive recipient and reinforces feelings of disempowerment. This article describes the development of RO, exploring its strengths and weaknesses. Literature on the subject is largely anecdotal and dated as RO has been largely superseded by the interventions discussed in later articles, e.g. reminiscence and validation therapy.
Developing nursing's future role 2: nurse's job satisfaction and morale
Authors: Nolan Mike , Brown Jayne , Naughton Maureen , Nolan Janet
Published: May 2014

This, the second of two articles, presents the results of a recent survey of nurses' job satisfaction and morale undertaken at the Northern General Hospital NHS Trust, Sheffield. The survey was conducted in order to provide a benchmark against which to gauge progress towards creating a work environment in which nurses are able to exercise maximum autonomy within a supportive and enabling culture. The results mirror recent national reports which highlight the increasing tension between workload pressures and the desire to provide holistic patient care. A number of factors were identified which suggest the need for remedial action across a range of fronts. Such factors are briefly described, together with the action taken to date to address the issues raised.
Psychiatric nurses make a difference to patients
Authors: Allen Jon
Published: May 2014

The recent Sainsbury Centre (1998) report Acute Problems claims to be a detailed 3-year study of the quality of care in acute psychiatric wards. Much of its findings, however, state what has already been reported elsewhere (Mental Health Act Commission, 1997; Gournay et al, 1998), e.g. high bed occupancy, low staffing levels and the fact that people who use services are severely mentally ill and have a complex mix of social and other problems. The report argues for a need to invest in the acute services, provide better environments and staffing, increase staff training and improve the integration of community services. Some of its findings and recommendations are contradictory. For example, it found that patients get better in admission units, but states that such units are antitherapeutic and that they should only be used briefly for acute crises.
Tegagen alginate dressing for moderate to heavily exuding wounds
Authors: Williams Clare
Published: May 2014

Traditionally known as ‘the mariner's cure’, alginates have been used as wound dressings for many years. Tegagen (formerly Tegagel) is an alginate dressing with improved performance from 3M. It is designed for a variety of wounds with moderate to high levels of exudate. Alginates are a very cost-effective treatment option for flat and cavity wounds of this type.
Advanced nursing practice from a cross-cultural perspective
Authors: Paniagua Hilary
Published: May 2014

This article describes the perceptions of a visiting lecturer exchange experience between Wolverhampton University, School of Nursing and Midwifery, and the University of Kentucky, Lexington, in the American state of Kentucky. The major goal of the visit was to learn health assessment skills to bring back to future advanced practice programmes within the university. The opportunity to work with a variety of nurse practitioners culminated in a unique review of the training development and evolution of advanced nursing practice in Kentucky. Some of the conceptual confusions of advanced nursing practice are explored, together with the features of a new blended role which combines the practice of two traditional positions: the medical skills of nurse practitioners and the expertise of clinical nurse specialists.
Evaluating the Pegasus Trinova: a data hierarchy approach
Authors: Taylor Lynn
Published: May 2014

Understanding the efficacy of patient support surfaces is essential if pressure sore management is to be both efficient and effective. However, laboratory and clinical studies in this area are fraught with well recognized problems. This investigation reports a combination of laboratory, randomized controlled trial (efficacy data) and measures of effectiveness to illustrate the beneficial role of a new dynamic integrated mattress and seat cushion system: the Pegasus Trinova. Successful prevention of sores among a vulnerable patient population, along with positive comments regarding the system's comfort and ‘user-friendliness’ are supported by laboratory measures of interface pressure to provide a hierarchy of data. Such an approach may present one solution to the lack of timeliness of most mattress clinical trials, thus allowing decisions regarding new support surfaces to be made upon the basis of evidence, not on anecdote or solely upon marketing claims.
A practical approach to dressing wounds in difficult positions
Authors: Fletcher Jacqui
Published: May 2014

Despite the availability of an increasing number of innovative dressing products, many patients' wounds remain a challenge to dress in practice. However, the creative use of widely available products and other resources can help to address some of the difficulties that are regularly encountered. If different sizes of dressing (to allow for cutting and shaping) or more innovatively shaped products (which may be more expensive per item) are used, this can result in a better dressing fit and therefore increase product wear time which is both clinically effective and cost-effective. When a good solution is found for dealing with certain wound types then great benefit can be gained from publishing the information to prevent others from struggling to overcome the same difficulties.
Current recommendations for isolation practices in nursing
Authors: Parker Lynn J
Published: May 2014

Attitudes have changed drastically over the centuries towards people with infections and how to contain them. Only as we approach the end of the 20th century are we starting to base our practices on scientific evidence and not on ritual, although rational thought is still not found in many practices and confusion surrounds the terminology used. With the introduction of clinical governance, and the statutory duty of health organizations to provide a quality service for patients supported by evidence-based practice, this article discusses isolation practices.
Job satisfaction among Swedish nurses and laboratory technologists
Authors: Lundh Ulla
Published: May 2014

Concerns about recruitment and retention of nursing staff are currently increasing in a number of countries. This article describes a study which identifies sources of job satisfaction among nurses and medical laboratory technologists in Sweden. A previously validated questionnaire was translated into Swedish and sent to all relevant staff working at a large hospital in southern Sweden. Analysis of responses suggests that while staff still found their work interesting, rewards are potentially decreasing and sources of stress increasing. Comparisons are made with literature from the UK and USA and the need for action to address a number of concerns is highlighted.
Examining the range of medicated and paste-impregnated bandages
Authors: Williams Clare
Published: May 2014

Medicated and paste-impregnated bandages have been used by healthcare professionals for many years, especially in the management of problem skin surrounding leg ulcers. This article examines the range of bandages and the indications for use as well as the role of zinc in wound healing.
Investing in practice: enquiry- and problem-based learning
Authors: Long Garth , Grandis Suzanne , Glasper Edward A
Published: May 2014

Enquiry-based learning (EBL) and problem-based learning (PBL) are two similar methods of educating nurses and midwives which have been recommended by the UKCC in its new report ‘Fitness for Practice’ (UKCC, 1999). The integration of theory and practice within the student programme is the key to bridging the theory/practice gap. The incorporation of EBL and PBL into the curriculum may help resolve this gap. As these methods of education foster learning through the use of real client scenarios it is important to stress that the partnership between clinical and academic staff is of paramount importance. This article explores EBL and PBL from the practitioner's perspective and examines some of the factors necessary for its successful implementation.
Implications of nursing role expansion for professional practice
Authors: Rushforth Helen , Glasper Edward Alan
Published: May 2014

The topic of nursing role expansion has caused much heated debate in the nursing press in recent years. The contemporary relevance of the debate is heightened by the current recruitment and retention crisis in nursing, and continued pressures to reduce junior doctors' hours and workload. This article re-examines the ‘expanded role debate’ by putting current concerns in an historical framework. The perceived benefits of role expansion are discussed, and balanced against continued concerns expressed by practitioners regarding possible detrimental effects on care delivery. The potential erosion of ‘caring’ as the heart of nursing practice is acknowledged, and challenges are made to the belief that nursing has the ‘monopoly on caring’. The issue of ‘nursing time’, perhaps the major barrier to continued role expansion, is also explored. The future division of labour within healthcare delivery is seen as pivotal to this aspect of the debate, and a pragmatic vision for the future is offered. Finally, the issue of the paucity of the evidence base underpinning role expansion is considered and a plea is made for future developments to be soundly underpinned by research.
Comparison of Rosidal K and SurePress in the treatment of venous leg ulcers
Authors: Moody Marion
Published: May 2014

Fifty-two patients (26 in each group) were recruited into this randomized, comparative, controlled trial of Rosidal K short-stretch compression bandage and SurePress long-stretch compression bandage in the treatment of venous leg ulcers. Patients were monitored for a maximum of 12 weeks. Each patient was seen weekly by a research nurse, who recorded the study variables. The mean percentage reduction in the wound bed surface area during the study period was 52% in the SurePress group and 73% in the Rosidal K group. Eight patients in each group saw their ulcers heal within the study period. The average limb volume reduction, based on the first 4 weeks of data collection, was 2.3cm for those in the Rosidal K group and 3.9cm in the SurePress group. Ulcer size increased in six patients allocated to SurePress bandages and in four patients allocated to Rosidal K bandages.
Impact of urinary incontinence on the quality of life of women
Authors: Harris Alison
Published: May 2014

There is a lot of debate among continence specialists as to the impact that urinary incontinence (UI) has upon the sufferer's quality of life (QoL). Furthermore, healthcare professionals involved in delivering care are examining ways to measure the outcomes of their healthcare interventions, in terms of not only symptom relief, but also patient-specified improvements to QoL. Healthcare professionals have yet to agree upon one standard tool for measuring the effect of UI upon sufferers' QoL. This article examines some of the current research on UI as experienced by females living in their own homes and its impact on their QoL.
The four-layer bandage system from a nursing perspective
Authors: Walsh Julia
Published: May 2014

This article describes an evaluation that took place in 20 health centres, community clinics and hospitals throughout the UK. The aim was to explore nurses' opinions of three different four-layer bandage systems: kit A (System 4); kit B (Charing Cross); and kit C (Profore). Fifty-seven pairs of nurses were involved; within each pair, one was the applier and one the wearer. Each nurse was asked to complete a questionnaire which highlighted their opinions relating to ease of application, conformability, comfort and preferred bandage length. Responses were analysed using simple frequency counts, means, standard errors, Fisher's exact test and Kruskal-Wallis' one-way analysis of variance. The nurses involved were regular users of either the Charing Cross or Profore systems. Kit A was significantly easier to apply than kit B for layer 1 (P<0.001), layer 2 (P<0.05) and layer 3 (P<0.01). There was no significant difference in relation to layer 4. With regard to ease of application there were no statistically significant differences between kits A and C or B and C. Layer 1 of kit A was significantly more conformable than layer 1 of kit B (P<0.001). There were no significant differences between kits B and C, or A and C or in relation to comfort for all bandage kits. Overall preference by the applier was: 25 for kit A, nine for kit B and 15 for kit C. Overall preference by the wearer was: 23 for kit A, 10 for kit B and 14 for kit C.
Clinical governance: the new NHS, new responsibilities?
Authors: Crinson Iain
Published: May 2014

The declared aim of the White Paper ‘The New NHS: Modern, Dependable’ is to restructure the NHS so that it is based on ‘partnership and driven by performance’ (Department of Health (DoH), 1997). The key organizing principles are those of efficiency and excellence. Establishing a framework for clinical governance is seen as central to establishing ‘an environment in which excellence in clinical care can flourish’ (DoH, 1998). These new arrangements will apply to the the practice of all clinical professionals, including nurses. Clinical governance offers a new opportunity for the nursing profession to raise standards of practice without being hamstrung by issues of patient throughput and price, as was the case under the last government. However, it also presents a challenge to the frameworks within which nursing has traditionally operated. In addition, clinical governance brings with it the potential for more direct involvement of non-clinicians in professional practice.
Conservative treatment of erectile dysfunction 1: anatomy/physiology
Authors: Dorey Grace
Published: May 2014

This is the first of a three-part article addressing whether physiotherapy involving pelvic floor muscle exercises is efficacious as a first-line treatment for erectile dysfunction (ED). In this, the first part of the article, the prevalence of ED and associated risk factors are considered after which the anatomy of the penis and the physiology of erection are outlined. This provides background for the second and third parts of the article which review the outcomes of published clinical trials investigating the treatment and prevention of ED, and assess the evidence for pelvic floor exercises relieving ED.
Are specialist nurses deskilling general nurses?
Authors: Castledine George
Published: May 2014

Specialization and sub-specialization are inevitable these days because of the rapid expansion and development in medical knowledge. It is impossible for one person to be expert in all aspects of health care. A specialist is someone who is educated and has experience in, and develops the competencies and skills of, a particular field or endeavour.
Preventing fungal infections in immunocompromised patients
Authors: Johnson Elizabeth M , Gilmore Mark , Newman Joan , Stephens Moira
Published: May 2014

The incidence of systemic fungal infections in immunosuppressed patients has increased in the past two decades (Fridkin and Jarvis, 1996). Bone marrow transplant recipients and patients with prolonged neutropenia are most at risk, particularly when environmental factors increase the presence of fungi and fungal spores. Preventive measures include air filtration, handwashing, exclusion of flowers and some foodstuffs and use of chemoprophylaxis. In April 1999, a meeting was held under the auspices of the European Group for Blood and Marrow Transplantation (UK) Nurses and Allied Professionals Group to discuss the role of nurses in the management of patients at risk of systemic fungal infection. Issues discussed included: the need for nurses to recognize risk factors for systemic fungal infection; the role of nurses in giving feedback to patients; and the use of antifungal agents and associated problems, such as non-compliance and side-effects.
Patients' attitudes towards the use of gloves by healthcare staff
Authors: Woloski-Wruble Anna , DeKeyser Freda , Levi Sara , Margalith Ilana
Published: May 2014

There is a concern among healthcare providers regarding the use of gloves in non-mandated clinical situations and its impact on patient sensitivities. A convenience sample of 76 Israeli hospital inpatients were surveyed to measure patients' attitudes towards the use of gloves by healthcare providers. The Patient Sensitivity Questionnaire (PSQ) was developed and used to collect the data. Overall, patients were found to have a positive attitude towards the use of gloves in most patient care situations. Significant differences in patient attitudes towards glove use were found based on country of origin and number of hospital admissions in the previous year. The study concluded that hospitalized patients, in general, support healthcare providers' use of gloves. In addition, subjects agreed with the (American) Occupational Safety and Health Administration regulations regarding glove use.
Gerontological nursing 2: refocusing the community agenda
Authors: Tolson Debbie , Nolan Mike
Published: May 2014

This, the second in a series of articles considering potential developments in gerontological nursing, focuses on a community setting. It highlights current trends in policy which emphasizes the promotion of independence and outlines implications for community nurses. The authors argue that if new roles are to emerge then the educational preparation of community nurses must reflect more fully future policy initiatives.
Repose: the cost-effective solution for prompt discharge of patients
Authors: Hampton Sylvie
Published: May 2014

Pressure ulcer prevention is expensive and at times difficult to achieve. Formation, or the potential formation, of pressure ulcers can lead to delayed patient discharge, particularly when the appropriate equipment is unavailable on the day of discharge. This article reviews the potential of Repose, an inflatable mattress overlay, to be an inexpensive and clinically effective alternative to alternating air mattress systems.
The risks associated with blood and blood product transfusion
Authors: Higgins Chris
Published: May 2014

Although transfusion of blood and blood products is often of life-saving benefit for the many patients who receive transfusions every year, it is not without considerable risk. Nurses need to be aware of these risks so that they can respond to patient anxiety about transfusion. This article outlines risks associated with transfusion and the measures taken to minimize them. Attention will be focused principally on the two most significant risks: transmission of serious blood-borne infection and the potentially fatal acute immune haemolytic reaction that can occur if patients receive incompatible red cells. Other significant adverse effects will be discussed briefly. Recent initiatives aimed at monitoring the incidence of these adverse effects and increasing the safety of blood transfusion will be discussed, with special emphasis on the nurse's role in the transfusion process.
Advanced nursing practice: an introduction to physical assessment
Authors: Price Christopher IM , Han Seong W , Rutherford Iain A
Published: May 2014

Changing philosophies of clinical management and moves to reduce junior doctors' hours have led to increasing pressure upon nurses to take on the responsibility for assessing and initiating the management of acutely ill patients. Although nurses have been educated to assess, plan, and deliver care in a format known as the nursing process, this does not fully equip them for the demands of their rapidly developing roles. With increased responsibility comes the risk of increased stress and legal accountability, particularly where inadequate support is provided. In an effort to address this matter, this article briefly considers the theory of gaining clinical expertise, and describes a framework to facilitate physical assessment.
The Verge Videometer wound measurement package
Authors: Williams Clare
Published: May 2014

Wound measurement can be made as simple or as complex as time allows, but there Is no doubt that wound measurement is required in some degree as part of the patient documentation process. To help assess the progress of wound healing, BES Rehab Ltd is distributing the Verge Vldeometer (VeV), a wound tracking system which can be used for precise wound measurement, tracking and documentation. The VeV is suitable for use in hospitals, outpatient clinics and in the community as well as being useful for those conducting research into wound progression.
Getting research into practice: developing oral hygiene standards
Authors: Curzio Joan , McCowan Maggie
Published: May 2014

In 1997, the then Victoria Infirmary NHS Trust established a nursing research and practice development committee (NRPDC) to implement evidence-based practice in nursing care in response to its nursing strategy for 1998–2000. A survey of nursing projects was undertaken in 1996 and repeated in spring of 1998. Initially, 107 projects were identified which included 58 reviews of the literature. In 1998, 95 projects were identified with 42 reviews of literature. The number of research projects being undertaken by nurses in the trust increased from four to 15 and the number of audits increased from nine to 45. The NRPDC established a link nurse system to assist in developing practice at ward level and they have been offering a series of educational seminars. Oral hygiene was the first topic tackled trustwide, with a mouth care standard developed and staff knowledge subsequently surveyed 6 months after it was put into practice. Results demonstrated a good level of knowledge for general oral hygiene among trained and untrained staff. However, specialist oral care and care of stomatitis require some further updating. This survey has identified the increasing sophistication of the projects being undertaken by the nursing staff across the trust and the support they are receiving. This arrangement has provided the opportunity to demonstrate the impact of having a senior researcher available for advice at trust level. The NRPDC can improve the quality of evidence-based care delivered within the trust and it can provide a model for the implementation of evidence-based practice.
A new century without pressure ulcers?
Authors: Haalboom Jeen RE
Published: May 2014

During the last decades of the 20th century health care was characterized by the increasing influence of evidence- based medicine. For example, medication is only used when it is proven that it really works. Also, thanks to better health care, there is a growing population of older patients who require more and more medical and nursing attention, thereby creating more expense. Western countries have to be very conscious of cost-effectiveness in health care.
Web watch
Authors: Gibson Sue
Published: May 2014

Welcome to this edition of Web Watch which looks at the newly launched NHS Web site. This site contains a plentiful array of Government health-related information and includes some useful links. As ever we urge you to bear in mind that you should use your professional judgment over any material you receive from the Internet, just as you would when reading material in print.
Legal aspects of consent 7: young persons of 16 and 17 years
Authors: Dimond Bridgit
Published: May 2014

A 16-year-old girl under local authority care was suffering from anorexia nervosa. At one point she was fed by nasogastric tube and had her arms encased in plaster. Her condition became critical and she refused to move to a specialist hospital. The local authority applied to the High Court for the girl to be transferred to a treatment unit without her consent, and for leave to give her medical treatment without her consent. Leave was given by the High Court judge. By 30 June, although 5 feet, 7 inches tall, she weighed only 5 stone, 7 pounds. The Court of Appeal made an emergency order enabling her to be taken to and treated at a specialist hospital in London, notwithstanding her lack of consent (Re W (a minor) (medical treatment) [1992]).
Healthcare professions must work better as teams
Authors: Castledine George
Published: May 2014

Service managers are demanding more integration, communication and flexibility among healthcare professions. Therefore, the caring professions are under increasing pressure to examine the way in which they work together.
Pain management 2: the use of psychological approaches to pain
Authors: Field Linda , Adams Nicola
Published: May 2014

This article is the second of a two-part series looking at the psychological and social factors which affect pain perception. The first article (Vol 10(14): 903–11) examined neurophysiological and psychological factors of pain perception. This article considers the importance of the nurse–patient interaction in the management of patients' pain. It outlines the adoption of several psychological approaches which could be utilized by nurses when dealing with patients in pain. The need to encourage a feeling of control over pain is discussed in relation to the use of patientcontrolled analgesia and the development of positive coping skills. The value of good communication skills is emphasized as being essential in encouraging patients in pain to utilize these psychological approaches.
Treatment of a wound infection in a patient with mantle cell lymphoma
Authors: Dunford Cheryl E
Published: May 2014

This case study examines the impact of a severe wound infection on a patient undergoing chemotherapy for the treatment of mantle cell lymphoma. The study illustrates how life threatening an infection can become in a patient whose body is compromised as a consequence of both disease and chemotherapy treatment. A number of specialist products were required in order to overcome the infection, debride and heal the wound. These included larval therapy, vacuum-assisted closure and Leptospermum honey. While this case study focuses on the successful outcome of one particular patient it aims to raise awareness of the role of specialist products, both old and new, in improving healing rates of complex wounds.
Students' experiences on neonatal nurse practitioner programmes
Authors: Redshaw Margaret , Harvey Merryl
Published: May 2014

As part of a study evaluating neonatal nurse practitioner programmes in England, data were collected on the experience of students from four separate English National Board (ENB, A19) programmes. A total of 123 nurses participated. Data were collected from 68 nurses using questionnaires at three points (the start, middle and end of the programmes), while 55 nurses completed a single questionnaire at the end of the programme. The data show key concerns relating to the content and organization of courses, the need for effective clinical supervision and teaching during the programmes, role transition issues and the value of informal and formal professional support. Senior and experienced nurses may find that their exposure to programmes of this kind is of interest and relevance to nurses facing similar challenges in other fields. It is also of vital importance in planning future skill mix and organizing critical care in specialties such as neonatal care.
Family Nursing Network: Scottish initiative to support family care
Authors: Claveirole Anne , Mitchell Ruth , Whyte Dorothy
Published: May 2014

This article describes the foundation in 1997 of a Family Nursing Network (FNN) in Edinburgh involving nurses from local trusts and Scottish universities. The purpose of the FNN is to support the use of family nursing in practice, research and education. Family nursing proposes that health care should focus on the needs of the family as a unit rather than as the context of care for a family member with health needs. Family nursing is not common practice in the UK but some nurses have found it highly relevant to their care. The World Health Organization (WHO) promotes the family health nurse as an important component of health care in the community for the future and family nursing could well provide the foundation for such practice. Definitions of the family and family nursing are offered, the conceptual background is analysed and the work achieved by the FNN is reviewed. The authors write on behalf of the FNN.
Biogel® Super-Sensitive and Biogel® Indicator glove systems
Authors: Grant Carol
Published: May 2014

Surgical gloves have been in use since the late 19th century. Initially, gloves were introduced to protect clinical staff from the carbolic acid used to sterilize equipment and prepare skin before surgery. During the mid-20th century emphasis was more towards protecting the patient from the clinician's skin flora and now, at the beginning of the 21st century, the balance lies between protecting the patient from the clinician and the clinician from the patient. The three main types of glove are latex, vinyl and polythene and they can be used singly or as part of a doublegloving system. This article discusses how one hospital evaluated the glove systems Biogel® Super-Sensitive and Biogel® Indicator underglove from Regent Medical (a division of SSL International). The results indicate that both systems are acceptable to clinical staff in a variety of specialty areas.
Clinical teaching is the key to improved practice
Authors: Castledine George
Published: May 2014

Ever since nurse education moved into higher education there has been problems over student nurses' practice placements. When hospitals used to train their own nurses there was a greater commitment to having students on wards and in clinical departments. Nowadays, ward staff are less committed because of the extra demands that having students places on them.
Whatever has happened to nursing research?
Authors: Castledine George
Published: May 2014

The trouble with nursing research is that there are not enough nurses committed to it. Nursing suffers from the false perception that nurses are technical care givers and the focus in health care today is on treatment and medical conditions. Researching and identifying ‘nursing’ does not have the status of other subject areas such as the biological and social sciences. Nurses are generally not thought of as scholars and creative thinkers. This view leads to nursing knowledge being devalued.
NICE guidelines unfair for Alzheimer's disease
Authors: Lowery Kath
Published: May 2014

The National Institute for Clinical Excellence (NICE) guidance on the use of cholinesterase inhibitors in Alzheimer's disease (AD) was undoubtedly published with good intentions (NICE, 2001). However, far from eradicating the scourge of postcode prescribing in relation to AD, these guidelines could actually exacerbate inequality.
How relevant to nursing care is your degree?
Authors: Castledine George
Published: May 2014

Recently, Graham Zellick, the Vice-Chancellor of London University, said: ‘Some graduates have got useless degrees from third-rate institutions, which they have left with huge debts after an experience of 3 years that will have served them in no clear way at all’ (O'Leary, 2001).
The answer to reducing patient violence towards NHS staff
Authors: Cutcliffe John R
Published: May 2014

In November 2001, the UK Health Secretary, Mr Alan Milburn, gave the ‘go-ahead’ to deny patients treatment if they attack NHS staff. This radical move forms part of the sustained ‘zero tolerance zone’ campaign that the present Government supports. On initial consideration, one might regard this as an entirely positive development, particularly since few practitioners would disagree with Mr Milburn's comment:
Consent and the law: problems facing nurses
Authors: Dimond Bridgit
Published: May 2014

Over the last 50 years there has been a significant cultural change within health care. The main philosophy of the medical and nursing profession in relation to patients was concerned with paternalism, acting on their behalf, making decisions for them, and sparing them distressing information. Treatment and care were provided in the best interests of the patient but they were carried out in a paternalistic manner.
Where has the essence of nursing care gone?
Authors: Scott Helen
Published: May 2014

The Government has launched a very detailed ‘practical toolkit’ for nurses in a bid to improve nursing care. The Essence of Care (Department of Health (DoH), 2001) sets out standards or benchmarks that nurses must meet in relation to the eight principles of: self-care; personal and oral hygiene; nutrition; continence, bladder and bowel care; pressure ulcers; safety of clients with mental health needs; record keeping; and ensuring patients have privacy and dignity. For each category, best practice is defined, practitioners have to score themselves and steps are set out for staff to follow in order to meet the appropriate standard.
Euthanasia: what is the nursing and medical role?
Authors: Castledine George
Published: May 2014

The recent announcement by the Dutch parliament that it has approved a law to make the Netherlands the first country to decriminalize euthanasia has implications for all of us. On the one hand there will be those who will warn of a slippery slope towards murder or genocide. On the other, as the concepts of patient autonomy and informed consent are more prominent than ever before, many will see this move by the Dutch as a way of strengthening patients' voices, enabling them to make up their own minds and determining decisions about their own health care.
Why catheterize?: audit findings on the use of urinary catheters
Authors: Brennan Mary-Lou , Evans Ann
Published: May 2014

Urinary catheters can be associated with complications such as urinary tract infection, pain and discomfort. This article reports on an audit of 51 patients who had a urinary catheter inserted during their hospital stay. Urinary incontinence meant catheterization in 37.5% (n = 27) of cases, with 64.7% (n = 33) being catheterized by nurses. The study highlighted the need for accurate documentation and care planning; 15 patients did not have a plan of care for their catheter and only eight patients had a plan for the removal of the catheter. Catheterization is the most common cause of hospital-acquired infection, and therefore the use of catheters needs careful examination to reduce this type of infection. The question is raised whether catheterization is used as a convenience for nursing staff or as an essential aspect of care.
The importance of patients' nutritional status in wound healing
Authors: Russell Linda
Published: May 2014

Good nutritional status is essential for wound healing to take place. Ignoring nutritional status may compromise the patient's ability to heal and subsequently prolong the stages of wound healing. Glucose provides the body with its power source for wound healing and this gives energy for angiogenesis and the deposition of new tissue. Therefore, it is vital that the body receives adequate amounts of glucose to provide additional energy for wound healing. Fatty acids are essential for cell structure and have an important role in the inflammatory process. Wound healing is dependent on good nutrition and the presence of suitable polyunsaturated fatty acids in the diet. Protein deficiency has been demonstrated to contribute to poor healing rates with reduced collagen formation and wound dehiscence. High exudate loss can result in a deficit of as much as 100 g of protein in one day. This subsequently needs to be replaced with a high protein diet. Vitamins are also important in wound healing. Vitamin C deficiency contributes to fragile granulation tissue. There is a correlation between low serum albumin and body mass index (BMI) and the development of pressure ulcers. Also, low serum albumin and high Waterlow score have a positive association. The body automatically renews tissue while we are asleep but this does not mean that protein synthesis does not take place during our wakeful hours. Holistic assessment of nutrition and early detection of malnutrition are essential to promote effective wound healing.
Pressure ulcer care: can we learn from poorer countries?
Authors: Hampton Sylvie
Published: May 2014

Within the UK, nursing and medicine is demanding increased evidence-based care and randomized controlled trials (RCTs) have become the gold standard for research (Fogg and Gross, 2000). Indeed, the NHS Executive recommends RCTs as the most reliable evidence for the efficacy of interventions (NHS Centre for Reviews and Dissemination, 1997).
A call to examine tissue viability nurses' role
Authors: Gray David
Published: May 2014

Within this issue of the British Journal of Nursing's Tissue Viability Supplement, we feature the work of Charles Fox on the perceptions that tissue viability nurses have of their role (see Pp. 10–16). The data used in this article was obtained during a marketing survey for a commercial company planning its launch into the wound care market. The survey, although small in sample size, identifies some very interesting points.
Role definition and structured progress for tissue viability nurses
Authors: Finnie Alison
Published: May 2014

Tissue viability nursing is a relatively new specialty. We know that tissue viability nurses (TVNs) are a valuable resource and that the development of a coordinated service can improve patient care, reduce both risk and costs, and enhance the care of patients with wounds and skin problems.However, searching the literature for information on the role and value of a TVN reveals very little.
Providing a healthcare input to children in special schools
Authors: Marshall David , Foster Ida
Published: May 2014

The education of children with special educational needs is often accompanied by a requirement for medical or healthcare provision. If this cannot be done safely then the child's access to education is limited. No standardized template for the delivery of a healthcare input to children in special schools is apparent. This study sought to explore, through the use of an indepth needs assessment exercise and focus group interviews, what the most appropriate healthcare role was for delivering health care in a special school catering for children with a broad range of severe learning disabilities. While an overwhelming viewpoint of participants in focus groups perceived that a nurse was the only suitable person to undertake the role, the evidence gathered prompted the research steering group to suggest to the contrary, i.e. that the role of a healthcare worker with a national vocational qualification (NVQ) level 3 in care was the more appropriate person to maximize both the role of the nurse and the quality of care provided to these children.
Outcome measures for erectile dysfunction 1: literature review
Authors: Dorey Grace
Published: May 2014

This article describes and evaluates critically the outcome measures available for the assessment of the conservative treatment of erectile dysfunction (ED). The literature review identified 26 outcome measures. Of these, 14 were subjective and 12 were objective. Objective measures can provide more accurate information. However, owing to the sensitive nature of the problem, questionnaires which are reliable and sensitive to change can provide valuable data. Different outcome measures were needed for each of the separate components of ED. These components were found to be rigidity, vascular flow, nerve conductivity, intracavernosal pressure, ischiocavernosus muscle power, partner satisfaction and quality of life. An evaluation of outcome measures for each component of ED is provided in the second part of this article. Quick, simple, inexpensive and efficient outcome measures can be used by nurses to evaluate the impact of conservative treatment for ED.
Information Centre: responding to needs of older people and carers
Authors: Hanson Elizabeth , Andersson Bengt-Arne , Magnusson Lennart , Lidskog Ritva , Holm Kerstin
Published: May 2014

This article is the fourth in the series focusing on recent developments in the Elderly West Research Centre in western Sweden. It describes an innovative research, development and evaluation project, the Aldre Vast Information Centre (AV IC), which was developed in direct response to the local needs of Swedish older people and their family carers who participated in the EU ACTION project (Assisting Carers using Telematics Interventions to meet Older persons' Needs) outlined in the first article in this series (Vol 11(11): 759–63). Families requested easier access to information, education and support from professional carers. They also valued the informal support network from other family carers who listened and shared experiences together. In response to these needs, the AV IC project was established to provide telephone, videophone and internet support to older citizens and their families living in the Sjuharad area of west Sweden. The Information Centre is run by professionals and volunteers with the aim of empowering and supporting older people and their families to make informed choices and decisions regarding health and social care matters of importance to them. The project provides an innovative example of how the Aldre Vast Sjuharad user-focused philosophy (Magnusson et al, 2001) can be applied in practice to provide an appropriate evaluation model — namely, one that enables all those stakeholders in the IC to have a voice in its shape and direction.
Medical devices regulations and the Medical Devices Agency
Authors: Dimond Bridgit
Published: May 2014

Pansy suffered from a chronic lung condition which required frequent courses of antibiotics. As her veins were poor and cannulation was difficult, a passport was inserted into a vein in her arm in which antibiotics and other solutions were administered. After three courses of antibiotics over the course of several weeks, the nurses had difficulty in administering the medication through the passport but finally succeeded. Subsequently, during a routine X-ray of her lungs, it was discovered that the tube connected with the reservoir had become disconnected and had moved down the vein towards the heart.
National Service Framework for Older People: stroke coordinators
Authors: McDonald Paul S , Mayer Peter , Dunn Linda
Published: May 2014

The National Service Framework (NSF) for Older People aims to develop integrated stroke services with specialized treatment, carer involvement, secondary prevention and rehabilitation. There is an emphasis upon the role of stroke coordinators. The aim of this study was to examine the relationships between stroke coordinators and other agencies involved in stroke care, and to describe stroke coordinators' current roles. Interviews with 11 stroke coordinators across the West Midlands region took place and were evaluated using a grounded theory approach. The roles of stroke coordinators and the perceived levels of integration among stroke services varied between localities. In a few areas, a number of ‘adhesive’ factors helped bond the coordinator role to successful integration, while in most areas the absence of all or some of these factors made the role less effective. To meet the demands of the NSF, a stroke coordinator's role needs to be a high-profile, corporate function, requiring a higher level of autonomy, accountability and responsibility, and demanding creativity and innovation from postholders.
Discharge of frail older people from acute hospitals across Europe
Authors: Bendz Mona , Castledine George , Sderback Ingrid , Carvalho Gloria , Sapountzi-Krepia Despina
Published: May 2014

Over the last few years the number of elderly patients in acute hospitals throughout Europe has risen dramatically. The pressure on hospital beds leads to earlier discharge and the task of sending patients home from hospitals is becoming more complex. The provision of health and social services is organized in different ways all over Europe. Therefore, it would be of interest to know more about how different kinds of systems support the professional carers in their effort to satisfy the needs which older people and their significant others experience in the discharge process. A pilot study was set up mainly to provide information on what kinds of problems are inherent in a multicentred, interprofessional research project involving a large number of countries. The findings serve as an important knowledge base in a future project. Experiences from the pilot study and the benefits of it are presented.
Safer handling practice: influence of staff education on older people
Authors: Wilson Christine Brown
Published: May 2014

The purpose of this small-scale survey was to explore the level of moving and handling training undertaken by nurses within private sector continuing care environments and the potential this training had to influence the care of older people. This study uses a definition of safer handling practice derived from existing literature to examine how nurses report the application of this training and whether they observe changes to the mobility of older people within their care. The limitations of this study indicate that generalizations must be made cautiously. However, this study tentatively suggests that potential exists to influence positively the level of autonomy and independence of older people through the use of safer handling practice as defined within this study. Recommendations for further study are made.