bluuebunny/crossref_metadata_2025 huggingface dataset:
Evidence for the prevention of venous thromboembolism
Authors: Autar Ricky
Published: May 2014

Patients undergoing major orthopaedic surgery are at high risk of developing venous thromboembolism (VTE). VTE is preventable and venous prophylaxis consensus groups recommend that each patient is assessed for risk of VTE and then stratified into one of the three categories of risk. Rick stratification enables the choice of the most appropriate preventative interventions. This article examines a decision making framework for VTE prevention with particular focus on a validated risk assessment model (RAM) to facilitate risk stratification. The relevant literature is also scrutinised in terms of the best venous antithrombotic strategies, for patients undergoing major orthopaedic surgery, according to scientific evidence.
Pathophysiology, diagnosis and management of acute pancreatitis
Authors: Sargent Suzanne
Published: May 2014

Pancreatitis is an inflammation of the pancreas that can be either acute or chronic in origin and is caused by a varied range of aetiologies. However, in both types of the disease alcohol use may be a major contributor. In acute pancreatitis the symptoms can range from mild, which resolve within a few days, to severe, which is associated with both multi-organ failure and a high mortality necessitating admission to a high dependency or intensive care unit. As the incidence of acute pancreatitis is increasing it is imperative that nurses are familiar with the causes, underlying pathophysiology, diagnostic tests and the potentially vast range of complications that can occur in acute pancreatitis. This article reviews the current medical and nursing management of this condition.
Are specialist nurses in wound care corrupt?
Authors: Castledine George
Published: May 2014

Yes, says a company which has recently given evidence to the House of Commons Health Committee (HC) on NHS Deficits (HC, 2006). No, say clinical nurse specialists.
Pre-conception care and support for women with diabetes
Authors: Hofmanova Ivona
Published: May 2014

This article discusses the National Service Framework for Diabetes: Standards (Department of Health, 2001), with the main focus on Standard 9: diabetes and pregnancy. It concentrates on pre-conception care and support for women with pre-existing diabetes to optimize the outcome of their pregnancy. The rationale for this is the need to understand how this standard affects women with diabetes during childbearing age. Following an introduction to aetiology and epidemiology of diabetes, the author examines the importance of pre-conception care for women with diabetes. An acknowledgement of the deficits within the clinical environment aids recommendations on improvement of education and knowledge for nurses. Health promotion and patient support is emphasized to facilitate an understanding of the impact of diabetes on pregnancy and the necessity of the multidisciplinary team involvement before, during and after birth.
Motivation in nurse education practice: a case study approach
Authors: Murphy Fiona
Published: May 2014

‘There are three things to remember about education. The first is motivation. The second one is motivation. The third one is motivation’ (Maehr and Meyer, 1997 p372). It is important to understand motivation and the reasons why nurses, including educators and clinicians, need to continually motivate their students both in the classroom and within clinical practice. Using relevant literature, the following case study explores the significant issues pertinent in motivating a student undertaking a Postgraduate Diploma in Specialist Nursing. A combination of motivational and learning theories are used in the process of assisting this student to learn from her recent assessment failure and to become re-motivated. There is a discussion of the significance of this case and the key issues drawn from it, which may assist nursing staff in supporting student nurses to remain motivated within the clinical area.
Detachable functional focused rigidity cast for metatarsal fractures
Authors: Khanduja Vikas , Lim CBB , Vermulapalli KK , Lee CM , Banan H
Published: May 2014

This article aims to assess whether a detachable functional focused rigidity cast can be used as a one-off definitive treatment for proximal 5th metatarsal fractures. A prospective trial was carried out over a 2-year period. Forty-one patients with proximal 5th metatarsal fractures (tuberosity and Jones) were recruited and treated with a detachable focused rigidity cast after appropriate consent. Of the 39 patients with follow-up, six had a Jones fracture and 33 had tuberosity fractures. All 33 patients with tuberosity fractures achieved clinical union within 4–5weeks (mean of 4.2weeks). Four of the six patients with Jones fractures achieved clinical union in 8–12weeks. One achieved union in 14weeks and one underwent open reduction and internal fixation for delayed union. There were no complications related to the cast. The results support the use of a detachable focused rigidity cast as a one-off definitive treatment of tuberosity fractures of the 5th metatarsal. However, all the Jones fractures and the diaphyseal fractures should be referred to an orthopaedic team for further management.
Nurse practitioners - or advanced clinical nurses?
Authors: Barton Thomas David
Published: May 2014

This article reviews a specific finding from a research project that examined the experiences of students, teachers and clinicians involved in a nurse practitioner degree programme. The development of advanced clinical nursing roles has presented challenges to the professional structure of nursing, particularly in the area of the unregulated and confusing array of titles adopted by nurses that infer advanced clinical practice. Over a 2-year period, practitioner ethnography was used to examine a sample of 10 student nurse practitioners who were undertaking a clinical degree programme (BSc (Hons) Nurse Practitioner). Data were also collected from 11 other individuals involved in the degree programme: teachers, medical mentors and senior academics. The data were systematically analysed and structured, leading to the inductive identification of themes and frameworks. The sample's experience of the development of advanced clinical nursing roles led to consideration of the evolution of new career structures and identities associated with advanced nursing practice. This evidence enabled a view of advanced clinical nursing roles within a framework of advanced nursing practice. The development of advanced clinical nursing is dependent on the cooperation of clinical nurses, educators, managers, doctors and politicians. Nevertheless, that development can only succeed if strategic policy is backed by the development of a professional clinical nursing career framework that enables the process.
Involving NHS service users in teaching advanced clinical skills
Authors: Jones Colin
Published: May 2014

With the development of advanced practice roles in nursing, innovative ways of delivering programmes are continually sought by academic staff working within higher education. This study explores the ways in which NHS service users can be included in educational programmes to develop clinical examination skills for nurses. Although small scale and exploratory, this study concluded that NHS service users benefit from making a contribution towards the education of healthcare staff and feel empowered in the process.
Evaluation of innovations in nursing practice: report and discussion
Authors: Patrick Hannah , Roberts Natasha , Hutt Ruth , Hewitt Pauline , Connelly Jim , Oliver David
Published: May 2014

Aim: To assess whether a pilot study conducted in the UK achieved its objective to reduce admissions to hospital and bed days in patients identified as suitable recipients of case management by community matrons.

Background: The Department of Health has advocated the use of nurse-led case management to improve the coordination of care and prevent inappropriate hospital admissions.

Method: 66 patients and another 66 controls were identified for the ‘Evercare’ caseload according to criteria set by United Healthcare. Admissions data for the 6months after entry into the study were collected from the hospital information system.

Findings: Admission rates in both the control and intervention group decreased over time and there was no significant difference in rates between the two groups at 6months. There was no demonstrable effect on length of stay either. Users were satisfied with the service and nurses cited several clinical stories implying benefits for individual patients.
An overview of the common methods of wound debridement
Authors: Gwynne Babs , Newton Mary
Published: May 2014

There are several methods of wound debridement and the appropriate one should be chosen for maximum effectiveness. It therefore follows that practitioners must have a working knowledge of a wide variety of debridement methods and that they should recognize their own professional limitations and the need for referral for expert advice. This article aims to set out an overview of the indications, cautions and contraindications of the most commonly used methods of debridement at our disposal and to look briefly at some less often used alternatives.
Fundamentals of compression in the management of lymphoedema
Authors: Linnitt Nina , Davies Rhian
Published: May 2014

This article looks at graduated compression garments, one of the four cornerstones to lymphoedema management. It raises the awareness of the availability of differing compression classes, the differing ways the garments can be knitted and how to apply this to practice. It also aims to raise awareness of the importance of patient education regarding applying and wearing appropriate compression as part of a daily self-management regimen for patients with lymphoedema.
Human immunodeficiency virus and the older person
Authors: Peate Ian
Published: May 2014

This article outlines some of the issues which older people who are infected and/or affected by human immunodeficiency virus (HIV) may face. HIV does not discriminate against age, however, clinicians are now seeing an increasing number of HIV positive older people in their everyday practice. This trend is set to continue as HIV becomes more of a chronic health condition as a consequence of more sophisticated treatment regimens. The older population has largely been ignored in the quest to reduce the incidence of HIV infection. This article calls for more research to be conducted taking into account the unique needs of the older population. There is no place in contemporary nursing practice for practitioners to hold erroneous and outdated myths concerning the sexuality and lifestyle choice of the older person.
Prevention of DVT after orthopaedic surgery: the A-V Impulse System
Authors: Turnbull Betty
Published: May 2014

Deep vein thrombosis (DVT) is a major health problem, which affects 1 in 1000 people in the general population each year. It may be asymptomatic or cause swelling and pain, and can lead to potentially fatal complications. Immobilisation following bone surgery significantly increases the risk of DVT, and prevention is a salient goal for nursing. This article reviews the pathogenesis of DVT, and therapeutic venous thromboembolic prophylaxis in the prevention of DVT following orthopaedic surgery. Best nursing practice is outlined for management of the Arteriovenous (A-V) Impulse System®, the advent of which has had a positive impact on the incidence of DVT following orthopaedic surgery but requires further research to substantiate its effectiveness and determine patient acceptability.
Use and complications of peripheral vascular catheters: a prospective study
Authors: Zafar Abbas Syed , Shaw Steve , Qamar Abbas Syed
Published: May 2014

Peripheral vascular catheters (PVCs) are important medical devices but their insertion and usage are associated with discomfort and potential complications such as thrombophlebitis. This article looks into the various aspects of the practice of using PVCs, especially their complications and ways of avoiding them.

Aims: To determine the complications (and their associated factors) related to PVCs.

Design: Prospective

Setting: District General Hospital

Patients: A study was undertaken of 86 of the 106 patients consecutively admitted as an emergency over a period of 2 weeks who had a PVC inserted.

Methodsand interventions: The admitting doctors inserted the PVCs at their discretion. PVC sites were inspected daily.

Analysis and results: Of the 86 PVCs inserted, 42 were never used, while 43 were of large gauge and 29 were left in situ for over 72 hours. Eight patients developed thrombophlebitis, of which four had a large gauge PVC, two were never used and two were left in situ for over 72 hours (P=0.016).

Conclusions: Incidence of thrombophlebitis may be reduced by re-siting or removing PVCs within 72 hours. PVC gauge and whether it was used, were not associated with this complication.
Nutritional care for older people in hospitals
Authors: Wilson Rick
Published: May 2014

‘Incomparably the most important office of the nurse, after she has taken care of the patient’s air, is to take care to observe the effects of his food … it is quite incalculable the good that would certainly come from such sound and close observation in this most neglected branch of nursing’ Florence Nightingale (1859)
Pain management: setting up a nurse-led femoral nerve block service
Authors: Layzell Mandy
Published: May 2014

Managing pain following a fractured neck of femur is challenging for a number of reasons. This group of patients are typically older people and frail with multiple comorbidites and are often on numerous medications. In addition to a hip fracture, they commonly present with acute medical problems. Fractures cause significant pain which can be difficult to manage safely and effectively with the traditional analgesics. A femoral nerve block has been shown to be a safe and effective preoperative intervention for managing pain in this patient group while they wait for surgery. This article describes how an acute pain team have developed protocols and training to establish a nurse-led service for providing preoperative femoral nerve blocks to patients with fractured neck of femur.
Protecting the vulnerable older person
Authors: Castledine George
Published: May 2014

Old age is becoming a time of dread and anxiety for people. The recent outcry following the publication of research funded by Comic Relief and the Department of Health and carried out by the National Centre for Social Research and King’s College London, highlights many of the problems of abuse to older people in their own homes. Something very serious is happening in Britain which needs to be addressed immediately – it is not that long ago that I was writing about the importance of nurses acting as ‘champions’ for older people when they come into hospital.
Assessing the value of silicone and hydrocolloid products in stoma care
Authors: Berry Jeanette , Black Pat , Smith Rory , Stuchfield Barbara
Published: May 2014

Intact skin among many other functions provides a protective barrier between the body and its environment, which is critical in regulating trans-epidermal water loss (Wilkinson and Moor, 1982). The frequent application and removal of adhesives can damage skin by stripping away the outer epidermal layers. Older people, very young children and those with an underlying skin disorder may be particularly at risk (Gibelli et al, 1999; Lyons and Smith, 2003). Hydrocolloid adhesives, which hold moisture in the adhesive mass, are more skin friendly than the acrylic adhesives they now replace and have now become the material of choice for ostomy flanges and flange extenders (Smith et al, 2007). To understand stoma care nurses’ awareness of the value of technologically-advanced silicone and hydrocolloid products, the authors undertook a nationwide postal survey. The survey, commissioned by four companies in the United Kingdom, who make silicone and hydrocolloid products that can be used in stoma care, were keen to evaluate the awareness of these products to confirm their importance to the patient and why they should be appropriately categorized for reimbursement by the Department of Health.
Thinking and writing at Masters level: a reflective passage
Authors: Fowler John
Published: May 2014

This article identifies key characteristics of Masters level writing and the underpinning relationship of these characteristics to reflective thought. Classical models of reflective writing are reviewed and their focus on reflection as a progressive process is debated. A linear model of reflection is proposed and its application to reflective writing for Masters level assessments is examined. The classical authors tend to present reflection as a process in which the outcomes of reflection becomes deeper at advanced levels. While this is an appropriate application of the concept of reflection for the traditional academic essay, it might not always be so appropriate for other more applied aspects of thinking and writing particularly in the development of advanced nursing practice. A linear model of reflective writing which offers a more pragmatic perspective on reflection is developed.
Safer care for acutely ill patients
Authors: Fox Jane
Published: May 2014

Recently a family friend of many years was acutely ill in hospital, fortunately, she recovered and returned home. It was perhaps this incident that alerted me to the new guidelines released on 25 July 2007 by the National Institute for Health and Clinical Excellence (NICE, 2007) – Acutely Ill Patients in Hospital: Recognition of, and Response to, Acute Illness in Hospitalised Adults. The development of the guidelines were prompted by The National Patient Safety Agency (NPSA, 2007) publication, Safer Care for the Acutely Ill Patient: Learning From Serious Incidents, which is a comprehensive analysis of incident reports on 107 patients, whose deaths in acute hospitals were reported to the agency because of concerns about the safety of their care.
Skin care: an essential component of hand hygiene and infection control
Authors: Bissett Linda
Published: May 2014

Skin care is an important component of hand hygiene and also infection prevention education programmes relating to hand hygiene (Bissett, 2007a,b). Hand hygiene is the term commonly used to describe hand washing using plain soap or antiseptic soaps and hand rubbing using waterless antiseptic products or alcoholbased products. The importance of effective hand hygiene is well documented (Larson, 1995; Boyce et al, 2002; Horton and Parker, 2002) and can be achieved by following the six-step technique used for hand washing as illustrated by the Royal College of Nursing (2000). During hand washing, hand soaps not only remove soils, but also the natural oils that protect the skin. This can vary depending on the frequency of hand washing, the temperature of the water and the ability of the soap to be rinsed from the surface of the hands (Starobin, 2007). This article aims to examine the evidence available to enable healthcare staff to make an informed decision on the importance of following a skin care regime to reduce the risk of bacterial loading on the hands caused by damaged skin. This would consequently lead to an improvement in hand hygiene efficacy.
Haemophilia A: meeting the needs of individual patients
Authors: Khair Kate , J Geraghty Susan
Published: May 2014

The unpredictable nature of bleeding and complications, and the highly variable nature of haemophilia A, necessitate that each patient be dealt with on an individual basis with treatment tailored to specific needs. Safety of treatment is paramount and, due to concerns over viral safety, the use of recombinant factor VIII products has increased across Europe. Prophylaxis treatment has also increased, as recent studies have shown reductions in number of joint bleeds, fewer days lost from work, less need for surgery and fewer emergency hospital visits compared with on-demand regimens. Other factors that need to be considered include convenience for the patient, consistency of supply and cost. Consequently, management of haemophilia involves complex interrelationships between the patient, family and healthcare team.
An epidemiological overview of diabetes across the world
Authors: Meetoo Danny , McGovern Peter , Safadi Reema
Published: May 2014

Once the Cinderella of chronic diseases, diabetes mellitus is now fast emerging as one of the biggest health catastrophes the world has ever witnessed. Almost 6% of the world’s adult population now live with diabetes (Sicree et al, 2003; International Federation of Diabetes, 2006). It has been predicted that the total number of people with diabetes will rise to 366 million in less than 30 years if preventative action is not taken (Wild et al, 2004). Diabetes is no longer a concern of an individual country. It has huge global and societal implications, particularly in developing countries where the development of diabetes at an early age can lead to untoward human suffering, disability and socioeconomic cost. An internationally coordinated effort is required to improve human behaviour and lifestyle to halt the global diabetes epidemic and the development of such complications as retinopathy, nephropathy, neuropathy, cardiovascular diseases, peripheral vascular diseases and stroke. For such a formula to be successful, it is important for nurses to be proactive in their political role in ensuring that people with diabetes become expert in their condition. In so doing, healthcare systems and resources could be used more effectively to reduce real human and economic costs.
Improving patient care: measurement of outcome in rheumatoid arthritis
Authors: Miedany Y El , Palmer D , Gaafary M El
Published: May 2014

Although most people who are seen in rheumatology clinics are suffering from fatigue, pain, functional disability and/or psychological distress, fewer than 15% of healthcare professionals collect any formal quantitative information concerning these problems. In contrast with acute disease in hospital settings where quantitative data concerning functional status or pain are unnecessary as success or failure of the treatment is obvious within a short period, chronic diseases form a different challenge. Patient-reported outcomes are an attractive option in a busy medical practice, as the time burden is transferred from the clinician to the patient. Furthermore, such information is critical in the documentation of patient outcomes and results of care. This work was carried out to analyse a developed version of a multi-dimensional health assessment questionnaire. This questionnaire has been edited in a ‘patient-friendly’ format and its applicability is for standard use in a nurse-led clinical practice to monitor patients suffering from chronic inflammatory conditions in a busy rheumatology unit of a district general hospital.
Abuse by care professionals. Part 3: analysis of characteristics and reasons
Authors: Barber Christopher
Published: May 2014

In order to prevent abusive episodes and abusive behaviour from occurring it is important that society, in particular the health and social care sector, identify the individuals who may be at the greatest risk of abuse and those who are or may become abusers. This article attempts to define such behaviour and illustrate some of the reasons as to why particular groups are the targets of abuse and why particular individuals abuse.
E-learning and professional development – never too old to learn
Authors: Gill Anthony
Published: May 2014

A growing concern among healthcare professionals is the need to continually update knowledge and skills in order to enhance clinical practice. It is recognized that there are major concerns about recruitment and retention of staff within health care, and an increasing need for greater emphasis on valuing the existing workforce. This article contributes to the debate about the role of e-learning in conjunction with continuing professional development (CPD) and personal professional development. It describes how healthcare professionals utilized an innovative, self-managed, pickup and put-down distance learning module delivered online or by CD-ROM. Staff enrolled on the module were encouraged to complete a questionnaire online or by post upon completion of each unit; to enhance validity, telephone interviews were also conducted with selected staff. Results indicate that participants showed some improvement in all categories, especially patient care where 90% of staff reported some improvement after completing the course. This particular method of teaching and learning was shown to be favoured by staff as a method of CPD, and thus has the potential to enhance patient care.
Lymphoedema: a female health issue with implications for self care
Authors: Sneddon Margaret C , Lewis Melanie
Published: May 2014

Many women in the general population either have, or are at risk of developing, lymphoedema, which is an incurable but manageable life-long condition, which may have a devastating effect physically and emotionally. Factors that predispose women to develop lymphoedema are outlined in this article. Strategies to prevent or minimize the severity of lymphoedema are identified. The role of healthcare professionals in empowering women and promoting actions and attitudes that enable them to minimize the risk of developing lymphoedema or exacerbating established lymphoedema and facilitating coping are discussed
High expressed emotion, severe mental illness and substance use disorder
Authors: Watts Malcolm
Published: May 2014

This article discusses the behavioural attitudes of high expressed emotion as a major contributor to relapse in patients dually diagnosed with severe mental illness and substance use disorder. There are a number of research studies and authoritative texts on this particular problem and discussions identify the role expressed emotion plays in this condition. However, the majority of literature concentrate on how high expressed emotion affects the person’s mental illness causing relapse rather than any effect on their substance misuse. This article outlines severe mental illness and substance use disorder; identifies the components of expressed emotion and how this may contribute to relapse; management and care in this condition; the treatment and avoidance of expressed emotion by the family and the professional; and issues of nurse education, training and support.
Temperature measurement in children with cancer: an evaluation
Authors: El-Radhi A Sahib , Patel Swatee P
Published: May 2014

There is little agreement as to the most appropriate thermometer, the anatomical site to carry out temperature measurement in children with cancer, or the type of thermometer preferred by the patients. The authors carried out this study to assess temperature measurement in children with cancer who were admitted for febrile episodes. The body temperatures of children with cancer who were admitted consecutively between January and October 2005 to the paediatric department because of febrile episodes were measured on admission and over the next 24– 36 hours using an electronic thermometer sublingually as the standard reference site. These measurements were compared with those obtained with two ear-based thermometers, a forehead thermometer, and from the axilla (representing current practice). The parents were asked about the type of thermometer they used at home and the children were asked about the type of thermometer they preferred. There were 34 admissions during this period, of which 19 (56%) were confirmed as febrile. Altogether, 108 sets of temperature measurements were obtained, producing a total of 540 measurements from these admissions. Measurements with the two ear-based thermometers in febrile children achieved higher sensitivity than that with axillary and the forehead measurements. The ear-based thermometer was the most common type used at home while the forehead thermometer was the one preferred by the children. In conclusion, ear-based temperature measurements in febrile children were more accurate than axillary and forehead temperature measurements. The current practice of axillary temperature measurement needs to be re-considered.
Pulse oximetry knowledge and its effects on clinical practice
Authors: Paul Thomas
Published: May 2014

Aim: to explore literature pertaining to registered nurses’ and/or doctors’ knowledge in relation to the pulse oximetry in clinical practice.

Background: pulse oximeters provide non-invasive readings of both pulse rate and peripheral oxygen saturation, leading to quick identification of potential/actual problems. Because of this, clinicians, like nurses, may become too dependent on it, neglecting other aspects of the holistic assessment process.

Methods: a literature search was carried out between 1980 and 2006, with much of the data skewed towards 1994–2006. As the central focus was to be on pulse oximetry knowledge of nurses and/or doctors, articles included had to contain a central theme addressing this. Other criteria for inclusion were links between pulse oximetry and knowledge in clinical practice, nurses and/or doctors as participants in studies addressing this, as well as the clinical competency in relation to the device.

Conclusion: improving knowledge may not necessarily be the answer in improving clinical competency. Future research will need to be carried out to measure the connection between knowledge and competency and to use that as a basis for education and training.
Emollients: application of topical treatments to the skin
Authors: Dunning Gail
Published: May 2014

Nurses working in various clinical settings can make a real difference to the clinical effectiveness of topical applications to the skin by increasing their knowledge of the choice and mechanisms involved. This is particularly the case for nurses who are non-medical prescribers when considering first-line therapies for patients with eczema. It is important for all nurses to acknowledge that topical treatments, however simple, are a form of drug therapy and must be given the same considerations for their specific actions whether you are prescribing, applying or reviewing their effect. Emollients have an as important part to play in the treatment of all dry skin conditions. This article focuses on increasing the reader’s knowledge of the application of topical emollient therapy, as well as highlighting some practical tips to consider.
Skin antisepis: using 2% chlorhexidine gluconate in 70% isopropyl alcohol
Authors: Inwood Sheila
Published: May 2014

The insertion of peripheral and central venous access devices carries a high risk of healthcare-associated infection. One of the main risks of this procedure is the introduction of microorganisms from the patient’s own skin. To combat this, and to reduce the rates of healthcare-associated infection, effective skin antisepsis using 2% chlorhexidine gluconate (CHG) in 70% isopropyl alcohol (IPA) has been recommended by the epic2: National Evidence-Based Guidelines for Preventing HealthcareAssociated Infections in NHS Hospitals in England (Pratt et al, 2007). This article discribes the introduction of 2% CHG in 70% IPA into the United Kingdom healthcare market and gives a discussion of the recommendations of epic2 (Pratt et al, 2007). The article identifies the correct use of 2%CHG 70% IPA solution, by detailing the variety of products and applications now available. It also clarifies their correct application and use to enable Trusts to provide a high standard of infection control and reduce healthcare-associated infection. It highlights the potential incorrect use of the available products due to cost pressures within the healthcare setting.
Developmental differences and their clinical impact in adolescents
Authors: Singleton Laura
Published: May 2014

Adolescent mental health is a concern for health professionals as the prevalence of mental health problems appears to peak in adolescence and early adulthood because of the biological and psychosocial transitions that are occurring in this age group. Adolescence is a major transitional period between childhood and adulthood and many changes – physical, emotional and social – occur during this time. These changes can precipitate and perpetuate mental health difficulties in young people. Due to the amount of changes that occur in adolescence, younger and older adolescents are at quite distinct life stages and are biologically, cognitively, socially and emotionally distinct. There are also differences between younger and older adolescents in the prevalence of different disorders and in how they express their difficulties. It is, therefore, important for healthcare professionals to be mindful of the development level of the adolescents with whom they are working and the impact that this can have on the young person’s presentation, understanding of their problems and in their ability to use different therapeutic interventions.
Intellectual impairment and sexual health: information needs
Authors: Clark Louise L , O’Toole Mary S
Published: May 2014

Inclusion into the wider community for people with learning disabilities and intellectual impairment has been problematic for many people and in some cases the result has been an exacerbation of mental health problems or a reduction in adaptive functioning. Research has found that people who have chronic mental illness or intellectual impairment are a sexually active group although they might not always be perceived as such. Therefore, there are questions that may be raised over an identified lack of sexual health promotion and practices surrounding safe sex. This short article will examine particular barriers to sexual health care for this patient group in the areas of consent (to sexual acts, screening and treatment), communication and health promotion in this field. Implications for future practice are discussed.
Advanced nursing practice – the influences and accountabilities
Authors: Wiseman Heather
Published: May 2014

The past two decades have seen a proliferation of new, advanced clinical roles for nurses in the UK which has resulted in much debate about the nature of advanced practice as these new roles involve many tasks that were traditionally considered the remit of doctors. This article critically analyses the professional accountabilities of working at an advanced level and the influences which are driving the NHS modernization agenda with particular reference to the role of the Community Matron. It concludes that advanced nursing practice presents an opportunity for the combination of the art of nursing and advanced tasks, but emphasizes that new roles must develop within a recognized framework which takes account of the educational, ethical and legal accountability issues and clarifies the scope and remit of roles for health professionals, patients and indemnifying agents.
Patient-perceived discomfort with two coated urinary catheters
Authors: Litherland Anne Torine , Schiøtz Hjalmar A
Published: May 2014

Intermittent catheterization is now the preferred method for urethral catheterization of the urinary bladder when an indwelling catheter is not required. Nevertheless, the procedure may cause discomfort or pain. This randomized, prospective study was done to compare patient-perceived discomfort between two commonly used hydrophilic, single-use catheters in women. A total of 196 women referred to the urogynaecology section in the outpatient department were randomized to be catheterized with either a LoFric (n=102) or a SpeediCath (n=94) catheter. Both catheters are hydrophilic, low friction, single-use, disposable catheters. Discomfort was measured using a visual analogue scale (VAS). The results showed no difference in degree of patient-perceived discomfort between the two groups. Median score was 0.75 VAS points in both groups, which indicates little discomfort. Half of all the patients stated that they experienced no discomfort at all.
Autonomy and care: respecting the wishes of the deceased patient
Authors: Sanders Karen , Fullbrook Suzanne
Published: May 2014

In previous articles it has been established that a duty of care is owed to all those for whom we care, a duty not to cause harm, to continuously aim to provide the best possible care and treatment, to act at all times in the best interests of those for whom we care. This includes respecting the autonomous choices made by the person regarding the treatment of their body. Autonomy is the capacity to think, decide and act on the basis of such thought and decision, freely and independently (Gillon, 1986), in other words, deliberated self rule.
Anatomy and physiology of urinary elimination. Part 1
Authors: Pellatt Glynis Collis
Published: May 2014

Elimination of urine is an essential bodily function, but independence in this activity may be affected by physical and mental disability. Part 1 of this article discusses the anatomy and physiology of the renal and urinary tract and the production of urine. Urinalysis is a vital nursing assessment and the collection of specimens and the range of tests undertaken are outlined. Assisting patients to use the toilet, commode or bedpan is an essential nursing skill. The importance of sensitivity, empathy and moving and handling risk assessment is discussed, and the assessment and management of urinary tract infection and urinary tract stones are addressed. The importance of prevention of cross infection for nurses and patients is highlighted throughout the article.
Wound assessment and the TIME framework
Authors: Fletcher Jacqui
Published: May 2014

A structured wound assessment is a crucial part of managing any patient with a wound. Many different wound assessment tools currently exist but there is little standardization in the information they are used to record. A simple framework such as TIME can be used to co-ordinate the data collection into more useful elements which assist in planning cost-effective care. Clustering the information under the key headings of TIME encourages the practitioner to relate what they are seeing to what is happening at a cellular level and manage wounds in a proactive rather than reactive manner, setting clear management/care objectives to facilitate the wound to heal where this is appropriate.
Factors contributing to incidents in medicine administration. Part 1
Authors: Mary Fry Margaret , Dacey Caroline
Published: May 2014

Part one of this two part article explores the factors contributing to errors during the administration of medicines through a detailed literature review. Medication incidents cause serious harm to patients. In a typical NHS hospital approximately 7000 medication doses are administered daily (Audit Commission, 2002a). The costs of errors to patients, practitioners and the NHS are significant. While some errors can be prevented, it is unlikely that they will ever be eliminated as they arise from human nature (Kohn et al, 2000). There is a lack of strong evidence in the literature about what nurses feel the factors contributing to medication errors are. The majority of studies were carried out in the USA and tended to be carried out by non-nurses with the exception of those by Gladstone (1995), Hand and Barber (2000) and King (2004). Gibson (2001) felt that nurses’ experiences and knowledge appear to be under-valued.
Healthcare beliefs of Indian patients living with leg and foot ulcers
Authors: Lewis Christine
Published: May 2014

This article presents the results of a previously unexplored aspect of qualitative leg ulcer research. The study has examined the lived experience and cultural illness explanations of a sample of BritishIndian patients living with leg and foot ulceration. Semi-structured interviews were used to collect data from 16 Indian patients drawn from legulcer clinics and district nursing lists in Ealing Primary Care Trust and Hounslow Primary Care Trust. Eight respondents had venous ulceration, seven were diabetic and had ulcers of arterial aetiology, and one had ulceration due to lymphoedema. Popular perceptions of the causes of leg ulceration were influenced by the humoral theories of balance and imbalance. Other explanations included poor circulation, lowered immunity, bad blood, being cursed and doing something wrong in a past life or this life.
Chronic wound audit: evaluation of a tissue viability service
Authors: Tait Christine , Gibson Elaine
Published: May 2014

A chronic wound audit was carried out at the Conquest Hospital, East Sussex, to establish the prevalence of chronic wounds within the Trust, in light of evaluation of the tissue viability service. At the time of audit the Trust employed two specialist nurses on a part time basis (3 days a week) with 2 days clinical work on the wards. A total of 372 patients were included in the audit, 56 patients had a total of 82 chronic wounds. These wounds were subdivided into wound types. The highest numbers of chronic wounds were pressure ulcers grade 1–4, including the new category of moisture lesions totalling 47.5%. Surgical wounds followed at 20.7%. There was a marked reduction in grade 3–4 pressure ulcers consistent with the pressure ulcer prevalence report from August 2006 that saw an overall reduction of hospital acquired pressure ulcers of 3.9%. This was attributed to the purchase of pressure relieving equipment, the development of a pressure ulcer help line and focused education on pressure ulcer prevention throughout the wards. The mean bed stay for both medical and surgical patients was 28.5 bed days but with surgical patients alone median bed stay was a staggering 45.5 days.
The role of the pathologist in wound management
Authors: BG Lansdown Alan
Published: May 2014

Skin wounds result from a wide variety of physical insults, traumas and idiopathic causes. All are prone to infection and vulnerable to dehydration, contamination and further damage from environmental insult. Appropriate therapy depends upon correct diagnosis of the lesion, wound bed preparation with antimicrobial measures as required, and selection and application of suitable dressings. Whereas tissue viability clinicians and nurses will routinely assess levels of tissue damage and infection through observation of the colour, depth and size of wounds, backed up by microbiological assessment, a range of laboratory pathological services are available to give a wider picture of clinical wounds and possible causes of indolence and non-healing. This review identifies the contribution that specialist pathologists can make to identifying immunological changes in patients and toxic events resulting from the use of xenobiotic materials in wound management, and unravelling the mechanistic action of wound care products. Emphasis is placed on the central role of research in furthering the study of wound healing and mechanisms of chronicity.
Home-based infusion therapy for patients with Fabry disease
Authors: Cousins Alison , Lee Philip , Rorman Dan , Raas-Rothschild Annick , Banikazemi Maryam , Waldek Steve , Thompson Lorraine
Published: May 2014

Fabry disease is an inherited, progressive, life-threatening disease; therefore, lifelong therapy is needed. By replacing the deficient enzyme, disease progression may be delayed or halted, thereby avoiding serious complications. Hospital-based agalsidase therapy is generally perceived as inconvenient and home-based infusion therapy is greatly appreciated by patients, their families and healthcare professionals. Patients can get familiar with infusion therapy in a hospital setting and, if specific requirements are fulfilled, routine nurse-assisted infusion, or self-care, at the patient’s home can be organized. A stable patient who tolerates the infusion and a suitable home environment are prerequisites for home therapy. The authors’ clinical experiences underscore the safety and practicality of home therapy. In addition to a major positive impact on the patient’s quality of life, home infusion therapy may reduce the constraints of hospital resources. This article reviews the collective experiences with agalsidase beta home infusion therapy and outlines how safe, patient-centred homecare can be organized. Home infusion therapy with Fabrazyme®should not be withheld from patients considered eligible according to the proposed criteria. Similar approaches to other enzyme therapies are also possible.
Can standard rheumatology clinical practice be patient-based?
Authors: Miedany Yasser El , Palmer Deborah
Published: May 2014

Patient-reported outcome measures (PROMs) are an attractive option in standard clinical practice. However, they do need to be validated on a broader spectrum of disease activity. Another factor to consider is patient adherence to treatment programmes which is directly linked to their satisfaction with clinical outcome. A recently developed multidimensional health assessment questionnaire has proved to be valid, save time and provide permanent medical and medico-legal documentation of the patient status at a given time. The questionnaire gives patients the opportunity to record their joint pain from their own perspective. The aim of this work was to examine whether the patient’s self-assessment of tender joint counts agrees with the physician’s evaluation, and whether it correlates with other disease activity parameters.
Measuring blood pressure using an automated sphygmomanometer
Authors: Wedgbury Kirsty , Valler-Jones Tracey
Published: May 2014

There has been increasing pressure to remove medical devices containing mercury from clinical areas, which is leading to the demise of the mercury sphygmomanometer. As a result, automated blood pressure devices have been embraced by clinicians for their convenience and ease of use. However, it is essential that clinicians are aware of their limitations and are able to select the correct sphygmomanometer dependent upon the clinical need. It is a recommendation of the Independent Advisory Group that auscultation, as a method of determining blood pressure, should continue to be taught to healthcare professionals. Nevertheless, the reality is that in most clinical areas the automated sphygmomanometer is readily available and appears to be the device of choice. Therefore, where treatment protocols are based on accurate blood pressure readings, the clinician must ensure that the equipment used is appropriate for that application.
The application of crime science to the prevention of elder abuse
Authors: Cox Karen
Published: May 2014

The abuse of older people is a significant problem, with estimates intimating that there may be over 340 000 cases per year in the United Kingdom. Despite improvements in screening and assessment to identify and treat those who are abused or at risk of abuse, the healthcare community remains preoccupied with prevalence rather than prevention. In light of the paucity of health-related research evidence to support the effectiveness of preventative measures, the application of crime prevention theory and knowledge is appropriate. Routine activity theory and situational crime prevention literature acknowledges the vulnerability of older people to abuse and the potential of any person employed as a carer to be an abuser. Preventative measures are focused on techniques that make abuse more difficult and more risky for the perpetrator and, therefore, less ‘rewarding’. The regulation of healthcare support workers and increased workplace surveillance are examples of the 25 techniques of situational prevention that could be applied in a healthcare setting.
Neurogenic continence. Part 2: neurogenic bladder management
Authors: Pellatt Glynis Collis , Geddis Tracey
Published: May 2014

This article addresses physical and psychosocial issues in neurogenic bladder management. The impact of neurogenic bladder and its assessment will be discussed. There are a wide range of treatment options available to manage neurogenic bladder dysfunction and this article offers an overview of key management techniques, including non-invasive techniques, self-intermittent and suprapubic catheters, medication and surgical management. The importance of the nursing role in assessment, teaching and supporting patients by enabling them to make informed choices about their bladder management is addressed.