bluuebunny/crossref_metadata_2025 huggingface dataset:
Reflection on care in recurrent sexually transmitted co-infections
Authors: Paparello Joel Zamora , Beyers Carl , Por Jitna
Published: May 2014

Reflection is a skill that nurses are expected to practise to help them continually re-evaluate their personal effectiveness in problem solving. This skill is necessary when caring for patients who are experiencing the complex challenges linked to psychosexual and psychosociological behavioural changes associated with HIV infection and recurrent sexually transmitted co-infections (STC-I). The Johns model of structured reflection was used in the reflection described here to aid the critical thinking process in helping a nurse to manage and deliver up-to-date, effective care and to develop a strong nurse-patient therapeutic relationship. A holistic approach is key to delivering care to patients with recurrent STC-I. This involves taking a sexual health history and establishing the correct diagnosis, followed by the administration of pharmaceutical and psychotherapeutic treatments to facilitate psychosexual, psychosocial, and psychological changes. This article uses a reflective learning experience in caring for a patient with recurrent STC-I to give insights on psychosexual and psychosociological behavioural strategies. Used with a diagnosis and pharmacological intervention, these strategies can be put into nursing practice and enhance the quality of nursing care.
Using behavioural methods to manage faecal incontinence
Authors: Chipps Tracey
Published: May 2014

Faecal incontinence is a common problem for patients who have suffered a stroke. However, patients arriving at a neurorehabilitation unit are often reluctant to disclose their problem, and transfer documentation is sometimes incomplete. Nurses need to be aware that this is a sensitive area for patients, which can adversely affect their rehabilitation progress. Nurses and other professional practitioners must work together as a team, as the impact of faecal incontinence can be highly distressing for patients, and can result in inefficient use of therapy time. This article examines how the rehabilitation nurse, using evidence-based practice, can manage faecal incontinence effectively within a structured assessment and therapy programme, and shows it is possible to manage patients' bowel actions proactively. The benefits of this include maximizing therapy and nursing time and preventing delayed discharges. This article is based on a thorough assessment originating from a case study.
Nurse-led homeless intermediate care: an economic evaluation
Authors: Dorney-Smith Samantha
Published: May 2014

This article describes a homeless intermediate care pilot project that took place at a 120-bedded homeless hostel in South London in 2009. During the year, 34 hostel clients directly benefited from intermediate care. At the end of the year, the number of hospital admissions to the hostel had dropped 77% relative to 2008, and the number of accident and emergency (A&E) attendances had dropped 52%. Hospital ‘did not attends’ (DNAs) were 22% lower. An economic evaluation found that the pilot project was cost neutral overall, and there is some evidence that health outcomes improved. The project now has mainstream funding and has recently received a national community nursing award. Its success has been recognized nationally as an example of innovative practice in work with vulnerable groups ( Department of Health (DH), 2010 ).
To pray or not to pray: a question of ethics
Authors: French Charlotte , Narayanasamy Aru
Published: May 2014

There is a widespread belief that nurses have a duty to provide spiritual care. However, many feel there is still a need for debate surrounding the ethical use of prayer in both nursing research and practice. By using critical reflections and evidence-based literature, this paper develops a discourse on the ethics of prayer as a spiritual intervention in nursing and health care practice. Several key ethical issues are highlighted. In regards to research, lack of informed consent is a major concern in both research and nursing practice. Key ethical issues in practice include questions around intention and authority, e.g. despite the religious beliefs of the nurse, intentions to proselytize must be avoided to protect patient autonomy and avoid abuse of the nurse's authority. Furthermore, prayer has unknown side effects and implications. This paper concludes that, in practice, nurses must reconcile their personal, spiritual beliefs with their professional duties, and while this may be a delicate balance, it is not yet appropriate to encourage or dissuade a patient from their beliefs until appropriate research evidence is produced.
Implementation of ‘sign-off’ mentorship: different perspectives
Authors: Barker Mandy , Blacow Lewis , Cosgrove Stella , Howorth Nigel , Jackson Gordon , McMahon Jacqueline
Published: May 2014

Students who entered nurse training from September 2007 onwards are required to have a sign-off mentor (SOM) in their final clinical placement. The sign-off mentor is responsible for confirming to the Nursing and Midwifery Council (NMC) that a student nurse has met all the requirements of pre-registration clinical assessment and can be registered as a nurse. This became mandatory in September 2010, and this article describes how one acute NHS foundation Trust implemented and managed this process, with contributions from practice education facilitators, an SOM and a student.
Preventing adverse healthcare events: lessons from abroad
Authors: Tingle John
Published: May 2014

John Tingle discusses a patient safety report from Minnesota, USA which contains some important lessons for maintaining and developing a safe and proper healthcare treatment environment.
Effective management strategies for osteoarthritis
Authors: Walker Jennie
Published: May 2014

Osteoarthritis (OA) is a chronic disease which affects a significant number of people during working life and retirement. The principle symptoms of OA are pain, stiffness, and potentially reduced movement and function of the affected joint. In severe OA the ability to engage in work or social activity may be restricted and as a result, the health-related quality of life of the patient may be affected. There are a variety of approaches which can be implemented to manage symptoms, including the use of orthoses, exercise programmes or in severe cases, arthroplasty. It is important that emphasis is placed on patient empowerment and shared decision-making with regard to managing symptoms and preserving or improving function or the affected joint(s).
Critical care training: using Twitter as a teaching tool
Authors: Mistry Virendra
Published: May 2014

In 2010, the Joint Information Systems Committee (JISC) funded a project to explore the usefulness of Twitter as a teaching tool. The project, which was based at the Clinical Simulation Centre at the University of Glamorgan, involved the creation of four short, videoed clinical scenarios and used a high-fidelity mannequin-based simulator. A group of twelve learners on a BSc Critical Care course accessed these videos asynchronously and were encouraged to ‘tweet’ very short messages on the evolving condition of the patient in the videos, on key clinical decision points or respond to specific questions posted by the tutors. Another group of learners on a pre-registration nursing course used Twitter in a synchronous, face-to-face classroom environment and also tweeted their responses to the videos. The overall aim of the project was to explore the merits, or otherwise, of Twitter as a tool to scaffold learning and engage nursing students in reflection and clinical decision making.
The RCN's literacy competences for evidence-based practice
Authors: Gasper Alan
Published: May 2014

Professor Alan Gasper discusses the Royal College of Nursing's recently announced information literacy competences, which set out skills required by nurses to deliver safe and effective evidence-based care
Nurses’ experiences of a colorectal cancer screening pilot
Authors: Robb Kathryn A. , Smith Samuel George , Power Emily , Kralj-Hans Ines , Vance Maggie , Wardle Jane , Atkin Wendy
Published: May 2014

This article describes a study that set out to explore the experience of endoscopy nurse practitioners participating in the Department of Health-funded UK Nurse-led Flexible Sigmoidoscopy Colorectal Cancer Screening Pilot. Semi-structured interviews were conducted with the three nurse practitioners involved and were analysed using Thematic Analysis, a qualitative method for analysing and reporting patterns (themes) within data. Nurse practitioners found that participating in the study improved their skills and provided job satisfaction despite the hard work it entailed. A varied workload consisting of diagnostic and screening procedures, in addition to the other duties of nurse practitioners, may be desirable for nurses working in the field of gastroenterology.
Meeting NMC Standards through development of a mentor register
Authors: Chris Walsh
Published: May 2014

The NMC Standards to Support Learning and Assessment in Practice (NMC, 2008) require health trusts to provide a current and up to date local register of mentors and practice teachers available to support students on NMC approved programmes. Within the Belfast Health and Social Care Trust, this has allowed opportunities for the development of new and exciting software in conjunction with the IT Department, which will pave the way for a reliable and robust implementation of the standards at ward level. The project has brokered dynamic relationships between nursing and IT advancements and shown that computer software can provide unique solutions to regulatory requirements.
The impact of osteoarthritis on psychological wellbeing
Authors: Elizabeth Weathers , Rena Creedon
Published: May 2014

Osteoarthritis (OA) is now considered one of the ten most disabling diseases in developed countries, and it is estimated that worldwide 18% of women and 9.6% of men over 60 years suffer from this condition. It is therefore vital to take the demographics of this disorder and the health needs of this age group, including associated psychological and social elements, into account when identifying the extent the problems associated with OA impact on the individual. Elderly patients, however, sometimes accept their condition and adopt a positive outlook towards their OA, using this as a coping strategy. This association with and acceptance of pain by older patients as a normal part of the ageing process may compromise the patient’s ability to undertake activities of daily living.
Men and cancer: the gender dimension
Authors: Peate Ian
Published: May 2014

Cancer affects more men than women; evidence shows that men are almost 40% more likely than women to die from cancer ( Men's Health Forum, 2009 ). The three cancers that only affect men are penile, prostate and testicular cancers, with prostate cancer being the most common of all cancers in men. This article provides an overview of the health of men in the UK from a male cancer perspective. It suggests that gender is a significant determinant of health status, and that the nursing must take this into account when proffessor health services and when planning and devising strategy and policy. There are complexities and inter-relationships between gender and social class, ethnicity, disability, sexuality and age that are associated with male health. Ways in which the challenges faced by men and ways in which men access health services are discussed. Further research is needed to address this important healthcare issue.
Writing for professional publication. Part 10: publishing a project report
Authors: Fowler John
Published: May 2014

This series of writing for professional publication has, so far, presented the preparation you need to do before starting to write an article. This was followed by the practicalities of writing the abstract, creating interest in the reader's mind, how an article for publication differs from that of an academic essay, how case studies can be used in publications, and choosing the correct journal for your particular article. This article discusses how you can present project reports for publication.
Essential care after an inpatient fall: National Patient Safety Agency advice
Authors: Tingle John
Published: May 2014

John Tingle discusses a recent National Patient Safety Agency Rapid Response Report on essential care after an inpatient fall. To give the discussion a broader perspective and context he also introduces a US analysis of healthcare strategies that can be employed to reduce inpatient hospital falls.
What do NHS staff think about working in the NHS?
Authors: Tingle John
Published: May 2014

John Tingle discusses some issues highlighted by the 2010 NHS Staff Survey in England.
A meta-synthesis of research on leg ulceration and neuropathic pain
Authors: Taverner Tarnia , Closs José , Briggs Michelle
Published: May 2014

Leg ulceration represents a substantial health problem, and pain is likely to be an associated symptom. The aim of this meta-synthesis was to undertake a systematic review of qualitative studies investigating the experience of chronic painful leg ulceration. This study undertook the meta-synthesis approach described by Sandelowski and Barroso (2003) , which is a synthesis and re-interpretation of the findings from several qualitative studies. Findings were extracted and synthesized. The overarching theme was that patients with chronic leg ulceration suffer from persistent pain with associated sequelae. Word descriptors used by participants also suggested that patients have neuropathic pain. In addition, findings from the meta-synthesis suggested that pain associated with chronic leg ulcer may have a neuropathic pain component. Pain associated with leg ulceration is likely to have nociceptive properties as well as neuropathic properties. If neuropathic pain is not identified and managed effectively, patients are at risk of developing a chronic pain condition with associated sequelae, such as poor sleep, depression and suicidal ideation. It is proposed that early identification and management may enable appropriate pain management which may prevent or reduce the associated risks.
Laboratory performance of alternating pressure air mattresses
Authors: Bain Duncan
Published: May 2014

The performance of three different alternating pressure air mattresses with different geometries of air cell were compared (Nimbus 3, Heritage, Tamora Plus), using simple performance indices based on pressure mapping. The aim of this study was to examine the effect on performance of elevating the backrest and thigh section of the bed into sitting position. Ten healthy volunteers of various sizes were pressure-mapped over the full pressure cycle on three alternating pressure air mattresseses with differing cell geometries. This was then repeated with the beds profiled to a sitting position. Performance of the alternating pressure air mattresses in terms of their ability to redistribute pressure dynamically was assessed in the different positions. The different alternating pressure air mattresses performed similarly with the bed in the lying flat position, but smaller cells appeared to be more effective in the sitting position. A conclusion was made that cell geometry may have an effect on the ability of the mattress to achieve alternating behaviour in the sitting position.
A cost-effective pressure damage prevention strategy
Authors: Large Jenny
Published: May 2014

This article describes the development of a pressure ulcer prevention strategy, with the aim of establishing if the implementation of best practice would impact on the incidence of pressure ulcers in a healthcare setting. The strategy was piloted in a large 78-bedded nursing home. A full audit of the patients' notes and existing care pathways was conducted in order to inform the structure of the prevention plan. It was found that there were no protocols for the use of Cavilon barrier products and that it was not part of a standard care pathway. A prevention strategy was designed based on these findings and an education package delivered to all staff. Training in the appropriate use of Aderma™ Dermal Pads was also provided so that they could be put in place as an early preventative measure in patients at risk of pressure damage or those showing the symptoms. The results of the study showed that by establishing a best practice care pathway, the incidence of pressure ulcers could be reduced.
Implanted ports: benefits, challenges and guidance for use
Authors: Dougherty Lisa
Published: May 2014

Implanted ports are long-term central venous access devices implanted under the skin, usually on the chest wall. They are easy to maintain and have few complications. They are safe and well tolerated and enable the patients to continue with normal daily activities.
The assessment and management of skin tears in care homes
Authors: Stephen-Haynes Jackie , Callaghan Rosie , Bethell Elaine , Greenwood Michelle
Published: May 2014

This article discusses a project conducted in Worcestershire nursing homes to review current practices in the management of skin tears and the subsequent development and implementation of guidelines resulting in a standardised client care package. An initial audit in five care homes was followed by an in-depth audit in 52 homes over a 12-week period. This led to the development of resources and the ‘STAR box’ to assist with implementation of timely and appropriate care delivery.
Venous leg ulceration and graduated compression
Authors: Lay-Flurrie Karen
Published: May 2014

Venous leg ulceration is the most common type of ulceration. Incompetency of the valves in the leg results in raised venous pressure which gives rise to the signs and symptoms of venous hypertension. The application of compression bandage therapy remains the cornerstone of treatment in the healing of venous leg ulceration. Application of the correct level of pressure to reverse venous hypertension is essential for such therapy to be successful and practitioners need to be trained in assessment and application techniques to ensure that the recommended level of pressure is applied without causing adverse problems and risks to the patient.
Initiating growth hormone therapy for children and adolescents
Authors: Acerini Carlo , Albanese Assunta , Casey Angela , Denvir Louise , Jones Julie , Mathew Verghese , Musson Pauline , Sparrow Susan
Published: May 2014

It is common for children and adolescents on growth hormone (GH) treatment to miss one or more injections per week, thereby compromising their linear growth outcome. Among factors likely to affect treatment concordance are patient education and support in the selection of the most appropriate GH injection device. The authors discovered inconsistencies in the process of starting patients on GH therapy throughout the UK, and found that there were no clinical recommendations to support health professionals starting patients on treatment. This article describes the issues involved and the development of practical recommendations for use when starting paediatric patients on long-term GH therapy.
The role of the ward manager in promoting patient safety
Authors: Pinnock David
Published: May 2014

In this article the role of the ward manager in promoting patient safety is explored. The background to the development of the patient safety agenda is briefly discussed and the relationship between quality and safety is illustrated. The pivotal importance of the role of the ward manager in delivering services to patients is underlined and literature on patient safety is examined to identify what a ward manager can do to make care safer.

Possible actions of the ward manager to improve safety discussed in the literature are structured around the Leadership Framework. This framework identifies seven domains for the leadership of service delivery. Ward managers use their personal qualities, and network and work within teams, while managing performance and facilitating innovation, change and measurement for improvement. The challenge of promoting patient safety for ward managers is briefly explored and recommendations for further research are made.
Medicines non-adherence: adult literacy and implications for practice
Authors: Bowskill Dianne , Garner Lucy
Published: May 2014

Functional health literacy is defined as the level at which individuals can obtain, process and understand basic health information ( Martin et al, 2009 ). Government statistics suggest low functional health literacy is an under-recognised and growing problem in UK health care. It is associated with high hospitalisation ( Baker et al, 1998 ) and increased medicines non-adherence ( Kalichman et al, 1999 ). Health professionals are poor at assessing and identifying those at risk because they have yet to acknowledge the prevalence of the problem. Initiatives attempting to address medicines non-adherence promote patient involvement in treatment decisions but remain ineffective if patients cannot read or understand written instructions. To help patients with low functional health literacy practitioners should speak slowly, repeat information, use plain, non-medical language and adopt teach-back techniques. These actions take extra time but are relatively easy to adopt and with a little thought become part of everyday practice.
Managing the acutely ill adult with sickle cell disease
Authors: Brown Marvelle
Published: May 2014

Sickle cell disease (SCD) is an autosomal recessively inherited condition, affecting the structure of the haemoglobin. SCD is a long-term chronic condition which is manifested by periods of acute painful sickling crisis, known as vaso-occlusive crisis (VOC) and is the cause of 90% of sickle cell-related hospital admissions. SCD is one of the most common genetic conditions worldwide and in the UK there are approximately 12 500 people living with it ( Streetly et al, 1997 ; Howard et al, 2008 ), making it more common than cystic fibrosis, yet there still remains many challenges in managing these patients when they become acutely ill. Lack of awareness and understanding of the illness, concerns regarding addiction and limited attention to the psycho-social implications of the illness, leads to less than effective care for this patient group when they are hospitalized.

The aims of this article are to outline the pathophysiology of SCD, identify the causes ofVOC and discuss the key principles of nursing management for patients experiencing a VOC.
Setting up a social enterprise for clinician-led lymphoedema services
Authors: Warrilow Mary , Jones Kris
Published: May 2014

The introduction of social enterprises into healthcare has brought about opportunities and challenges for providers and clinicians. Dudley Lymphoedema Service, a team originally of five staff members, has undergone radical changes. The team has successfully gone through the Department of Health's right to request programme to move from a primary care trust service to become a social enterprise, LymphCare UK, which is a community interest company. There are only approximately 40 NHS services throughout the country that have taken this option as part of government changes and plans to put clinicians at the helm of services. Becoming a social enterprise has led to the service becoming bespoke, more responsive, flexible and innovative. Stepping out of the NHS has not been an easy journey but is one that the team is confident will improve outcomes for the organisation and the patients it serves.
Students' experiences of electronic health records in practice
Authors: Baillie Lesley , Chadwick Sandra , Mann Robert , Brooke-Read Melanie
Published: May 2014

Aim:

The purpose of the study was to investigate nursing and midwifery students' experiences of electronic health records (EHRs) in practice.

Background:

As EHRs are increasingly being implemented in the NHS, student nurses and midwives are gaining experience in their use.

Method:

Three focus groups were conducted on a university campus in England: one with midwifery students (n=6); one with mental health nursing students (n=5); and one with adult nursing students (n=6). The focus group data was analysed thematically after transcription.

Results:

Students perceived the benefits of EHRs for care delivery as better information availability and quality of record keeping. Their concerns related to practical and logistical issues, and difficulties in adjusting to electronic systems.

Conclusion:

If students have positive experiences with EHRs during training and have opportunities to use EHR systems while on placement, they are more likely support the implementation of EHRs as they enter the workplace as qualified staff.
Reflecting on nurses’ views on using research in practice
Authors: Heaslip Vanessa , Hewitt-Taylor Jaqui , Rowe Nicholas E
Published: May 2014

This paper follows a previous paper ( Hewitt-Taylor et al, 2012 ) in which the authors summarised their reflections on the literature relating to the application of research in practice. This paper builds on these reflections and reports on the findings from one aspect of a study that explored nurses’ views on using research in practice. Quantitative methods of data collection and analysis were used and data were gathered using questionnaires. The findings suggest that nurses generally value research, but this does not necessarily mean that they base individual decisions on particular research findings, or that research is considered the most important form of evidence in direct practice. In addition, the resources that enable nurses to find, appraise and make decisions about using research, are not always readily available in practice settings. From this part of the study, it can be concluded that for research utilisation to increase, time, resources, role models and environments that support this ethos are needed, and that an emphasis on research should not eclipse other key forms of nursing knowledge such as patient views and experiences, and professional expertise in the promotion of evidence-based practice.
Health and medical services for the 2012 Olympic Games
Authors: Venning Pam
Published: May 2014

This summer, London will become the first city to host the Olympic Games for a third time. The last time the torch made its way around the UK was 1948; a year many will associate with the inception of the NHS.

On 5 July, the NHS took control of 480 000 hospital beds in England and Wales, and an estimated 125 000 nurses were on hand to care for patients ( Tweddell, 2008 ). Only a few weeks later, the London Olympics opened at Wembley Stadium, and as there was no Olympic Village, many athletes were housed in nursing accommodations ( Lane, 2010 )

Both the Olympic Games and the birth of a public health service made a significant mark on the UK landscape, and in the 64 years that followed, many things have changed. Some things, however, remain the same; nurses continue to serve the public with commitment, spirit and pride.

Not only will hundreds of nurses feature in the 2012 Olympic Games opening ceremony ( Ford, 2012 ), they will also play an important role in delivering the medical services planned for the event.
Palliative care nursing for children in the UK and Ireland
Authors: Hill Katie , Coyne Imelda
Published: May 2014

Currently, there are many changes taking place in the area of paediatric palliative care. These include the role of the nurse, development of national policies, and recommendations for the future of paediatric palliative care. This article discusses palliative care for children with life-limiting conditions in the UK and Ireland, highlights national and international developments in this area, describes current services, and makes recommendations for future developments. Paediatric palliative care should be holistic, family centred and tailored to meet the needs of each child and family. Palliative care should promote autonomy and allow informed choices regarding end-of-life care. Palliative care should begin at the time of diagnosis and continue beyond illness, through the bereavement process. It should be adaptable to allow care delivery in any setting; home, hospice or hospital. Health professionals providing paediatric palliative care should be appropriately trained in this specialist field and the best interests of the child should always be at the forefront of care.
Effectiveness of the new NMC mentor preparation course
Authors: Veeramah Ven
Published: May 2014

This study aimed to determine whether the mentor preparation course introduced in 2006 by the Nursing and Midwifery Council (NMC) and based on NMC mentor standards is meeting the needs of mentors to support preregistration students in practice. A cross-sectional survey was carried out, involving 346 mentors who successfully completed the new course. A self-administered postal questionnaire was used to collect data between December 2010 and February 2011, with a response rate of 57.5%. Overall, respondents felt adequately prepared for their role as mentors and were more confident in their ability to support preregistration students in practice. However, a significant number of respondents received little protected time away from clinical duties to complete the theoretical and practical components of the course and many indicated the need for more input on the practice assessment document used for assessing preregistration nursing and midwifery students.
Nurses' role in managing alcohol misuse among adolescents
Authors: Kiernan Claire , Ni Fhearail Aislinn , Coyne Imelda
Published: May 2014

Over the past decade, there has been an increase in the amount of alcohol consumed by young people, aged 11–17 years, in the UK and Ireland, which has implications for all health professionals caring for adolescents. Alcohol misuse is increasingly common among adolescents and is a significant concern for families, communities and society. Health professionals need to be aware of the dangers involved with underage drinking, how to recognise the signs of alcohol misuse, and how to intervene appropriately. Over the past few years, there has been a noticeable increase in the number of adolescents presenting to emergency departments (EDs) owing to alcohol-related injuries. This increase means that all nurses and other health professionals are suitably placed to provide education and support to adolescents who are consuming excessive alcohol. Regular alcohol misuse can lead to adverse health outcomes, and therefore nurses need to take an active role in health promotion to ensure that adolescents are aware of the associated dangers. This article summarises the harmful effects of underage drinking, the influencing factors and outlines the current guidelines on alcohol misuse in young people. It discusses strategies that nurses can use in the ED setting, and all healthcare settings, to motivate adolescents to change health-damaging behaviours.
Retrospective comparative audit of two peripheral IV securement dressings
Authors: Jackson Andrew
Published: May 2014

Reliable securement of peripheral venous cannulae (PVC) is an important factor in their maintenance. This audit in a district general hospital compares the occurrence of PVC restarts between a 3-month period in 2010 and the same 3 months in 2011. The only difference in the PVC care bundle between these dates was the implementation of an advanced securement dressing for cannulae in 2011. Results show a significant increase in cannulae attaining the maximum local protocol duration of 72 hours during 2011. Also, restarts owing to dressing-influenced factors (dislodgement, infiltration and leakage) were significantly lower in 2011 when the new dressing was used. The total number of PVC restarts during the comparative audit periods was 9% lower in 2011 compared with 2010. This data suggests that better PVC securement is leading to an overall reduction in PVC insertions but further evidence is required to support this conclusion.
HANDS: standardised intravascular practice based on evidence
Authors: Caguioa Jennifer , Pilpil Fernando , Greensitt Chris , Carnan Donna
Published: May 2014

Observed and audited variability in the insertion and care of vascular access devices (VADs), despite national guidance, led an intravascular (IV) team to develop seven basic standards under the mnemonic of HANDS. This initiative combined the Saving Lives guidance ( Department of Health, 2007 ) with IV care bundles to reinforce best practice. The main reasons for the project were to decrease bacteraemia rates related to IV devices and to improve practice. The strategy of strengthening care bundling — Project HANDS — with a targeted education programme was adopted to ensure IV practice was consistent and evidence based. This project took a novel approach that evaluated the application of infection control measures, using IV device care as a tool to influence organisational change. This resulted in quality improvements and better patient outcomes. Further actions include disseminating the learning from this project to healthcare partners and in the community.
A review of medical-grade honey in wound care
Authors: Belcher Judy
Published: May 2014

In the current healthcare environment, clinicians are increasingly under pressure to use wound care products that are cost effective. This includes products that can be used in a variety of wounds to achieve different outcomes, depending on the wound-bed requirements. Medical-grade honey has emerged as a product that can achieve a variety of outcomes within the wound and is safe and easy to use. This article reviews the use of a medical-grade honey, with a view to including it on the wound care formulary in both primary and secondary care. It featured in a poster presentation at the Wounds UK conference at Harrogate in 2011.
Staff perceptions of respiratory rate measurement in a general hospital
Authors: Philip Keir , Richardson Ruth , Cohen Maurice
Published: May 2014

Background:

the National Institute for Health and Care Excellence (NICE) (2007) states that ‘respiratory rate is the best marker of a sick patient and is the first observation that will indicate a problem or deterioration in condition’. It is therefore crucial that staff are confident that respiratory rates are recorded accurately.

Aims:

to assess perceptions of clinical staff regarding methods of assessment and reliability of respiratory rate recordings in observation charts.

Methods:

we developed a questionnaire using best practice guidelines. Some 41 ward-based clinical staff completed the questionnaires.

Findings:

confidence in the reliability of recordings is very low. Clinical staff think recordings are often estimated with no formal measurement, with ‘perceived lack of time’ being the most commonly cited explanation for inappropriate assessment.

Conclusions:

essential clinical information is not being used, as clinical staff lack confidence that it has been assessed correctly. Furthermore, inaccurate recordings could be actively misleading clinical care.
Medication adherence in Parkinson's
Authors: Wright Jenny , Walker Jennie
Published: May 2014

Parkinson's is a complex degenerative disease which affects both motor and non-motor function and as such requires regular reassessment and collaboration between the patient and the healthcare team to achieve optimal outcomes. Complex medication regimes are often prescribed to manage symptoms; however, issues such as compliance, adherence and concordance need to be considered. The Parkinson's Nurse Specialist plays a central role in understanding patient needs and ability to manage medication regimes. The nurse has a fundamental function in achieving optimal medication adherence throughout the disease trajectory.
Self-management in chronic oedema
Authors: Todd Marie
Published: May 2014

The number of people living with long-term conditions in the UK is increasing. This is putting an immense strain on already stretched health and social care resources. Government strategies are aimed at encouraging and supporting self-management of these conditions. Self-management of chronic oedema has always been a key aspect of care planning for this patient group. This article focuses on how nurses can encourage and support self-management in chronic oedema.
Developing the recognition and response skills of student nurses
Authors: Perkins Claire , Kisiel Maria
Published: May 2014

Acute deteriorations in health occur in all healthcare settings. Every health professional must therefore have the knowledge and skills to recognise and respond effectively to acute illness, in order to avert further deterioration. It is widely acknowledged that a robust understanding of physiological observations, in addition to effective interpretation and clinical decision-making skills, is required for this task ( Odell et al, 2009 ; Steen, 2010 ). A significant amount of work has been undertaken in one higher education institution (HEI) to ensure that theoretical preparation adequately equips nurses for this aspect of their role. However, it would appear from this evaluative study that some barriers may exist that prevent this essential theoretical knowledge from being embedded into clinical practice. This gap in transformational knowledge is important to highlight as there is an increasingly urgent need for these skills if acutely ill patients are to be successfully rescued (The National Confidential Enquiry into Patient Outcome and Death (NCEPOD), 2005 ; 2009 ; 2012 ; National Institute for Health and Care Excellence (NICE), 2007 ; Department of Health (DH), 2009 ). The dissolution of barriers that prevent the development of effective recognition and response skills is an important task for all those involved in acute care education, in both HEI and clinical settings.
Nurse management of cardiovascular risk factors in rheumatoid arthritis
Authors: Garcia-Diaz Silvia , Corominas Hèctor
Published: May 2014

Rheumatoid arthritis (RA) is a chronic, multi-system inflammatory disease. The incidence and prevalence of RA varies considerably between geographic areas and over time; the prevalence of RA in adults aged >20 years in Spain is around 0.5% ( Carmona et al, 2002 ). People with RA also have extra-articular manifestations, presenting an increased cardiovascular morbidity and mortality risk; therefore, cardiovascular risk screening and management strategies are necessary in individuals with RA. The importance of interventions in the management of people with RA and cardiovascular risk factors is recognised by the European League Against Rheumatism (EULAR) recommendations ( Peters et al, 2010 ). Rheumatology specialist nurses are well placed to include routine cardiovascular risk assessment for people with RA attending clinic, and to provide educational interventions to reduce cardiovascular risk, such as smoking cessation, weight loss, eating a balanced, low-fat diet and exercising regularly.
Influencing factors in MMR immunisation decision making
Authors: Hill Marie C , Cox Carol L
Published: May 2014

Immunisation decision making is not a straightforward process for parents. Many factors influence parental decision making on whether they immunise their child with the measles, mumps and rubella (MMR) vaccine. The feasibility study described in this article provides insight into influencing factors associated with decisions regarding the immunisation of children by parents. The study findings suggest that the practice nurse is a credible source of information for parents seeking informed decision making. At a time when the incidence of measles and mumps is rising in the UK, the provision of appropriate information by the practice nurse has the potential to increase uptake of the MMR vaccine.
Teaching patient safety and human factors in undergraduate nursing curricula in England: a pilot survey
Authors: Robson Wayne , Clark Debbie , Pinnock David , White Nick , Baxendale Bryn
Published: May 2014

Patient safety is a key priority for all healthcare systems, and there is growing recognition for the need to educate tomorrow's nurses about the role of human factors in reducing avoidable harm to patients. A pilot survey was sent to 20 schools of nursing in England to explore the teaching of patient safety and human factors. All 13 schools that responded (65% response rate) stated that patient safety was covered in their curricula and was allocated more than 4 hours; all the classes included human factors. Only two respondents indicated their teaching to be multi-professional. Awareness of the World Health Organization's multiprofessional patient safety curriculum guide was poor. Faculties also seemed unaware that the Institute for Healthcare Improvement provides free online patient safety modules for students and that there is a global network of student patient safety chapters.
The UK pertussis epidemic: implications for immunisation
Authors: Boulton Jacqueline
Published: May 2014

The UK is currently experiencing an epidemic of pertussis (whooping cough), in spite of the fact that uptake of immunisation against this disease has remained consistently high for some time. The number of cases is far higher in adults and adolescents, but there has also been a huge increase in the burden of disease among infants under 3 months, in whom the outcome is potentially far more serious. Last year, 14 infants died from the disease, prompting the Joint Committee on Vaccination and Immunisation (JCVI) to recommend vaccination for all women in the third trimester of pregnancy. This article looks at the background to the current epidemic, outlining the history of the disease; the underpinning immunological principles that have influenced attempts to control its spread to date; the current immunisation schedule; and other possible measures being considered.
Person-centred care: rhetoric and reality in a public healthcare system
Authors: McCrae Niall
Published: May 2014

Recent scandals in the NHS have undermined confidence in this institution. A key factor in substandard care is the competing demands on practitioners. Individualised care may be hindered by paternalism and collective organisation, while practitioners are expected to pursue evidence-based practice and person-centred care without acknowledging their differing goals. Drawing on a common theme from major philosophical conflicts in health services, this paper argues that instead of increasing managerial control, organisations should be empowering nurses to provide compassionate, person-centred care.
Solution-focused approach therapy for mental health nursing students
Authors: Evans Nicola , Evans Anne-Marie
Published: May 2014

Solution-focused therapy is a model of therapy that builds on the client's strengths, is future-focused and can be generally offered as a brief intervention. It can be used across multiple clinical settings and is not limited to being useful for clients accessing mental health services. Learning the underlying principles and developing a foundation level of skill in the approach was found to be achievable in an undergraduate nursing course, with students reporting an increase in their knowledge of the model and confidence in basic therapeutic skills in just one day of training. In this paper, we introduce the solution-focused approach in relation to nursing practice. We describe the template used for the training day offered to undergraduate mental health nurses. Students reported that this method of learning a therapeutic approach was helpful and increased both their knowledge and skill base.
Gastro-oesophageal reflux. Part 1: smoking and alcohol reduction
Authors: Talalwah Narmeen Al , Woodward Sue
Published: May 2014

Introduction:

Gastro-oesophageal reflux disease (GORD) is defined as an abnormal reflux of the stomach contents into the oesophagus, which provokes symptoms and impairs the quality of life. GORD has a high prevalence and incurs costs to the healthcare system. This is the first paper in a series of three exploring the conservative, medical and surgical treatment of GORD. This first paper presents a review of the effect of smoking and alcohol on reflux symptoms and the impact of smoking and alcohol reduction on symptoms of GORD.

Methods:

A search for English language studies on adults was conducted using three databases, MEDLINE, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL). Eleven relevant studies were included in the review.

Findings:

The effect of alcohol on the stimulation of reflux has been debated over the years in different studies. Some studies state that alcohol consumption induces reflux and moderate amounts exacerbate nocturnal gastrooesophageal heartburn reflux. However, other studies have found no association between alcohol consumption and reflux. Most reflux occurs during smoking because nicotine causes the lower oesophageal sphincter to relax, which increases the risk of reflux. Similarly, the number of cigarettes smoked is associated with the risk of reflux.

Conclusions:

Nurses need to be aware of the effect of smoking and alcohol on reflux to provide evidence-based advice to empower patients to change their lifestyle, which results in increased therapeutic compliance and a better clinical status. There is no evidence that reducing alcohol consumption decreases symptoms and only limited evidence on the effectiveness of smoking cessation. Further research into the effectiveness of these lifestyle modifications is therefore required.
The therapeutic use of doll therapy in dementia
Authors: Mitchell Gary , O’Donnell Hugh
Published: May 2014

Over the next 15 years, the number of people with dementia in the UK will increase significantly. There are clear limitations associated with the sole use of pharmacological interventions to address the cognitive decline and related problems that people with dementia and their carers will experience. As a result, health professionals, including nurses, need to consider the development and use of nonpharmacological therapies to help resolve the distress and decline in social function that people with dementia can experience. The use of doll therapy in dementia care appears to be increasing, even though there is limited empirical evidence to support its use and therapeutic effectiveness. It is suggested by advocates of doll therapy that its use can alleviate distress and promote comfort in some people with dementia. Despite these encouraging claims, the theoretical basis for the use of doll therapy in dementia is poorly understood and morally questionable. The purpose of this article is to provide healthcare professionals with a succinct overview of the theory behind the therapeutic use of dolls for people with dementia, a presentation and appraisal of the available empirical evidence and an appreciation of the potential ethical dilemmas that are involved.
Emergency airway management: common ventilation techniques
Authors: Higginson Ray , Parry Andy
Published: May 2014

Maintaining a patient’s airway and facilitating breathing are the main priorities during any emergency situation in which breathing is compromised. The key to safe management of an airway is thorough assessment, primarily to ensure the airway is patent. In an emergency situation, a bag-valve-mask may be the most effective way to assist ventilation. If ventilation is required for prolonged periods in an emergency situation, then endotracheal intubation should be performed. This involves the placement of a cuffed, endotracheal tube in the trachea, through which ventilation is maintained. Each tracheal intubation event should be anticipated as a potentially difficult intubation. Longer term ventilatory support may be achieved by the use of mechanical ventilators, which are designed to assist the movement of gases (air) into and out of a patient’s lungs, while minimising the work and effort of breathing. This article provides nurses with an overview of the techniques and equipment that is most often used within emergency and intensive care units to maintain the patency of a patient’s airway and provide ventilatory support.