bluuebunny/crossref_metadata_2025 huggingface dataset:
Providing appropriate health care to people with learning disabilities
Authors: Jackson Sue , Read Sue
Published: May 2014

People with learning disabilities often challenge health services and their carers. Recent reports identify the tragic consequences of services failing to identify and meet this populations’ health needs. This article integrates a case study of the planned hospital admission of a woman with learning disabilities. A nine-step strategy is adopted to proactively support the patient and associated disability, and general nurse carers to enable both a positive experience and a healthy outcome for all those involved. It is an example of how collaborative working, good reciprocal communication and creative thinking are imperative to effective support.
Factual and legal causation – their relation to negligence in nursing
Authors: Turton Gemma
Published: May 2014

Several elements must be shown to be fulfilled for a court to old that negligence has occurred, and a person is liable. One of these elements is ‘causation’, the idea that there must be a causal link between the claimant’s loss and the negligent behaviour of the defendant. This article considers the application of the tests of factual and legal causation to cases of medical negligence. It is argued that in light of the recent development of a number of exceptional approaches to factual causation, each relating to a particular causal problem, the causal process must be identified in any given case so that the correct test for factual causation can be applied. This is illustrated by reference to MRSA claims. It is further argued that where the negligence consists of misdiagnosis or mistreatment of existing illness the causal problem is unique to medical negligence and demands a unique approach to causation. The ‘scope of duty’ test for legal causation is illustrated in a medical context and it is argued that where the negligence consists of a failure to warn the patient of the risks involved in treatment, although the harm is clearly within the scope of the doctor’s duty, it is wrong to establish liability in the absence of factual causation.
Reducing the incidence of coronary heart disease
Authors: Chummun Harry
Published: May 2014

The incidence of coronary heart disease (CHD) has been significantly reduced by the introduction of the National Service Framework in 2000 but has not yet reached set targets. This article analyses the adverse effects of specific CHD risk factors to the cardiovascular system and proposes local and national strategies for further reduction in the incidence, morbidity and mortality of CHD. It provides an example of how nurses can use a health promotion programme to support patients in giving up smoking, a major contributing factor in CHD. The programme uses cognitive behaviour therapy to improve patients’ uptake and adherence.
Making rhetoric a reality: effective capacity building in mental healthcare provision
Authors: Hayes Catherine , Brizzolara Clare
Published: May 2014

Patients diagnosed with mental illness are statistically less likely to access physical healthcare services, resulting in increased mortality rates and diminished quality and decreased longevity of lifespan. This article identifies key aspects of the need for capacity building in, and between, all professional healthcare disciplines and utilizes a clinical case study to demonstrate the relevance of basic psychosocial interventions to all healthcare professionals. Alongside the practicalities of mental healthcare provision within the context of 21st-century society, discussion is extended to two basic theoretical models for understanding the relationship of mental illness to factors over which there can be no intraneous or conscious control. In this sense, the portrayal of patients with mental illness first and foremost as people whose somewhat transient demise from general wellbeing serves only to brand and stigmatize them from the point of diagnosis as fundamentally different to others. Mechanisms of how these stark rhetorical issues may be altered through building on the concept of therapeutic alliance with appropriately designed and insightful pathways of development for multidisciplinary healthcare teams aptly conclude the article.
Lobbying for fitness
Authors: Castledine George
Published: May 2014

When Lord Darzi of Denham, former health minister and architect of the new NHS reform agenda, said on leaving office in July that the health of the staff remained one of the most crucial areas of unfinished business, he was not far off the mark. Support for his view has now come from a recently published interim report by Dr Steve Boorman, a leading occupational health expert who has been examining the health and wellbeing of NHS staff. After 6 months of staff surveys, workshops, data reviews and responses from Trusts and experts in the field, Boorman sets out the key factors which are significant in producing an NHS workforce that is not caring enough about its own staff.
Providing care for adults with complex neurological disabilities
Authors: Baker Mark
Published: May 2014

Patients with long-term neurological conditions are highly dependent on registered nurses and healthcare assistants for care. This article highlights some of the issues nurses face in providing care to patients with long-term neurological conditions. A synopsis is given of a study currently underway, which is considering these issues. The study aims to explore the education and training requirements of registered nurses and healthcare assistants in providing care for adults with complex neurological conditions. During the 3-year study, data are being obtained from registered nurses, health-care assistants, and allied health professionals working with adults affected by complex neurological conditions, and from their relatives and families. The results of this study will be the subject of a future paper. It is anticipated that by addressing nursing education requirements in this speciality area, future nursing practice will be improved for this patient group, thus contributing to improved quality of life.
Deconstructing the ‘ivory tower’: building strategic curricula for health
Authors: Hayes Catherine
Published: May 2014

Within the context of postgraduate education, the majority of curriculum design for allied healthcare practitioners has stemmed from assumptions that learning is a one-dimensional concept with definitive starting and completion points, undertaken by the individual in pursuit of knowledge. This knowledge is perceived as being consumed by the learner and that it requires a formalized process of teaching in order to separate it from the rest of everyday activity and experience. This article charts the strategic development of a new and innovative approach to needs-led educational provision within multidisciplinary health care in higher education through the deconstruction of traditional approaches to teaching and learning. It also presents the case for merging the theoretical underpinnings of situated learning with the concept of problem-based learning, in which knowledge is created rather than consumed within the context of a new and innovative programme that seeks to build capacity in and between professional disciplines across the healthcare arena.
Starving amidst plenty: malnutrition is still a problem
Authors: Holder Helen
Published: May 2014

‘Thousands of patients are annually starved in the midst of plenty for want of attention to the ways which alone make it possible for them to take food’ (Florence Nightingale, 1860). While we have come a long way in nutritional care since the Crimean War, malnutrition or under nutrition is still prevalent in both hospitals and the community, with recent evidence showing at least one third of patients are malnourished on admission to hospital and during their hospital stay (British Association of Parenteral and Enteral Nutrition (BAPEN), 2009). As overweight and obesity figures in the UK continue to rise at an approximate cost to the NHS of £6.3 billion a year by 2015 (Foresight, 2007), malnutrition still remains a problem at a cost of approximately £13 billion a year (BAPEN, 2009). But is it given the attention it deserves within health care and the media?
Sharps management in hospital: an audit of equipment, practice and awareness
Authors: Aziz Ann Marie , Ashton Helen , Pagett Amanda , Jones Sue , Mullin Brian
Published: May 2014

The safe handling and disposal of needles and other sharp instruments forms part of an overall strategy to protect staff, patients and visitors from exposure to blood-borne pathogens. As with many infection prevention and control policies, the assessment and management of the risks associated with the use of sharps is paramount, and safe systems of work and engineering controls must be in place to minimize any identified risks. The use of sharps in hospitals should be avoided where possible; when their use is essential, particular care is required in handling and disposal – if possible, use safer sharps devices. An audit of sharps management was undertaken to observe equipment, practice and awareness. The audit reported very positive results. However, some areas needed further review to improve practice. The infection control team implemented an action plan as a result of the audit and set about initiating measures for training and awareness. It is necessary to audit sharps management routinely to have an accurate assessment of current practice and prevent occupational exposure to blood-borne pathogens.
Current guidance on the management Of acute coronary syndrome
Authors: Chummun Harry , Lutchman Anita , Gopaul Karina
Published: May 2014

Acute coronary syndrome (ACS) describes a spectrum of symptoms arising from the development of atherosclerosis. The degree of myocardial ischaemia depends on plaque stability and the extent of vessel occlusion. This article examines underlying pathophysiological processes and reviews current guidance and principles of managing ACS through symptom control, reducing mortality and maximizing secondary prevention. Nurses have a vital role in all aspects of delivering this care and meeting National Service Framework Standards for Coronary Heart Diseases (CHD) (2000). A clear understanding of the pathophysiological basis for ACS will reinforce clinical work, particularly in the recognition, monitoring and early management.
Solitary rectal ulcer syndrome: physiology and treatment options
Authors: Swatton Anna
Published: May 2014

Solitary rectal ulcer syndrome (SRUS) is a rare condition that can lead to pain, rectal bleeding and mucus. It is associated with chronic straining and abnormal defaecatory behaviour, including digitating and several unsuccessful visits to the toilet daily. Other symptoms can include tenesmus, altered bowel habit and incontinence. It can also be accompanied with a rectal prolapse, which may involve protrusion of either the rectal mucosa or the entire wall of the rectum. SRUS is known for its chronicity and can be difficult to treat. This article reviews SRUS, discussing possible causes and the various treatments that might be used, including medication, surgery and biofeedback therapy.
The challenges of setting up a teaching event for health-care staff
Authors: Noble Helen
Published: May 2014

This article describes the particular challenges encountered at a chronic kidney disease teaching event for nurses, including the problems of coaching learners with varied experience and using appropriate teaching methods to ensure learners remain focused. The importance of different learning styles are also discussed in reference to the relevant research. The pros and cons of a lecturetype presentation are explored and an example of a more varied lecture-style is provided. The case is also made for a facilitative approach to teaching that encourages deep-level learning. It is suggested that using vivid examples, such as case studies, can facilitate engagement with the presented material, encouraging learners to ask ‘what-if ’ questions that are designed to develop critical thinking. This approach assists learners to build their knowledge-base on both academic and real-life experience.
Nursing care for sleep problems in psychiatry: is there a problem?
Authors: Niet Gerrit de , Tiemens Bea , Hutschemaekers Giel
Published: May 2014

The aim of this article is to provide insight into the current state of nursing care for sleep problems in inpatient and outpatient psychiatric care for adults and the elderly, and to determine if there is any benefot to the implementation of alternative, evidence-based interventions. To research this, the authors carried out a cross-sectional survey by means of a specially developed questionnaire. Between October 2005 and June 2006, 1,181 questionnaires were sent to a sample of nurses working in inpatient and outpatient care for psychiatric patients in five different psychiatric institutions in the Netherlands. Descriptive statistics were used to describe the properties of the sample and its strata. The authors explored differences between subgroups using chi-square, Mann-Whitney or Student’s t-tests. The authors found that daytime interventions to prevent sleep problems are mostly structural, introducing a structured environment with, for example, set going to bed and getting up times, and stress management activities. Sleep problems during the night are typically approached by observation, environment control and stress management. Experience, knowledge gained by initial training and eminence advice (advice from peers, physicians or experts) are the most frequently used knowledge sources in the care of sleep problems. Nurses were seen to be aware of the importance of sleep and the importance of a good nursing management for sleep problems. However, interventions are rarely evidence-based. Although nurses are satisfied with the care being provided for sleep problems, they are willing to apply alternative evidence-based care. They identified the lack of knowledge, skills and time as obstacles for such implementation.
The impact of the European Union on Human Rights
Authors: Hodgson John
Published: May 2014

This article considers the impact of the European Convention on Human Rights and Fundamental Freedoms (ECHR), both in its own right since the 1950s, and in conjunction with the Human Rights Act 1998 (HRA) when this ‘brought these rights home’ by incorporating them into the domestic law of the UK thus enabling our judiciary to give effect to them directly. The ECHR and the HRA say very little, if anything, expressly about health or health care, but have been relied on by litigants in a wide range of contexts, including but not limited to, assisted reproduction, abortion, access to treatment, management of health records, end of life issues and the investigation of potentially negligent or criminal conduct by professionals.
Swine flu panic shows how little we really care
Authors: Beckford-Ball Jason
Published: May 2014

Ihave to confess that when the first reports of swine flu started circulating, I did have a strong sense of déjà vu – after all, we’ve been here before. Back in 2003, the world was under threat from another potentially lethal virus that began in an economically deprived part of the world among animal stocks and briefly (according to some anyway) threatened to turn into a global pandemic – Avian flu.
A new source of support for continence problems
Authors: Turton Gill
Published: May 2014

People who experience continence problems can often find it difficult to access support, especially as there is a dearth of publicity about the issue and many people who have an problem with continence feel stigmatized. Even when people do seek help, or experience difficulties after inpatient care, such as following childbirth, it can be difficult to access advice and appropriate products.
Should care homes adopt a static-led approach to pressure ulcer prevention?
Authors: Catherine Keen Delia
Published: May 2014

A static-led approach refers to the provision of high-specification foam mattresses for the whole of a population at risk of pressure damage. Such mattresses have been found to reduce the risk of pressure ulceration and cost less overall than standard mattresses, even in populations where only 1 in 100 patients develops a pressure ulcer. Reduced pressure ulcer prevalence and reduced costs resulting from decreased expenditure on dynamic mattresses following the implementation of a static-led approach have been reported. Pressure ulcers cause pain, a reduced quality of life, loss of independence, depression and social isolation for those in whom they develop. Organizations are increasingly having to pay out large sums of money following litigation surrounding pressure ulcers. This article explains why NHS healthcare providers and private care organizations need to work together to consider implementing a static-led approach to pressure ulcer prevention within care homes in order to reduce pressure ulcer incidence cost-effectively within their local populations.
Sexual health standards: do you measure up?
Authors: Peate Ian
Published: May 2014

Good sexual health is something everyone should have the right to enjoy; substandard sexual health can have a negative impact on a person and on communities. Sexual health has been identified in High Quality Care for All (Department of Health (DH), 2008) as one of the six key goals for which primary care trusts would commission comprehensive wellbeing and prevention services.
Nursing Roadmap for Quality: better for less?
Authors: Rashid Claire
Published: May 2014

The Chief Nursing Officer, Dame Christine Beasley recently launched The Nursing Roadmap for Quality (Department of Health (DH), 2010). The ‘roadmap’ is intended to steer nurses towards tools, resources and approaches to help them become more efficient and provide better care for patients. The roadmap comes at the end of a decade of unprecedented investment in healthcare. However, the NHS must now adapt to rising demand and expectations at a time of financial constraint. In tougher times we clearly need different approaches, but which approaches are the most effective? Can the Nursing Roadmap help? And is it really possible to do more, better with less?
A procedure for providing advice and support for nurses with a disability
Authors: Simons Martin
Published: May 2014

Declaring a disability can prove challenging for an individual. It may also represent a challenge for that individual’s manager, particularly if it is something they have had little experience of. Knowing that advice and support is available to both parties should make the process much easier and help to provide more positive results. This article looks at how a procedure has been implemented by one NHS Trust to help individuals and managers address the needs of staff and students with a disability, through reasonable adjustments suggested to support them. Any such adjustments need to be assessed for their practicality in clinical settings. Positive action and a practical, sensitive approach will lead to happier staff and a more confident manager who is better equipped to deal with colleagues and students who are disabled or develop a disability. This should also lead to a positive impact on overall quality of patient care
Encouraging young people to participate in their health services
Authors: Glasper Alan
Published: May 2014

Professor Alan Glasper examines new guidance on involving children and young people in decision-making processes involving their own health care
First impressions
Authors: Hill Rosalind
Published: May 2014

F irstly, allow me to introduce myself: I am the new editor of the British Journal of Nursing, following on from a number of tough acts to follow. Previously, I have been the editor of the British Journal of Healthcare Management and Nursing Prescribing
Cause for optimism? Government plans for a patient-led NHS
Authors: Glasper Alan
Published: May 2014

Professor Alan Glasper outlines the new Government’s plans for the NHS, including a commitment to a free service that empowers users to have a greater say in their health care
Cannulae and infection control in theatre
Authors: Marie Aziz Ann
Published: May 2014

Healthcare-associated infections (HAIs) are those that are not present or incubating when an individual enters hospital, but are acquired while in hospital. At any one time, 8% of patients have an infection acquired in hospital (Department of Health (DH), 2008). On average, an infection adds 3–10 days to the length of a patient’s stay in hospital. It can cost £4000–£10 000 more to treat a patient with an infection than one without an infection (DH, 2008). It is not surprising, then, that attention has been focused on tackling HAIs and, in particular, in-dwelling devices such as cannulae that have a potential for causing infections
Can the NICE quality standards help drive NHS improvements?
Authors: Glasper Alan
Published: May 2014

Professor Alan Glasper examines the implications of the NICE quality standards, which are designed, in part, to support health professionals such as nurses in making informed, evidence?based care decisions in the best interests of patients
Advance directives and personality-changing illness
Authors: Foster Charles
Published: May 2014

An advance decision (AD) to refuse treatment allows an individual to express his/her wishes regarding future treatment in the event of losing capacity to make decisions. Relevant and applicable ADs are legally binding, even when refusal of the specfied treatment will lead to the patient’s death; but health professionals are required under the Mental Capacity Act to consider a number of factors in deciding whether a patient’s AD should be followed. The decision for the health professional is not always clear-cut. For example, what happens when Alzheimer’s changes an indivdual’s personality so much that they seem to be a different person: does their previous decision still stand? This article examines the criteria to be considered in such a case, and highlights the wider principles to be followed in making any decision on whether to follow an individual’s instruction to refuse treatment
Time to retire … or carry on nursing?
Authors: Castledine George
Published: May 2014

Plans to scrap the default retirement age (DRA) have met with strong criticism from business groups and fears that the Government have rushed the proposals through without proper consultation. For nurses it means that, from next October, employers will be unable to automatically lay off staff when they reach the age of 65 years. Although the DRA will be scrapped in October the real effects will not be felt until April onwards, as employers must give 6 months’ notice to staff that they want to retire. This all seems a little ironic in the nursing context, since the Government has been telling people that they want them to work longer due to the problems with pension funds and the possible skills shortage when the ‘baby boomer’ generation retire, and there are insufficient young people to look after them
Talking ‘bout my generation
Authors: Nazarko Linda
Published: May 2014

Mrs Pinker* is ready for discharge, but her sons, George and Paul, think she should be admitted to a residential home rather than return home. Mrs Pinker lives alone and every 3 or 4 weeks she wakes up in the middle of the night, becomes anxious and calls 999. An ambulance is dispatched and Mrs Pinker is usually taken to accident and emergency
Recognition and treatment of anaphylaxis in hospital
Authors: Jevon Phil
Published: May 2014

Anaphylaxis is a life-threatening, generalized or systemic hypersensitivity reaction characterized by rapidly developing airway, and/or breathing, and/or circulation compromise, usually associated with skin and mucosal changes. Summoning expert help, positioning the patient appropriately, administering high-flow oxygen, and administering adrenaline by intramuscular injection are the key initial treatment and management options. This article draws on the literature, including published guidelines, to discuss the recognition and treatment of anaphylaxis in hospital
Can high-impact nursing actions result in enhanced patient care?
Authors: Glasper Alan
Published: May 2014

Professor Alan Glasper outlines the Government’s vision for an NHS ‘liberated from bureaucracy’, where nurses will be expected to drive quality improvements at grass-roots level
Regulating support workers
Authors: Castledine George
Published: May 2014

With growing concern about the way health support workers function and are extending their role, the publication of a new report is good timing. The review was commissioned by the Nursing and Midwifery Council (NMC) from the National Nursing Research Unit of King’s College London, the key objectives of which were: assess the evidence of risks presented to public protection from an unregulated health support workforce and the evidence of benefits of regulation; identify and consider key questions to be addressed in developing models of regulation; and make recommendations for further work required in taking regulation forwards
The best-turned-out theatre nurse: BJN 100 years ago
Authors: Bishop Stanmore
Published: May 2014

Writing about the value of the theatre nurse 100 years ago, Mr Stanmore Bishop (F.R.C.S) wrote in the BJN on 1 January 1910
Alcohol abuse among young people: the inconvenient truth
Authors: Glasper Alan
Published: May 2014

People have drunk alcohol for as long as they’ve known about its existence, and it doesn’t appear this will change any time soon. But the amount of alcohol consumed by children and young people in Britain is now spiralling out of control and putting a significant strain on NHS resources. In light of a new report, Alan Glasper discusses how this escalating problem can be tackled.
Systemic lupus erythematosus: the basics of nursing care
Authors: Wheeler Tracey
Published: May 2014

Systemic lupus erythematosus is a complex multi-system autoimmune disorder that frequently requires both physical and psychological care from nurses working in non-specialist areas. Both primary and secondary care nurses should have a working knowledge of this unfamiliar condition, so that they may support the patient with SLE at whatever stage of their care pathway. This article seeks to outline the important principles in lupus management for the non specialist nurse, and to give some pointers towards informed care
Sticks and stones...
Authors: Nazarko Linda
Published: May 2014

Linda Nazarko speaks out after recently witnessing the effect verbal abuse has on front line staff.
Raffles, human eggs and the market place in human material
Authors: McHale Jean
Published: May 2014

This article considers a recent case of human eggs being made available as a raffle prize. It explores the issue of a market in human material. It considers how at present English law is in general against such commodification of human material. It explores the policy arguments for changing the law in the area and suggests that the issue of maintaining criminal prohibitions at a time when patients can bypass such restrictions by seeking treatment abroad should come under further reconsideration by policy makers.
The Prime Minister’s commission reports: what they mean for nurses
Authors: Karstadt Lyn
Published: May 2014

One year on from the publication of Gordon Brown’s initial Commission report, Lyn Karstadt takes stock of its recommendations, and urges nurses to continue to make themselves heard.
Managing pressure ulcers in patients with a spinal cord injury: a case study
Authors: Warren Diana V
Published: May 2014

Grade 4 pressure ulceration is a common and often unavoidable secondary complication for patients who have sustained a traumatic spinal cord injury. Pressure ulcer management involves treating infection, providing a moist wound-healing environment and choosing the appropriate dressing. However, the case of Mr M highlights other issues such as pain, a poor appetite and sleep disturbance, which all delay wound healing. This article discusses ulcer prevention, from the initial assessment of the spinal injury to patient repositioning using the ‘log-rolling’ technique. Although this technique is not effective in providing prolonged pressure relief, it did reduce Mr M’s pain. This article also suggests recommendations for future practice, including the need to relate to patients on a personal level, which should reduce mental health deterioration and increase the patient’s quality of life, and to take a multidisciplinary approach to managing and treating pressure ulceration.
Prisoner health: assessing a nurse-led hepatitis C testing clinic
Authors: Perrett Stephanie E
Published: May 2014

Prisons provide an ideal setting in which to carry out blood-borne virus testing among a high-risk population. This paper describes a nurse-led testing programme offered to all prisoners within the substance misuse unit at a local prison in South Wales over a 4-year period. Challenges to organizing such a clinic within the prison setting are discussed. Between April 2006 and April 2010, approximately 4500 prisoners were admitted through the substance misuse unit. Blood-borne virus testing took place among 176 prisoners, of which 24 were hepatitis C seropositive, 19 were confirmed as virus-positive, and eight were referred to specialist teams to consider treatment. Among prison populations blood-borne virus testing needs to be encouraged and improved. Offering testing provides opportunities for harm minimization, education and referrals for treatment. Such provisions are needed to benefit the health of individuals, their families and the wider public health.
The global problem of adverse patient safety incidents in health care
Authors: Tingle John
Published: May 2014

John Tingle discusses work carried out by the World Health Organization in patient safety and a report from the European Commission
Cleaning the hospital environment — a focus on Difficil-S
Authors: Madeo Maurice
Published: May 2014

Providing a healthcare environment that is aesthetically clean and microbiologically safe, remains a key component to combating the spread of healthcare-associated infections (HCAIs). Patients now demand to be cared for in an environment that is conducive to healing without the fear of contracting an HCAI. The number of ‘superbugs’ are escalating, posing a challenge when cleaning and disinfecting surfaces. There has been little regard paid to the products used within the clinical setting and how these may affect the quality of cleaning and disinfection. The variety of patient equipment now present within wards and the pace staff are exposed to requires a simplified cleaning regime. One such way forward may be the use of Difficil-S®, which is a sporicidal and cleaning agent providing an opportunity to simplify the cleaning process within the clinical setting.
Supporting self and others: from staff nurse to nurse consultant. Part 4: Mentoring
Authors: Fowler John
Published: May 2014

This series of articles explores various ways of supporting staff who work in the fast-moving and ever-changing health service. In previous articles, John Fowler an experienced nursing lecturer, author and consultant, examined the importance of developing a supportive working culture, learning from experience and the role of preceptorship. This article examines how the principles of mentoring, as practiced in the business world, can be applied to nursing.
Driving health promotion into the community: an initiative evaluated
Authors: Paniagua Hilary , Reilly Carol , Evans Jill , Bond Patricia
Published: May 2014

Health promotion and lifestyle advice is traditionally undertaken within health centres and general practices. However, evidence indicates that it can have modest impact on preventing disease. More contemporary ideas emphasize a community-based approach to health promotion activities and ultimately focus any screening performance according to the needs of the public. Utilizing a multi-level community approach to health promotion and screening activity within the Black Country is highlighted as being highly successful in shaping a dynamic local community initiative.
Supporting self and others: from staff nurse to nurse consultant. Part 7: One-to-one sessions
Authors: Fowler John
Published: May 2014

This series of articles explores various ways of supporting staff who work in the fast-moving and ever-changing health service. In previous articles, John Fowler an experienced nursing lecturer, author and consultant, examined the importance of developing a supportive working culture and the role of preceptorship, mentoring, clinical supervision and giving feedback. This article examines how to make a one-to-one session supportive and focused.
Nutritional intervention and quality of life in palliative care patients
Authors: Fleming Mick , Hollins Martin Caroline J , Martin Colin R
Published: May 2014

Quality of life measures can be used by health professionals to assess effectiveness of nutritional interventions administered to palliative care patients. Stabilizing, maintaining and attempting to increase weight in palliative care patients through the support of oral feeding, and provision of artificial feeding, has been shown to mediate the metabolic and physical wasting effects of the disease process and improve general comfort. A quality of life instrument is a multi-dimensional questionnaire that health professionals can use to measure domains relating to physical, psychological and social aspects of living, and health and disease outcomes. There are three instruments specifically designed to assess quality of life in patients receiving palliative care. These are: The Palliative Care Quality of life Instrument, The Assessment of Quality of Life at the End of Life (AQEL), and The Spitzer Quality of Life Index (SQLI). General use quality of life measures are multifaceted; however, for use with palliative care patients, they have added dimensions of spirituality, existential issues (purpose and meaning of life), family members' perceptions of quality of care, symptom control and family support. Use of quality of life scales provides health professionals and organizations with an ideal measure for planning, targeting and evaluating health interventions.
Long-term conditions: does the NHS support patients?
Authors: Glasper Alan
Published: May 2014

Professor Alan Glasper Considers the results of the Department of Health study into the attitudes and behaviour of those living with a long-term condition. While the results are generally positive, work still needs to be done to both prevent long-term conditions from occurring in the first place and support those living with them.
Developing criteria to assist in the palliative phase of COPD
Authors: Trueman Jacqui , Trueman Ian
Published: May 2014

For people with chronic obstructive pulmonary disease (COPD), hospital admission can be associated with a poor prognosis. Consequently, the end–stage of the illness needs to be recognized for timely palliative care to be initiated. Tools to enhance the palliative phase, such as the Gold Standards Framework and the Liverpool Care Pathway, rely on the recognition of the final phase of a person's life. The illness trajectory of cancer makes this recognition far easier than for COPD, and as a result, many patients and their families manage at home with limited support. The Lincolnshire Respiratory Network has developed criteria to help recognize the end stage of COPD, which correlate well with recommendations from the Consultation on a Strategy for Services for COPD in England ( Department of Health, 2010 ). However, there needs to be appropriate training to assist practitioners in their confidence to refer patients with end-stage COPD to palliative care providers.
Parkinson's: symptoms, treatments and research
Authors: Heisters Daiga
Published: May 2014

Parkinson's is a incurable progressive neurological condition caused by a degeneration of dopamine-producing cells. The most common symptoms of the condition include slowness of movement, tremor and muscle stiffness; other symptoms include sleep difficulties, depression and anxiety. Parkinson's is usually controlled by medication but other treatments and therapies, such as occupational therapy, physiotherapy and speech and language therapy, can also be effective in controlling and managing symptoms. The timing of this medication is key to the successful management of Parkinson's. Delays to initiating medication or missed doses can have serious consequences, and it can take some time for symptoms to stabilize.

Research into treatments for Parkinson's and, ultimately, finding a cure for the condition, is ongoing. Parkinson's UK researchers are working on projects to identify the causes of cell death and tests to detect the condition at its earliest possible stage. Current treatments can help to ease the symptoms but none can repair the damage in the brain or slow the progress of the condition; now, Parkinson's UK researchers are working to develop new treatments that can.
Childhood sexual abuse: help make it ‘Safe to Say’
Authors: Tong Evelyn , Gillespie Mark
Published: May 2014

Childhood sexual abuse remains a taboo subject and requires sensitive handling by committed and caring services ( Scottish Executive, 2004 ). By introducing a training programme, Safe to Say, the Scottish Association of Mental Health aims to improve the confidence and competence of healthcare workers when faced with the sensitive disclosure of childhood abuse. This article aims to explore the effects of childhood sexual abuse and the attitudes of health professionals when faced with adult survivors disclosing such abuse. Despite Government strategies, there still appears to be a lack of suitable services for adult survivors of childhood sexual abuse, even though health professionals have an essential role in supporting disclosure and promoting recovery ( Read et al, 2005 ).
Indwelling urinary catheters: accurate monitoring of urine output
Authors: Foxley Sue
Published: May 2014

Caring for patients who have an indwelling urinary catheter is a common feature of clinical nursing practice in the acute care environment, which for some patients is essential to their medical management. However, evidence suggests that in many cases catheterization may be unjustified, exposing the patient to a significant risk of acquiring a urinary tract infection, which extends length of stay and imposes an extra burden of care and cost. Improving the care for these patients depends on good education, implementation of best practice, adequate resources, and effective devices and treatment. This article focuses on a clinical, unbiased review of a new product for the accurate monitoring of urine output.
Audit of blood culture technique and documentation to improve practice
Authors: Aziz Ann-Marie
Published: May 2014

Blood cultures should only be taken if there is clinical suspicion of an infection and should not be used for routine assessment. It is essential that blood cultures are taken using the correct technique and with appropriate documentation. A blood culture documentation sticker should be inserted in the patient's notes to identify the site used, the time and date taken and whether the aseptic non-touch technique was used. An audit was performed to assess the blood culture-taking technique and documentation practice in a Manchester hospital. The results of the audit revealed good documentation when requesting blood cultures but poor recording of the procedure and a low compliance rate of using blood culture documentation stickers. The results were fed back to hospital staff with recommendations to improve blood culture-taking practice.
Management of occupational blood exposures: a 4-year review
Authors: Flynn Mairead Holland , Reid Alex
Published: May 2014

In the healthcare setting, occupational blood exposure (OBE) is a well recognised hazard. Following exposure, prompt and correct management is required to prevent infection and minimise adverse psychological impact. The aim of the study was to ascertain whether or not documentation of the management and follow up of OBEs was appropriate and in line with best practice. Of the 134 cases reviewed, 65% of staff who reported an OBE attended for management on the day of the injury. The instrument type was documented in 95% of cases, and degree of injury in 91%. However, the provision of first aid was adequately documented for only 36% of exposure cases and the provision of adequate information and advice was documented for just 33%. Only approximately half of 23% of healthcare workers requiring follow up completed this within the recommended time frame. This study identified deficits in documentation, communication and follow up. However, this will likely improve with the recommendations outlined in this article.
NMC ‘lacks clear vision of role’: CHRE publishes interim report
Authors: Glasper Alan
Published: May 2014

Professor Alan Glasper discusses the interim report published by the Council for Health Care Regulatory Excellence (CHRE) of its strategic review of the Nursing and Midwifery Council (NMC)
Work-based learning in health and social care
Authors: Phillips Sue
Published: May 2014

This article examines some of the issues encountered in helping to develop and facilitate work-based learning (WBL) in clinical areas from the author's perspective of APEL/WBL co-ordinator. The advantages of work-based learning to both organisations and practitioners are discussed, together with possible drawbacks. The article concludes by identifying the positive aspects, including that of practice development, but suggests caution in attempting to use work-based learning in all circumstances.
Health Foundation report calls for a better model of patient interaction
Authors: Tingle John
Published: May 2014

John Tingle discusses the Health Foundation's report on clinician-patient interaction
Safeguarding patients as a student nurse
Authors: Louise Botten Emma
Published: May 2014

Emma Louise Botten is a second-year nursing student at King's College London and a regular contributor to the BJON Student Column. In this issue, Emma emphasises the importance of your role as a student nurse in safeguarding your patients. She provides an overview of resources available to student nurses and some practical tips she has gathered from her own experience.
Duty of confidence and the use of social networking sites
Authors: Griffith Richard
Published: May 2014

Social networking sites are a popular form of online communication used by an estimated 350 000 registered nurses. The use of such sites by nurses must be done with caution because their duty of confidence extends to their online presence and inappropriate remarks or pictures posted online can call their fitness to practise into question. This article reviews the scope of a nurse's duty of confidence and discusses the requirements for the acceptable use of social networks by health professionals.
Issues of patient sexuality in nurse education
Authors: Billinǵton Tracey
Published: May 2014

Tracey Billington is a substance misuse nurse and a part-time MSc student at Northumbria University. Here, she reflects on her experiences as a trainee nurse dealing with the complexities of patient sexual health and the need for this area to be taken more seriously by the nursing profession, beginning with its inclusion and emphasis in the nurse education curriculum.
Heart to heart: a programme for children on a cardiac ward
Authors: Scarfe Gabrielle , Redshaw Sarah , Wilson Valerie , Dengler Lexi
Published: May 2014

This paper presents three research case studies of children who have had surgery for a cardiac condition and discusses the experiences of the children and their families through their responses to the Heart Beads programme, as well as the insights gained by staff. The Children's Hospital at Westmead has a significant population of children with cardiac conditions. For many of these, diagnosis signals the beginning of a long, arduous journey with multiple procedures and admissions. The hospital has a family-centred care focus, and the cardiac ward undertook a project to implement and progress changes consistent with this approach. Staff developed the Heart Beads programme to enhance the care of children being treated for cardiac conditions. The programme involves children receiving distinct beads specific to each cardiac procedure, treatment, or event in recognition of their experience. A total of 7 staff members and 11 families were interviewed and particular stories were noted by staff. The case studies presented illustrated how nursing staff were able to recognize potential improvements to care and acknowledge the experiences of patients and families. Assumptions questioned as a result of the programme related to the complexity of the child's condition and gender. The death of a child and the acknowledgement of the child's life is also considered. Heart Beads allowed staff to reflect on the positive aspects of the care they provided.
Mattress cleanliness: the role of monitoring and maintenance
Authors: Aziz Ann-Marie
Published: May 2014

A clean and tidy environment provides the right setting for good patient care. It is fundamental in preventing and/or controlling the spread of healthcare-associated infections (HCAI). Cleanliness is an essential component for the comfort and dignity of patients, particularly those for whom a hospital is home for any length of time. Patients spend a lot of their time in bed so it is important for them to be provided with well maintained and clean mattresses. Beds, and especially the mattresses, should be cleaned and inspected regularly so patients know they are being cared for in a clean and safe environment. To prolong the life of the mattress and reduce infection risks, inspections for damage and contamination must take place on a regular basis. Assessment criteria for the audit of a mattress can include a visual inspection, a cover permeability test and a foam support surface test. These assessments will ensure the mattress is compliant with current standards and identify whether or not they require condemning. Mattress care can be improved by adopting unified good practices that can be standardized and audited regularly.
Pneumonia part 2:signs, symptoms and vaccinations
Authors: Driver Carolyn
Published: May 2014

Streptococcus pneumoniae is a cause of significant morbidity and mortality worldwide. There are many different serotypes of the organism which may be carried by up to 50% of children under the age of 6 years, as well as many adults. The organism is associated with both pneumonia and invasive pneumococcal disease, which may result in septicemia or meningitis. It is also a principal cause of otits media and sinusitis, which are not life-threatening, but generate a lot of discomfort, loss of schooling or working days, and around 60 000 GP consultations per year in the UK. Vaccination is a safe and effective way to prevent this infection from causing significant ill health.
Smoking behaviour and interaction: the observation process in research
Authors: Geraghty Jemell
Published: May 2014

To those starting off on the research journey, the term ‘qualitative research’ can often seem a daunting prospect. The world of research methodology and theory is emerged in a rich history of its own terminology, meanings and experiences. Research and innovation are integral parts of the nurse practitioner's role, yet many have little understanding of the theoretical frameworks and methodologies surrounding the vast areas of qualitative and quantitative research. As part of a doctorate, the author undertook a small qualitative study, choosing her own method and question. Intrigued by the phenomenon of smoking addiction, she observed the behaviours and interactions of people who smoke. The focus of this article, however, is the process by which the study was carried out, rather than the observations themselves. This paper presents observational research from the perspective of a nurse practitioner embarking on a journey with qualitative designs.
Improving quality of care for older people
Authors: Tingle John
Published: May 2014

John Tingle discusses the recent draft report by the Commission on improving dignity in care.