bluuebunny/crossref_metadata_2025 huggingface dataset:
Conservative treatment of erectile dysfunction 2: clinical trials
Authors: Dorey Grace
Published: May 2014

This is the second of a three-part paper addressing whether physiotherapy involving pelvic floor muscle exercises (PFMEs) is efficacious as a first-line treatment for erectile dysfunction (ED). The first part (Vol 9(11): 691–4) highlighted the prevalence of ED, associated risk factors, the anatomy of the penis and the physiology of erection. This part concentrates on the computer-aided and manual search for published clinical trials investigating the treatment and prevention of ED. The methodological quality of the trials was assessed using criteria based on generally accepted principles of interventional research. The literature search revealed 14 trials which met the broad inclusion criteria. Of these, eight trials used PFMEs with or without biofeedback or electrical stimulation.
CliniSorb activated charcoal dressing for odour control
Authors: Williams Clare
Published: May 2014

The potential for charcoal cloth in wound management relates to its well demonstrated ability to adsorb small gas molecules. Charcoal has become increasingly used to contain odour and is especially useful in the management of fungating lesions. This article looks at CliniSorb activated charcoal odour control dressing (distributed by CliniMed) and describes its construction, action and place in wound management.
Role of community mental health nurses for people with dementia
Authors: Ho Danny
Published: May 2014

This is an exploratory study into how eight family carers of people living with dementia perceived the role of their community mental health nurse (CMHN). Using a descriptive qualitative approach with semistructured interviews, areas of the CMHNs' role that the eight carers found supportive were identified and discussed under four main themes: (1) emotional support and advice (2) liaison and networking (3) training and information giving and (4) isolation and loneliness. The study also highlighted certain qualities of the CMHN which were found to be valuable and helpful to the carers. This study suggests that the carers of people living with dementia have many varied needs and they perceive the role of the CMHN as very important and valuable in terms of supporting them in caring for their loved ones. Although not intended as a focus of the study, the carers also highlighted certain desirable qualities in the CMHN that may have implications for all those involved in ensuring a high standard of community mental health nursing service to this client group.
Malnutrition in critically ill patients in internsive care units
Authors: Quirk Joanne
Published: May 2014

The provision of artificial nutrition for critically ill patients is of great importance as many are unable to maintain their own nutritional needs. The administration of total parenteral nutrition (TPN) and enteral nutrition (EN) has become a daily practice in intensive care units. Despite this, many patients remain undernourished or even malnourished and it is estimated that the incidence of malnutrition in intensive care patients could be as high as 50% (McCain, 1993). The reasons by which patients become or remain undernourished are multifactorial and range from physiological to iatrogenic. In order to lessen the catabolic state which results from the hypermetabolism associated with critical illness, prompt and adequate nutritional support must be delivered. It is essential that members of the multidisciplinary team caring for critically ill patients are aware of the importance of nutrition and the deleterious effects of malnutrition to achieve the best possible outcome for patients.
Pulmonary disease and smoking: a case for health promotion
Authors: Coakley Ann-Louise , Ruston Annmarie
Published: May 2014

Emphasis on smoking cessation for patients with chest diseases, especially those with chronic obstructive pulmonary disease (COPD), is not new, but the latest guidelines from the British Thoracic Society highlight the necessity of helping patients to stop smoking. Health professionals do not seem ready to take on this role. Smoking cessation needs to become a priority of health promotion for all patients with COPD. A recent training needs assessment underlined the fact that training and support for those undertaking this role require urgent attention.
Article Review
Authors: Beech Ian , Fothergil Ann , Hannigan Ben , Cutcliffe John , Ward Martin
Published: May 2014

Cutcliffe JR (1999) Qualified nurses' lived experience of violence perpetrated by individuals suffering from enduring mental health problems: a hermeneutic study. Int J Nurs Studies 36: 105–116
Inadequate staffing leads to poor nursing care
Authors: Castledine George
Published: May 2014

Inadequate nurse staffing levels is causing a crisis in the quality of nursing care. At present there is no high quality piece of research to back up this claim; however, other evidence is starting to emerge. An example is a personal account, written by a doctor, of what happened when his father was admitted to an intensive care unit (ITU) (Goulder, 2001). Goulder states how he had to act as his father's personal physician to make sure that his father survived his hospitalization. For example, he knew that a legacy of his father having had polio was severely restricted chest expansion. This factor was ignored by the ITU staff and his father nearly died when he was being weaned off the ventilator.
Transjugular liver biopsy: method of choice for taking a biopsy
Authors: Karamshi Mina
Published: May 2014

A transjugular liver biopsy is a route of obtaining a biopsy of the liver for the diagnosis and management of patients with hepatic disease. In this article the author will demonstrate how a liver biopsy via the transjugular route is taken using X-ray guidance and will describe the method step-by-step as it is performed at the Royal Free Hospital. Finally, the indications and advantages of using this method will be considered. This article should increase awareness of what a transjugular liver biopsy is and inform the reader of how a tissue sample is taken, thus enabling further understanding of the procedure. It is concluded that the transjugular route of obtaining a liver biopsy enables a good size and quality of sample to be taken in a safe and effective manner with only one pass (one attempt) being required. This method involves minimal complications and has many advantages.
The need to reform NHS complaints procedures
Authors: Tingle John
Published: May 2014

Improvement in the quality of health care delivered in the NHS is high on the Government's agenda. This is clear from the introduction of new organizations such as the National Institute for Clinical Excellence and the Commission of Health Improvement, and the publication of numerous policy discussion documents. New developments in the health quality field are happening at a fast rate and it is difficult for nurses to keep up to date.
Nurses must not suppress their inner emotions
Authors: Castledine George
Published: May 2014

Like everyone else, these past few weeks my mind has been on the atrocities that took place in New York and Washington. In particular, I have been very impressed by the heroism and bravery of the emergency services. Nurses, like firemen and policemen, have to cope with not only the unexpected but also the unpleasant. It is very difficult to prepare such individuals for traumatic events, especially when they reach the scale of what happened on 11 September. ‘There is nothing which could prepare you for that’, said one fireman as he recounted the awfulness of what he had seen. Stress and coping is relevant to everyone, but it has particular significance for those working in the emergency and caring services.
Hospital league tables: a help or hindrance?
Authors: Castledine George
Published: May 2014

Who is really benefiting from the publication of the latest hospital league tables in England? From a nursing perspective they tell us little about what is actually going on in hospitals. The hospital as an institution for the care of the sick has a long and noble history, but the latest attempts at reform seem to be vanishing into a fog of financial and bureaucratic complexity.
Legal aspects of consent 15: living wills and the common law
Authors: Dimond Bridgit
Published: May 2014

Since watching a programme on dementia on the television, Sam had always been terrified of losing his mental faculties. He therefore told his daughter that if he ever suffered from a disease which led to mental incapacity he would not wish to have any treatment. Some years later early signs of motor neurone's disease appeared and his condition worsened rapidly. He became incapable of swallowing and his mind deteriorated, so he was no longer able to express his views. His daughter told the healthcare staff at the hospital about his previous wishes and said that he would not wish to be fed artificially. Would staff be justified in giving him artificial feeding, contrary to the daughter's views?
Safer handling practice for nurses: a review of the literature
Authors: Wilson Christine Brown
Published: May 2014

The lifting and handling of people is an integral part of nursing care and has been blamed for a high incidence of back injuries to nurses. Changes to nursing practice have been dictated by this level of injury following the passing of health and safety legislation in 1992. This review seeks to evaluate the growing body of research from a range of disciplines in order to establish an evidence base for the moving and handling of patients. It identifies that studies considering the impact of changes in practice on patient outcomes are lacking. The term ‘safer handling practice’ has been used by the author to indicate a new way of thinking in relation to moving and handling people in health and care settings. A definition of safer handling practice has been derived from the literature with concomitant implications for training. Using this body of knowledge alongside studies investigating mobility of older people, the literature was used deductively to ascertain that safer handling practice has the potential to influence positively the mobility of older people. The author suggests further research to be conducted in the field of safer handling practice.
The dynamics and processes of ‘ending’ in clinical supervision
Authors: Chambers Mary , Cutcliffe John JR
Published: May 2014

While there is a growing number of papers in academic and professional nursing journals that focus on clinical supervision, there remain unanswered questions and unresolved issues. One such issue where there is a distinct paucity of theoretical or empirical work is that of ‘ending’ within clinical supervision. Accordingly, this article examines key issues and dynamics of ending within clinical supervision. These key issues are summarized as: ending when the supervisor is reluctant to let go; parallel processes in ending in clinical supervision and ending in clinical relationships; the different ending dynamics of different approaches to clinical supervision; endings in group supervision; ending as a form of bereavement; healthy endings in clinical supervision; and endings as an opportunity for growth and celebration. The authors posit that an understanding of these processes can help facilitate a ‘healthy’ ending in clinical supervision. Furthermore, there may be particular merit in considering dynamics that, when present, create the best chance of all parties experiencing a healthy ending, namely: the ending is negotiated; the ending is gradual rather than sudden and all parties work towards the ending; the supervisee retains (wherever possible) a degree of control over the timing of the ending; and both supervisor and supervisee achieve a sense of closure.
Legal aspects of consent 18: issues relating to euthanasia
Authors: Dimond Bridgit
Published: May 2014

Norah was in the terminal stages of cancer. She lived with her single daughter, Jane, and was being cared for by Macmillan nurses who came to see her daily. She was on a high level of morphine but still suffered considerable pain. A consultant in palliative care visited her to reassess her medication levels, but Norah found that the new medication still left her with considerable discomfort and pain. Norah asked her daughter to help her end her life. What is the law?
Urinary tract stones: causes, complications and treatment
Authors: Steggall Martin J
Published: May 2014

Stones or calculi in the urinary tract affect up to 12% of men and 5% of women by the age of 70 years, with more than a third of individuals having a strong family history (Unwin, 1996). Complications include obstruction in the urinary tract, pain, nausea, vomiting and sepsis. Common causes are: urine stasis, infection, presence of foreign bodies, dehydration, diet and periods of immobility. Encouraging initial diuresis could exacerbate rather than relieve symptoms. Discharge advice is a key feature of preventing recurrence once the predisposing factors have been identified. The relationship between patient and nurse is an invaluable and ideal opportunity for nurses to educate patients in appropriately changing dietary habit and in maintaining a urine output of greater than 2 litres per day.
Lessons of Alder Hey: consent must be informed
Authors: Glasper Edward A , Powell Catherine
Published: May 2014

As the storm was breaking over the wholesale removal of organs from the bodies of dead children without parental consent at Alder Hey, it quickly became apparent that many other hospitals throughout the UK have also developed collections of children's organs. An audit conducted by the Chief Medical Officer, Professor Liam Donaldson, revealed that hospitals collectively have stored anywhere between 40000 and 50000 organs.
Contribution of multidisciplinary team to pain management
Authors: Haigh Carol
Published: May 2014

A fundamental part of satisfactory acute pain management is the regular and objective assessment of the patient's pain. The responsibility for this ongoing assessment is generally incorporated into the nursing role. Given the multidisciplinary nature of modern health care it is contended that this assessment is not the sole obligation of nursing or medical staff and that any healthcare professional who is offering treatment or therapy to patients should incorporate pain assessment into their treatment plan. This article outlines a small research study that assesses the contribution that the multidisciplinary team (MDT) makes towards pain management and pain assessment in particular. It highlights the importance of pain assessment and the fact that management is a multidisciplinary issue.
Legal aspects of consent 2: the different forms of consent
Authors: Dimond Bridgit
Published: May 2014

Mary, following preoperative medication, was taken to theatre for a biopsy for possible breast cancer. When the theatre staff went through their check list they could not find a consent form. The consultant surgeon said that he had seen her in the outpatients' department 2 weeks before and she had given a clear consent, not only for the biopsy but also for a radical mastectomy should the results show that to be necessary. He said that he had no problems with continuing the operation. The theatre sister was unsure of the legal position.
Philosophical and ethical issues in human organ transplantation
Authors: Mackenzie Katherine M
Published: May 2014

Organ transplantation has moved over 30 years from being experimental and heroic to being the treatment of choice in many terminal diseases of vital organs, such as biliary atresis which would require a liver transplant, or pulmonary fibrosis which would require a heart/lung transplant. There are now many older and chronically sick people than ever before (Hudak et al, 1998). Transplantation offers hope for an improved quality of life. All patients have a right to care, although there remains a dichotomy between the holistic model of care and the medical model. The UKCC's (1992) Code of Professional Conduct informs practice, and clauses 1 and 5 are of particular importance in relation to this client group. This article looks at some of the problems patients may develop pre- and post-transplant and the support required to overcome or minimize these problems. Implications for healthcare staff are considered.
Successful ageing: keeping the ‘person’ in person-centred care
Authors: Nolan Mike
Published: May 2014

This article, based on a paper given at the International Network for Studies Concerning Older Adults conference, Brazil, charts the emergence of notions of successful ageing, health-related quality of life and person-centred care which currently figure prominently in debates about health and social care. It argues that these developments reflect the importance given to autonomy and independence, values which potentially disadvantage the oldest and frailest members of society. It is suggested that there is a need for a more inclusive conceptualization of person-centred care which recognizes the values of interdependence and reciprocity.
Nurses must be ready for clinical negligence
Authors: Eaves Derek
Published: May 2014

Have the four letters CNST impinged on your working life yet? If not they will in the near future. The Clinical Negligence Scheme for Trusts (CNST) is part of the NHS Litigation Authority. It provides a means for all trusts in the NHS to fund the cost of clinical negligence litigation and to encourage and support effective management of claims and risk. It sets out standards of practice which trusts must adhere to in order to reduce the risk to patients.
Matron is to stage a comeback in nursing
Authors: Scott Helen
Published: May 2014

The reintroduction of the role of matron into the NHS seems to be an acknowledgement by the Government that standards of patient care have been declining and that patient services in hospitals are not being well managed.
Legal aspects of consent 5: how to judge mental capacity
Authors: Dimond Bridgit
Published: May 2014

Doctors advised a patient (‘C’) from Broadmoor Special Hospital, who was suffering from chronic paranoid schizophrenia, that he had gangrene in his foot. He was transferred to Heatherwood Hospital where the doctor diagnosed a grossly infected right leg with a necrotic ulcer covering the whole of the dorsum. The consultant vascular surgeon considered that ‘C’ would die imminently unless he had a below-knee amputation. His chances of survival were assessed as being no better than 15% if he just had conservative treatment. ‘C’ stated that he would prefer to die with two feet than live with one. He therefore refused to give consent to the operation and he sought an injunction from the High Court to stop the amputation from going ahead (Re C (adult: refusal of medical treatment), [1994]).
Reflections on Wound Care in Australia
Authors: Torrance Colin
Published: May 2014

Wound care and, in particular, pressure ulcers, have been one of my major interests in nursing for over 20 years. My first experience in nursing was as a nursing auxiliary in an elderly care ward. One lasting impression from that experience was that we could do better in terms of both treating and preventing pressure ulcers. Over the years, I have been encouraged by the developments of wound care in the UK.
How do we make the NHS value our services?
Authors: Gray David
Published: May 2014

The role played by tissue viability nurse specialists (TVNSs) within the NHS is, for the most part, unrecognized. The NHS would be a poorer place were it not for the work carried out by TVNSs who ensure that high-risk patients receive pressure-reducing equipment, that wounds are managed efficiently and that the NHS receives value for money wherever possible. We perform a key role within the NHS. So whose fault is it that our contribution is unrecognized? There is no doubt we have created a rod for our own backs because of our failure to quantify and highlight our work. It therefore follows that we hold the key to changing this situation.
ARTICLE
Authors: Cutcliffe John JR , Ward Martin
Published: May 2014

This article reports on an exploratory study that attempted to identify aspects of the care organization that may affect the violent behaviour of clients. Having noted that violence in psychiatric settings is a significant problem, the authors pointed out that there was a dearth of literature that examined the influence of the organization in relation to violent client behaviour.
Handling clinical negligence claims: the NHS must improve
Authors: Tingle John
Published: May 2014

The influential House of Commons Committee of Public Accounts has just published a report on handling clinical negligence claims in England (House of Commons, 2002). The report is well worth reading because it discusses clearly the problems of our clinical negligence system and what can be done to improve it. As nurses can often be the first people that patients turn to when they have a problem, it is important that they have some idea of the system that patients may have to negotiate.
Older people who smoke: why nurses should help them to stop
Authors: Kerr Susan M , Watson Hazel E , Tolson Debbie
Published: May 2014

Smoking is the greatest preventable cause of ill health and premature death in the UK. Although the prevalence of smoking is lower among adults over 65 years than in younger age groups, the actual number of older smokers is increasing steadily as the proportion of older adults in the population rises. If nurses are to function effectively in their role as health promoters it is important that they base their practice on appropriate research-based evidence. In this article we discuss the current evidence on the health consequences of smoking in later life and the benefits of cessation. We provide information on approaches that are recommended when helping older adults to stop smoking and we discuss some of the barriers to behavioural change. Our aim is to provide nurses with information that will help them to help older smokers make informed choices.
Recruits from overseas need better assessment and support
Authors: Close Ann
Published: May 2014

The decision of David Nunn, a consultant orthopaedic surgeon, to stop a patient’s operation half way through because some of the nurses could not follow his instructions has raised much debate about the ability of foreign healthcare professionals to communicate effectively and the consequences this might have on patient care. This is not a new problem as the NHS has periodically recruited internationally to meet the demand for doctors and nurses. However, the problem has been magnified in recent years because of massive increases in targeted overseas recruitment.
Web Watch
Authors: Mangan Paul
Published: May 2014

This edition of Web Watch looks at sites relating to dermatology. While we have been careful to list only sites that have been recommended by specialists in the field, we re-emphasize our usual warning about evaluating any material you get from the internet in the same way that you would with materials you find anywhere else.
Early detection of mental health problems in older people
Authors: Sayers Jayne , Watts Sue , Bhutani Gita
Published: May 2014

A survey of the mental health needs of older adults, conducted in 1996 by the Mental Health Services of Salford NHS Trust (Watts et al, 1996), confirmed earlier research findings that mental health problems in older adults are under-recognized and under-treated. This article reports on this survey, the aims of which were to identify within an inner city area in northwest England the extent and method by which primary care staff detect mild to moderate mental health problems in later life, and the best way to support the teams to detect and manage these issues effectively. As a result, this 11-week survey was conducted which sought to interview all attendees aged 65 years and above at a general practice. Given the high levels of psychological distress and low levels of identification, education/training was provided for practice staff, enabling them to develop the use of appropriate screening tools. The article concludes by discussing how the evaluation of the project by the primary healthcare teams involved has demonstrated that primary healthcare nurses can be trained in brief assessment tools and management techniques suitable for primary healthcare settings.
Recognizing and valuing higher level practice
Authors: Castledine George
Published: May 2014

It has been my privilege to chair the UKCC group exploring the concept of ‘higher level practice’. This month sees the publication of our final report and outlines the work of the group and the findings of the special pilot to assess the value of the UKCC's standards and assessment system (UKCC, 2002). The background to our work goes back to the 1990s, when the Council was developing its work on postregistration education and possible further regulation of nurses, who were developing or expanding their nursing roles. Two levels of practice beyond the point of registration, advanced and specialist, were identified (UKCC, 1994).
Nurses should be united if they want to be taken seriously
Authors: Rodriguez Maria Anguita
Published: May 2014

Over half of UK nurses have considered leaving their current posts because of low pay and because they feel undervalued. These are the findings of a survey of 3500 nurses and midwives published in the Unison report Simply Slipping Away (Unison, 2002), which forms part of Unison's evidence to nurses' pay review body. Other reasons given for the discontent among nurses include an unfair grading system, unpaid overtime and lack of access to training. In addition, two-thirds of the nurses report frequent staff shortages and an increased workload, the latter mainly being as a result of Government targets.
RCN's definition of nursing: what makes nursing unique?
Authors: Scott Helen
Published: May 2014

The RCN has been deliberating over a new definition of nursing and has recently put forward the following for consultation: ‘Nursing is the use of clinical judgment and the provision of care to enable people to promote, improve, maintain, or recover health or, when death is inevitable, to die peacefully’ (RCN, 2002).
Acupuncture: evidence for its use in chronic low back pain
Authors: Henderson Helen
Published: May 2014

Back pain is a major economic burden in the UK, with increasing numbers of patients seeking complementary therapies, such as acupuncture, as a means to supplement traditional medical treatments. Studies to date have produced conflicting results relating to the efficacy of acupuncture and thus this systematic review will provide a concise summary of the clinical scenario in Western countries. A search of various electronic databases identified 11 articles consisting of three case studies, five randomized controlled trials, and two cross-over trials. Systematic examination of these articles did not provide definitive evidence to support or refute the use of acupuncture in the treatment of low back pain. In an era of increasing demands for evidence-based practice and professional accountability, the absence of irrefutable scientific evidence places nurses and medics in a vulnerable position.
Clinical governance and assessing and managing clinical risk
Authors: Dimond Bridgit
Published: May 2014

Joshua worked in paediatrics and was concerned about the frequency of injuries caused to babies as a result of intravenous fluids being pumped into the tissue. It appeared that the mechanical pumps were not sufficiently sensitive to cut out when the vein tissued and there had been several cases where it appeared that serious harm had been caused to a baby.
Legal aspects of consent 21: amputations of healthy limbs
Authors: Dimond Bridgit
Published: May 2014

Martina suffered from apotemnophilia, a rare psychological condition related to body dysmorphic disorder. Her GP referred her to a general surgeon, Mr Walker. She pleaded with him that he should amputate her left leg. Mr Walker saw no signs of disease, and said that there was no physical justification for surgery. Martina said that she would put her leg over the railway line or cut it off herself if he did not operate. As a consequence Mr Walker carried out the amputation but is now facing an investigation by his employers. What is the law?.
Collecting pressure ulcer prevention and management outcomes: 1
Authors: Clark Michael , Benbow Maureen , Butcher Martyn , Gebhardt Krzys , Teasley Gail , Zoller Jim
Published: May 2014

This article, the first of two parts, presents the argument that a combination of efficacy and effectiveness is required to assess fully the impact of interventions such as pressure-redistributing beds and mattresses. The methodology adopted within a multinational, multicentre, prospective, non-randomized cohort study, designed to record the occurrence and characteristics of patients vulnerable to, or with, established pressure ulcers, is described. General demographic data and the characteristics of the pressure ulcers experienced by the 2507 UK subjects recruited to the study across four UK hospitals between July 1996 and May 1998 are presented, with pressure ulcers affecting 218 subjects of whom 100 presented with ulcers on admission to hospital. Fourteen subjects developed severe ulcers, while a further 24 were admitted with full-thickness pressure ulcers. The second part of this article will report further details of the characteristics of the UK sample. Future articles will consider the subjects examined in greater detail and will also discuss the combination of this dataset with similar data collected in the USA.
Management of intravascular devices to prevent infection
Authors: Parker Lynn
Published: May 2014

Intravenous therapy is an essential part of clinical care used in a wide variety of healthcare settings. Thus, intravenous catheters have become indispensable to clinical practice. However, catheter-related-bloodstream infections (CR-BSIs) are a major source of morbidity and mortality, especially in hospital patients. Strategies to prevent infection need to change and develop to reflect the advances in technology and delivery of health care. Current guidance recommends a number of strategies to reduce the incidence of CR-BSIs. These include applying the principles of asepsis, the choice of catheter material, the site of insertion and when to replace equipment used. This article reviews the guidelines for current clinical practice.
Transair® Paediatric Mattress replacement system evaluation
Authors: Law Jaki
Published: May 2014

While a plethora of pressure-relieving and reducing equipment is available to nurses for the prevention and treatment of pressure ulcers, very little of it is specifically designed or appropriate for paediatric patients. The limited choice that does exist concentrates on neonates or babies, which is problematic for the nurse dealing with the older child. Children may be at increased risk of developing pressure injury as a result of the forces of friction, shearing and pressure that result from being nursed on a support system designed for the adult patient. This gap in service provision may cause dilemmas for the nurse who has a duty to ‘cause no harm’ (UKCC, 1992) in his/her attempt to protect and treat a child. This article introduces a new product available from Karomed (a division of the Verna Group) that has been specifically designed with the child in mind.
Review of advances in pressure ulcer management since 1992
Authors: Dealey Carol
Published: May 2014

This article seeks to review the progress in the treatment and prevention of pressure ulcers over the last 10 years under the headings of attitudes, politics, research and best practice. It is considered that attitudes have changed and there is a greater awareness of, and interest in, the topic among other healthcare professionals, not just nurses. This may be in part because the topic has risen up the political agenda following studies which have highlighted the numbers of sufferers and the cost of treatment. Unfortunately, there is a scarcity of high quality research to inform practice. Despite these limitations, overall, there has been some progress in preventing and treating pressure ulcers, but there is still a considerable journey ahead.
Should Diane Pretty's husband be allowed to help her to die?
Authors: Dimond Bridgit
Published: May 2014

It is ironic that the very day it is announced that Miss B has died peacefully in her sleep after her ventilator had been switched off (Bale, 2002), the European Court of Human Rights has published its decision on Diane Pretty's case. It has decided that it is not contrary to her human rights for her husband not to be given an immunity from prosecution should he aid and abet her suicide. Thus, the law has supported one woman's wish to die but rejected the pleas of another. Is the law an ass or is there a logic and consistency between these two apparently irreconcilable decisions?
Nurses must not integrate medical tasks into nursing
Authors: Castledine George
Published: May 2014

The future of the profession of nursing has never been so uncertain as it is today. There have always been external forces trying to influence its direction and development, but more recently it has been the Government. Sometimes the nursing profession has control and a say in what is happening to it, but at the moment it seems its voice has been conspicuous by its absence. Much is being done to promote and develop clinical leaders, but where are those dynamic senior professionals who so often in the past have been keen to question nursing and the future direction of the profession?.
Correspondence
Authors: Fawcett Tonks N , Jarvis Allson , Waiwaiku Leona , Johnson Sue , Leak Kathy
Published: May 2014

Further to the challenge posed by an anonymous letter (Vol 11(21): 1362) we would like to outline the fundamental role we feel the academic staff have as liaison lecturers in the School of Nursing Studies, University of Edinburgh.
Matron role is of value and worth developing
Authors: Castledine George
Published: May 2014

When I was first asked to participate in my trust's modern matron initiative, I was sceptical and unsure of the purpose. It has always been part of popular mythology that matrons are some special breed of people, sub-human or super-human by turn, a peculiar hybrid of dragon-lady and nun. There have been numerous films, books and comic stories which have encouraged the image of matrons as tyrants, devoting their lives to running hospitals with iron rods, coldly interrupting medical pranksters and ensuring staff and patients obey the rules.
It is not difficult to keep professional profiles
Authors: Castledine George
Published: May 2014

I wonder how many registered nurses reading this column still do not have a personal professional profile (PPP)? Judging by some informal enquiries that I have made, there are certainly a very large number of you out there. The reasons for this are varied, but in particular there is still much confusion over what constitutes a recognized and acceptable PPP.
An exploration of the factors that affect nurses' record keeping
Authors: Taylor Helen
Published: May 2014

It is generally accepted that written documentation is significant not only as a communication medium in nursing, but also in the fulfilment of a number of other professional and legal obligations for nurses. The literature suggests, however, that the records nurses keep often fail either to represent the care delivered or the patient's health status accurately. This article explores a number of possible reasons for this, including: nurses' apathy to documentation; the time-consuming nature of documentation; discrepancies between nurse/patient and nurse/nurse interpretation of the significance of an event; and nurses' literacy skills. The article identifies key areas that practising nurses and nurse educationalists need to consider if accurate and reflective nursing records are to be made. Nurses should be encouraged and supported to regard record keeping as a positive contribution to patient care, rather than as a chore to be endured.
Debate continues over all-graduate profession
Authors: Jarvis Alison , Fawcett Tonks N
Published: May 2014

How disappointing to read your support for the Royal College of Nursing's (RCN's) rejection of nursing being an all-graduate profession — ‘RCN votes that nursing should not become all-graduate’ (Vol 12(9): 524) — particularly when you recognize the strengths of the argument for an all-graduate workforce which were very much to the purpose.
Care study: the Leg Club Model and the sharing of knowledge
Authors: Lindsay Ellie , Hawkins Jen
Published: May 2014

The empowerment of patients can be considered an important part of the nurse's role in the management of chronic venous leg ulcers. This article describes how one individual's healing rate improved when she was given greater control over her own care by a partnership formed with her nursing team. The negative impact of a subsequent change to a more autocratic care regime is discussed. The authors investigate how nurse education, reflection and sharing best practice could overcome barriers to patients becoming more involved in their own individualized wound management and treatment. The role of the Leg Club Model (a clinic held in a social environment as opposed to a medical setting) in promoting an environment of collaborative working, open communication and knowledge sharing is examined.
Senior staff nurse who physically abused clients in a home
Authors: Castledine George
Published: May 2014

Beryl had been working as a care assistant for 8 weeks at a nursing home for people with learning disabilities and physical handicaps. During this time she witnessed several incidents involving the senior nurse and some of the residents.
New reforms made to the NHS clinical negligence system
Authors: Tingle John
Published: May 2014

The Chief Medical Officer, Professor Sir Liam Donaldson, has just published his long-awaited report into clinical negligence in the NHS. The report, Making Amends (Department of Health (DoH), 2003), sets out proposals for consultation designed to reform the handling of clinical negligence claims in the NHS. It makes a total of 19 recommendations which, if implemented, will affect nurses as they can and have been involved in litigation and complaints. Nurses will, therefore, need to know, as a matter of practical necessity, the mechanics of the system that resolves disputes about the provision of NHS health care to patients and their duties under that system.
Nurses are getting more and more disillusioned
Authors: Castledine George
Published: May 2014

There seem to be two conflicting views relating to nursing at the moment: the first is that nursing and nurses are developing new roles, breaking boundaries and taking over exciting medical tasks previously carried out by doctors; the second is that nurses are losing their way and their traditional care role is being eroded and taken over by healthcare assistants.
Nurse education: is it becoming too academic?
Authors: Castledine George
Published: May 2014

Traditionally, at this time of year new students are about to commence their undergraduate careers in nursing. Perhaps uppermost among their thoughts will be the familiar question: ‘When do we get to practice with patients?.’
Nurse education and the NHS must integrate more
Authors: Castledine George
Published: May 2014

Recently I attended the 30th anniversary of the Department of Nursing (now the School of Nursing, Midwifery and Health Visiting) at Manchester University. Like many, I am rather apprehensive about attending reunions, as I tend to feel that my peers and I have moved on. This event, however, was different because in terms of the development of nursing in the UK, Manchester was the cradle of nursing education and the stimulus for much nursing research and practice development.
Midwives and the correct administration of medicines
Authors: Dimond Bridgit
Published: May 2014

Miriam, a student midwife, was called to attend a home birth and arrived before the registered midwife. The woman was in considerable pain and had in her possession pethidine which had been left by the GP. She asked the student midwife to inject her with it. What is the legal position?
Enrolled nurse who pretended she had completed conversion course
Authors: Castledine George
Published: May 2014

A few years ago the then UKCC encouraged enrolled nurses to undertake an appropriate course to enable them to register as registered nurses. The differences between state enrolled nurses (SENs) and state registered nurses (SRNs) were rapidly reducing and many enrolled nurses were easily capable of performing at the higher level.
Laws relating to HIV/AIDS infection and the rights of employees
Authors: Dimond Bridgit
Published: May 2014

Following a holiday in Africa, Brenda, a nurse, was told that she had probably been infected with the human immunodeficiency virus. She felt reasonably fit and since she worked in ophthalmic outpatients, an area where there was a very low risk of infecting patients, she wanted to keep this information to herself. What is the law?.
Correspondence
Authors: Waiwaku Leona , Jacobs Audrey
Published: May 2014

I am from a Third World country. I trained in a rural hospital which was run by American missionaries, where clinical guidelines and management standing orders were developed and used effectively.
Nurse who failed to ensure patient received adequate analgesia
Authors: Castledine George
Published: May 2014

Jane was a 45-year-old woman who had recently been admitted to hospital for investigations into breathlessness and weight loss. Within a few days she was diagnosed as suffering from cancer and, because of the severity of her diagnosis and symptoms, was immediately commenced on palliative care.
Diabetes: classification and strategies for integrated care
Authors: King Kathryn M
Published: May 2014

This article is the third in a series of three in-depth literature reviews on diabetes. The first article (Vol 12(18): 1091–5) detailed the history of diabetes from the first recorded mention of the disease in the Ebers papyrus through to the discovery of insulin. The second (Vol 12(19): 1137–41) dealt with the history of insulin over the past 80 years and the development of possible alternatives. This final article in the series details the new classifications for diabetes and addresses the aetiology, pathophysiology and complications of the disease. While discussing both type 1 and type 2 diabetes, the article concentrates on the newly defined type 1 diabetes mellitus. An examination of the recently released National Service Framework for Diabetes: Delivery Strategy (DoH, 2003) is included, healthcare provision is discussed, as is the role of the diabetes specialist nurse. An insight is given into the challenges and opportunities available for healthcare practitioners to work in partnership to reform the way in which diabetes services are managed.
It is important that managers target stress in the workplace
Authors: Birchenall Professor Peter D , Parrish OBE Alan A
Published: May 2014

Increased demands placed on the NHS are invariably passed down to the staff, who then have to cope with the pressures of extra work. The effect of this is that key personnel are becoming, in their own words, ‘stressed out’. Employers must recognize and address the issue of stress to safeguard not only the interests of their staff but also that of service users. When one considers the detrimental effect that stress has on the performance of an individual, it is amazing that relatively few senior managers take measures to identify and ameliorate stress.
12-lead ECG interpretation 2: right ventricular and posterior infarcts
Authors: Docherty Brendan
Published: May 2014

Some myocardial abnormalities can have serious consequences if not detected, and may negatively affect overall patient outcomes. Right ventricular and posterior myocardial infarction are two types of myocardial injury that may seriously affect the patient's haemodynamic status, but can be recognized easily if appropriate specialized 12-lead electrocardiograms (ECGs) are recorded and analysed. The nurse is best placed to conduct advanced ECG interpretation, in partnership with medical colleagues, and taking into account the patient's clinical symptoms and cardiac risk factors. This article should be read in conjunction with the first article (Vol 12(21): 1248–55).
Guide for nurses to surviving health service politics
Authors: Birchenall PD , Parrish Alan A
Published: May 2014

Working in a team that respects equality, where strengths are valued and each member looks after the other, can be an exhilarating experience. Happiness or otherwise at work depends largely on ‘office politics’. All workplaces contain a political element; in some it is more overt than in others. From our own experience we know of many negative aspects connected to the political dimension of work. We have had first-hand experience of bullying, intimidation and cronyism masquerading under the label of ‘strong management’.
The benefits of putting spirit into an organization
Authors: Castledine George
Published: May 2014

Organizations and institutions influence our lives in various ways. They can make us feel welcome and involved or isolated and unwanted. Many of us spend the majority of our working lives in an institution and many suffer the consequences of being in the same setting for too long. In the past the effects of living or working in the same place were known as ‘institutionalization’. The worst effects were seen in large long-term psychiatric hospitals, where the patients had lost the will to do anything because the staff had fallen into too rigid a routine and a negative way of doing things. Today, many workplaces can also destroy people's lives, especially if the atmosphere or spirit of the institution is not geared towards a positive developmental approach.
Reducing infections associated with central venous catheters
Authors: Rickard Norman AS
Published: May 2014

The cost of infections in central venous catheters (CVCs) is high both to the NHS and to the patients and their carers. This article discusses reduction of infection in patients with CVCs. Adding to the debate on how to do this, three interlinked factors are discussed: (1) the virulence of the invading microorganisms, (2) the environment for microbial growth, and (3) the host defence mechanisms. The article encourages healthcare workers to use interprofessional groups to write, update frequently, and discuss protocols designed to reduce infections.The discussion and updating of the protocols, based on local experience, monitoring actions and infection rates within the interprofessional group, will assist in the reduction of infection.
Introduction of a community nutrition risk assessment tool
Authors: Bartholomew Christine M , Burton Sin , Davidson Louise A
Published: May 2014

This article describes the introduction of a community nutrition risk assessment (CNRA) initiative in liaison with a local primary care trust (PCT). A pilot was undertaken in order to produce local evidence of the benefits of nutrition risk screening and thus gain support from the PCT for full implementation of the CNRA. The results from the pilot, which indicated that a substantial financial saving for the PCT was possible with a corresponding improvement in patient care, were sufficiently convincing for the PCT to sanction the introduction of the CNRA throughout the local community. Seven steps for success are recommended which may be of use to other healthcare professionals who are considering such a process for their own community patients or indeed any other multiprofessional initiative which requires PCT support. Such steps include identification of those who may help or hinder the process and a thorough preparation of a concise evidence-based proposal which should assist in persuading those less enthusiastic to accept and support the vision.
Update and overview of the law relating to health and safety
Authors: Dimond Bridgit
Published: May 2014

This series on health and safety law has, over the past year, explored the laws which apply to health and safety in relation to health care. It has covered a wide spectrum of topics. In this final article of the series these topics will be updated in the light of recent developments in both NHS initiatives and in the law.