bluuebunny/crossref_metadata_2025 huggingface dataset:
Legal aspects of consent 4: duty to inform patients of risks
Authors: Dimond Bridgit
Published: May 2014

Fred has suffered for many years with a hernia and has been placed on the waiting list for surgery. He is finally admitted, but is extremely frightened, never having had any contact with hospitals before. He keeps asking what will happen to him. Nurses discover that his mother died when he was only 8 years old following an operation for the removal of gall stones. He is afraid that the same thing will happen to him.
Treatment of pressure ulcers in a rehabilitation ward
Authors: Cook Stephen L
Published: May 2014

This article presents a case study of a patient transferred to a rehabilitation unit for elderly people. The aim of the article is to show that, with a dynamic and committed multidisciplinary team approach, the prevention and treatment of difficult pressure ulcers can be achieved in an ever increasingly frail elderly population. The article will discuss the methods used to treat and tackle the challenges that staff encounter when treating these patients.
Legal aspects of consent 19: research/mentally competent adult
Authors: Dimond Bridgit
Published: May 2014

Sylvia was admitted to hospital for an hysterectomy. Before the operation, she agreed to take part in a research project designed to test the effectiveness of different forms of operative care, and undertstood that some additional tissue would be removed. The day after the operation she suffered from extreme pain and felt sure that this was because of the additional procedure undertaken. She now regrets agreeing to participate in the research and is wondering what action she can take. What is the law?
Medical language must be clarified for patients
Authors: Castledine George
Published: May 2014

Over 30 years ago, Alistair Cooke, broadcaster and writer, was invited to speak at a famous medical school in the USA, where the audience was primarily from a medical background. The subject he chose to speak about was the ‘patient’ because ‘the patients, when doctors see them, are usually too terrified to speak up for themselves’ (Cooke, 1986). He made a plea to his medical audience that they ‘come halfway to the patient in explaining to them health and disease’.
Evaluation of Acti-Wrap: a new cohesive retention bandage
Authors: Fraser Kate
Published: May 2014

Retention bandages are designed to keep dressings, devices and creams in place without causing discomfort to the patient. They should be light-weight, soft and conformable and should not cause unwanted compression. Acti-Wrap retention bandage (Activa Healthcare) is a new, conforming bandage which is easy to apply and because of its cohesive nature stays in place. This product focus looks at the ways in which the bandage can be used effectively and the cost-effectiveness of using this type of bandage. The simple evaluation described in this article compares Acti-Wrap with two other frequently used retention bandages.
Legal aspects of consent 23: Department of Health guidelines
Authors: Diamond Bridgit
Published: May 2014

This it the last article in the series on the legal aspects of consent. It looks at recent guidance that has been published by the Department of Health on consent for examinations and treatment. It discusses the content of this document and covers the main principles which apply in relation to consent as highlighted in this series.
Statutory provisions of the Health and Safety at Work Act 1974
Authors: Dimond Bridgit
Published: May 2014

Rose is working as a staff nurse in the operating theatre of Roger Park Hospital when there is an explosion. She is severely burnt. Following an inspection by the Health and Safety Inspectorate, the Roger Park NHS trust is informed that it will be prosecuted. It appears that the cause of the explosion was the result of gases igniting because of an electrical fault in a patient monitor.
Injecting drug use: developing a drop-in wound care clinic
Authors: Finnie Alison , Nicholson Paul
Published: May 2014

The first part of this two-part series examined the difficulties facing nurses working with injecting drug users with skin problems (Finnie and Nicolson, 2002). This article describes the needs of homeless people with skin complaints and the innovative development of a specific drop-in wound care clinic within The Big Issue Scotland premises in Glasgow. It illustrates some practical and political difficulties of working with a unique and challenging client group, and of developing a wound care service outwith the NHS. Case studies illustrate individual people and their own challenges.
Review of an independent audit into the clinical efficacy of VACUTEX™
Authors: Deeth Michelle
Published: May 2014

An independent report was completed and analysed by Pharmaceutical Research Associates International in August 2001 (Pro-Tex, 2001). This company provides a service to carry out independent project work and research studies within the healthcare sector. The project involved 73 tissue viability nurses and 93 patients, whereby the performance of VACUTEX™ capillary action wound dressing was assessed on both acute and chronic wounds. The audit takes into account the varying cultures across England and Wales and demonstrates this rapid method of comparing previous dressings used on a multitude of wound types, with analysis focusing on the versatility and efficacy of the VACUTEX™ capillary action wound dressing. This article reviews the findings of the audit.
Management of faecal incontinence of a patient with spinal cord injury
Authors: Slater Wendy
Published: May 2014

This case study of an outpatient with a C6 spinal cord injury who was experiencing episodes of faecal incontinence, and the successful application of evidence-based care, highlights the need for comprehensive assessment of chronic bowel problems and a ‘return to basics’. Using Gibbs' (1988) reflective cycle, the author discusses emerging issues and analyses them with reference to the supporting literature. As a result of this reflective study a comprehensive bowel assessment form was devised to ensure that staff do not automatically prescribe aperients, but reassess every aspect of a patient's bowel regimen when problems arise. In addition, a fact sheet describing the correct methods for digital stimulation, and a quality of life scoring tool, have been written.
Nurse who treated frail patients with disrespect and force
Authors: Castledine George
Published: May 2014

Hilda worked as a registered mental health nurse for a large community health service. She was based on night duty in a special hospital for the care of older people. Most of the patients she was caring for were short stay and had been admitted for assessment of their medical and healthcare nursing needs.
Journal reviewing: is it in need of reform?
Authors: Paniagua Hillary
Published: May 2014

As a reviewer I found the comment piece by Peter Birchenall and Alan Parrish on revising the system of reviewing journals very interesting — ‘Journal reviewers and reviews: should the system be revised?’ (Vol 12(13): 773). However, I was a little surprised at some of their comments and was not entirely sure what they were actually asking for, or indeed as to why.
An overview of the management of nocturnal enuresis in children
Authors: Rogers June
Published: May 2014

Nocturnal enuresis is one of the common conditions of childhood and left untreated can cause increasing stress and anxiety for the child and disruption for the family. This article gives an overview of the potential contributory factors to the cause of bedwetting and highlights the importance of carrying out a focused assessment using the ‘three systems’ approach, to not only exclude any underlying pathology but also help direct treatment. The different treatment options are discussed and emphasis is placed on involving the child and family in the decision-making process. A child-focused approach will help ensure that whatever treatment is chosen, either the alarm or desmopressin will lead towards the best treatment outcome.
CHD prevention: the importance of identifying dyslipidaemia
Authors: Foxton Julie
Published: May 2014

Coronary heart disease (CHD) is the major cause of death worldwide (Murray and Lopez, 1997) and confers a significant socioeconomic burden on all populations. The careful identification and optimal treatment of all individuals at risk of CHD is necessary for significant reductions in morbidity and mortality to be realized. This strategy demands an integrated approach by healthcare teams, with nurses playing a significant role at all stages of patient care. Guidelines advocate lipid lowering as a central component of all treatment regimens. Identification by nurses of all individuals who would benefit from lifestyle and therapeutic interventions to normalize lipid profiles, as well as the recognition of the impact of increasing prevalences of diabetes and obesity on the risk of developing CHD, are clearly critical. Nurses also have an important role to play in the implementation of drug regimens and lifestyle changes, including appropriate ways to minimize the treatment gap and maximize patient concordance.
Less time spent in training a solution to nurse shortages?
Authors: Finlay Noeleen , Irwin Joan , James Christine
Published: May 2014

Severe shortages of registered nurses have been widely publicized in the professional and political arenas. The main factors contributing to this appear to be recruitment shortfall, nurses leaving the profession and an ageing workforce. Various initiatives have been considered and implemented to address this crisis, e.g. increases in funding for the recruitment and training of more student nurses (Macleod Clark, 2003).
Nurses must protect vulnerable older people
Authors: Castledine George
Published: May 2014

I met Harry in the hospital corridor; he was shouting for help. When I reached him he was with a taxi driver who had brought him into the hospital to visit his wife. They were both lost and the taxi driver was anxious to get back to her cab. I therefore offered to take Harry to the ward. Harry was 93 years of age, so was his wife. They had no friends or relatives and relied heavily upon the local taxi firm for transportation. He took my arm gratefully as he was partially blind, and as we walked along the corridor he told me his anxieties about his wife's condition. When we reached the ward, Harry's wife called out to him and within a few minutes they were happily reunited.
Giving medicinal information to mentally capacitated patients
Authors: Dimond Bridgit
Published: May 2014

Roy was advised that a new drug which had just come on the market would assist his chronic depression. He was not given any further information, but after taking it for a few days found that it had a strong effect on his personality and he became aggressive and violent. As a consequence of a fight at work he lost his job and now claims that had he known of these effects he would not have taken the new drug.
Nurse who covered up for a sister who was having problems
Authors: Castledine George
Published: May 2014

Jenny had been a registered nurse for nearly a year when she took up a new post as a staff nurse on a general medical ward. She soon settled into the ward routine and felt that all the staff were very friendly and helpful.
Paediatric staff nurse who did not improve after education
Authors: Castledine George
Published: May 2014

Fitting in and adjusting to a new ward team can be difficult at times, especially if you are from a different ethnic and cultural background. In the following case, Lisa was a very well qualified and experienced paediatric nurse who came to Britain to try and further her career in nursing.
Value of clinical teaching must be recognized
Authors: Castledine George
Published: May 2014

When nursing schools were part of hospitals, there was little difference in the culture between education and practice. Today, with nursing education firmly entrenched in higher education and separate to clinical practice, there is a more significant difference.
Nurses' role in the new NHS: standardization of practice
Authors: Hewitt-Taylor Jaqui
Published: May 2014

The changes that have been proposed or introduced in healthcare provision since the publication of ‘A First Class Service’ (Department of Health (DoH), 1998) and ‘The NHS Plan’ (DoH, 2000) have the potential to enhance the quality and equality of patient care across the country. These include the development of national technology appraisals and clinical guidelines, greater flexibility over the roles performed by some healthcare professionals, and the development of care protocols. This article identifies some of the issues that these initiatives present to nursing, including standardization of practice and addressing individual need, the interface between care protocols or guidelines and professional judgment, and the need for a clear definition of the role of nursing.
Research into RIK and Nimbus 3 mattresses
Authors: McLeod Alastair
Published: May 2014

There were several puzzling aspects to both the design and conclusions drawn in Russell et al's recent comparison of the RIK and Nimbus 3 mattresses (Vol 12(4): 254). Most surprising was the assertion that the overall performance of the two products was ‘similar’, given that 17.3% of patients' ulcers on the RIK system deteriorated to grade 3.
Nurses must be more aware of patient safety initiatives
Authors: Tingle John
Published: May 2014

The National Patient Safety Agency (NPSA) has just launched a package of practical guidance and support to help improve patient safety in the NHS. Nurses everywhere should read the guidance and be aware of the resources that the NPSA provides to ensure the safety of patients and that lessons are learnt when things go wrong. Patient safety is a fundamental prerequisite to good professional practice and it underpins such concepts as clinical governance and clinical risk management. Nurses must practise safely and be able to respond appropriately when they see others compromising patient safety.
Nurse who would not acknowledge her lack of competence
Authors: Castledine George
Published: May 2014

If ever a nurse is suspected of incompetence it is important that concerns are reported to a senior manager so that an assessment of the nurse can be carried out. In the following case a school nurse (Ann) had been reported on several occasions because of the way in which she was carrying out her work. Her senior manager decided to assess Ann and went along to one of the primary schools to which Ann was allocated. Ann was due to undertake health assessments of several children at the school. There was no problem with the way that Ann spoke to the children or their mothers, but what became evident was that Ann was unsure of how to record and plot the children's height and weight on the growth or centile chart. When the manager pointed this error out, Ann replied that she was usually okay but must be nervous today.
Recognizing and developing talent on the shop floor
Authors: Birchenall PD , Parrish Alan A
Published: May 2014

Among the many things that contribute to the success of the NHS is willingness by managers to identify and nurture talent among the nursing workforce. There will always be employees who have skills, talents and potential, which if encouraged could make a significant contribution to the organizational vision. It is no exaggeration to suggest that everyone employed within the service has something to offer. For example, an individual may have a huge talent in motivating people; another could be a gifted administrator or may have a special ability for teaching basic practical skills to student nurses, which they do in a quiet, unassuming way. Whatever the talent, it should be recognized and nurtured.
Nursing home manager who failed to provide a safe environment for clients
Authors: Castledine George
Published: May 2014

It is not often that nurse managers fall foul of the Nursing and Midwifery Council (NMC) professional conduct system. The following case is not only an example of how this can happen, but also how important it is for nurses to ensure that patients are cared for in an environment that is conducive to safe, therapeutic and ethical practice.
Liability for death: manslaughter, murder and other criminal offences
Authors: Dimond Bridgit
Published: May 2014

Martha Brown by mistake administered twice the dosage of pain killer which was prescribed for Ted Snow. He convulsed and she realized immediately that something was amiss and called the doctor and pharmacist. However, he died before they were able to take remedial action. Since it was only a small mistake (admittedly with horrendous consequences), she is wondering what the consequences in law might be.
The management of pain in multiple sclerosis: a care-study approach
Authors: Gray Elizabeth
Published: May 2014

Pain is a commonly reported symptom of multiple sclerosis (MS). However, the literature surrounding pain management for people with MS appears limited. This article describes how pain was managed for one patient. It suggests that the MS nurse is pivotal in ensuring that patients receive adequate pain control. The MS nurse can coordinate timely assessment, monitor effectiveness and side-effects linked with a pain-management plan, and provide education and support to patients in order to allow them to take responsibility for their own pain management.
Decontamination of medical devices: legislation and compliance to practice
Authors: Parker Lynn J
Published: May 2014

The amount of legislation and guidelines published on decontamination reflects the current attitude of politicians and the general public to the desire to reduce the risk of infection. Incidents, such as bovine spongiform encephalopathy (BSE) in cattle with the subsequent risk of transmission of variant Creutzfeldt-Jakob disease (vCJD), require greater compliance by healthcare workers to the guidance both in the hospital and the wider community. The change in care provision and the demands of government require proof of compliance through audit and the subsequent growth in training and education. This article will look at recent government guidance and the implications it has for clinical practice.
Not for resuscitation instructions: the law for children in the UK
Authors: Dimond Bridgit
Published: May 2014

David Glass, a boy of 13 years, was severely disabled with only a limited life span. His mother wished him to receive whatever medical treatment was necessary to prolong his life. Following an incident in which the hospital gave the child diamorphine against the mother's wishes, family members resuscitated the child and prevented him from dying. There was a complete breakdown of trust between the family and the hospital. His mother, Ms Glass, sought a declaration as to the course doctors in the hospital should take if the boy were admitted for emergency treatment and disagreements arose as to the treatment to be given to or withheld from the child. The judge refused the mother's application for judicial review and she appealed to the Court of Appeal (R v. Portsmouth Hospitals NHS Trust ex p. Glass [1999]).
NICE guidelines: the management, treatment and care of COPD
Authors: Scullion Jane E
Published: May 2014

Over a year ago the National Institute for Clinical Excellence (NICE) commissioned national guidelines for managing chronic obstructive pulmonary disease (COPD) in both primary and secondary care. The resulting guidelines published earlier this year are the result of a systematic review of the evidence in the published literature and where this has not been available expert opinion has informed recommendations. The document makes over 200 recommendations for practice with seven key areas where it was felt that implementation of the recommendations would have the largest impact on the management of COPD. The result is a comprehensive document concentrating on the health aspects of COPD and the following article looks at the guideline and concentrates on the seven priority areas.
Managing and caring for a patient with a complicated wound
Authors: Stalick Liora
Published: May 2014

The patient discussed in this care study is a 91-year-old woman admitted to hospital from her own home. She presented with reduced mobility, constipation, increased confusion and reduced oral intake. Her history included small vessel disease and a stroke. On admission she also had a number of grade two pressure ulcers on her buttocks. The surrounding skin appeared macerated and the patient complained of pain when the skin was cleaned after she was incontinent of both urine and faeces. It was expected that the wound would be fast healing, as it was superficial, but the healing rate proved otherwise. This article will focus on incontinence management as well as ways of aiding in healing a pressure ulcer where skin is macerated and the patient has many risk factors.
Nurses must be more vocal about public health
Authors: Castledine George
Published: May 2014

Following the publication of the Government's long-awaited report on public health (Department of Health (DoH), 2004), it is timely to ask: ‘What are nurses doing about it?’ Observers could easily claim that, whereas doctors are always keen to comment on aspects of public health concern, nurses are often sadly lacking behind. Too quiet? Nothing to say? Or not politically assertive enough? There are many nurses who are very humanistically oriented, but it seems they spend far too little time and effort in getting their message about public health concerns across to the wider community.
Integration of critical care and palliative care at end of life
Authors: Pattison Natalie
Published: May 2014

End-of-life care in the critical care environment suffers from a lack of clarity and uncertainty. Critical care nurses may often feel torn between wanting to do everything possible to sustain a patient's life and wanting to do what is in the patient's best interests. Reframing the focus of care from cure to comfort can be an uncomfortable shift for nurses, who may not be in control of when the change of goals takes place. Good end-of-life care should be a core competency for all nurses and it is our responsibility to ensure that decisions to forgo life-sustaining treatment in critical care are appropriate and timely. Futility, conflict and resources all factor in such decisions. Nurses must ensure the transition from cure to comfort does not emphasize a dichotomy between palliative care and critical care but instead focuses on the provision of the best possible end-of-life care.
Comparison of four different dressings on donor site wounds
Authors: Beldon Pauline
Published: May 2014

Following nursing observation of the difficulties of healing of donor site wounds, including trauma and pain on removal of dressings, a blind randomized study was undertaken to determine which of four dressings provided the greatest comfort, had the fastest healing time and could be removed without trauma. Forty patients had one of four dressings applied in theatre: paraffin gauze, alginate alone, alginate with film cover or film alone. An observer was present who was unaware of the dressing used and recorded patient observations and nursing records for information. The study revealed that the dressing that caused patients most discomfort and trauma on removal was paraffin gauze. Alginate with film dressing was found to be most successful in treating these patients.
Russka pressure-relieving low air-loss mattress system
Authors: Collins Fiona
Published: May 2014

Pressure ulcers are distressing, frequently occur in immobile and malnourished patients and the cost to patients in terms of pain and anguish must be a prime consideration. There is little information on the incidence and prevalence of pressure ulcer development within the independent sector, as this is difficult to obtain. However, with advances in treatment and technology, combined with more people with complex and multiple needs being cared for at home, the requirement for specialist pressure-relieving support surfaces in the community is increasing. This article reviews the need for clinical and cost-effective pressure-relieving surface solutions in the community and introduces the concept of the Russka pressure-relieving low air-loss system.
General nurse who gave inaccurate information in healthcare records
Authors: Castledine George
Published: May 2014

Freda House is a special unit which cares for frail elderly blind people. There are various houses which make up the unit and one of these serves as a nursing facility of 24 beds. People are admitted to the nursing house only when they are in a very vulnerable situation and require intensive nursing care.
Pressures on mental health units are affecting service
Authors: Greatley Angela
Published: May 2014

Hospital care for people with mental health problems has undergone a transformation in the past 20years, from the ‘water tower’ hospitals of old, in which people stayed for many years, to the acute inpatient units of today. Yet, as a new survey published by the Sainsbury Centre for Mental Health (SCMH) showed last month, those acute units are struggling to offer people a decent service under huge pressures (SCMH, 2005).
Should nurses be randomly tested for alcohol abuse?
Authors: Castledine George
Published: May 2014

There is no doubt that nursing is a stressful occupation, which can sometimes drive some nurses to drink. Recently it has been suggested in the media that, because of the type of work doctors and nurses perform, they should be randomly tested for drugs and alcohol. But is there a big problem of substance abuse among nurses? Certainly many nurses drink alcohol and are renowned for their wild parties and tendency to play hard after a tough shift.
Cranking up a failing NHS complaints system
Authors: Tingle John , Dunmore Laura
Published: May 2014

It has been known for some time that all is not well with the handling of complaints in the NHS. Health service ombudsman (HSO), Ann Abraham, reported on the problems of the current NHS complaints system (2005). In the report she stated:
Conference report: towards transcultural spirituality
Authors: Narayanasamy Aru
Published: May 2014

What follows is a brief commentary on the conference ‘Towards Transcultural Spirituality’ held at the University of Hull on 19 July 2005. The conference was organized by Margaret Holloway, Professor of Social Work in collaboration with visiting Professor Cecilia Chan, Hong Kong University. The conference explored our understandings of spirituality and implications for community relations and professional practice, from a range of disciplinary, religious and philosophical perspectives. The words spirituality, religion, culture, ethnicity and diversity can be ugly notions in the context of the London suicide bombings, which resulted in loss, devastation, despair, anger, emptiness and bewilderment. The list goes on. Yet, ironically, spirituality, religion, faiths and beliefs, culture and ethnicity can all be sources of comfort, support, hope, meaning and purpose, inspiration and connectedness. These can be a platform for shared humanity.
Registered nurse who failed in her duties to care for patients
Authors: Castledine George
Published: May 2014

The role of the care assistant is becoming more and more crucial these days. Not only do they provide essential patient care, but they also play a vital role in supporting the registered nurse in her work.
Access to medical reports
Authors: Dimond Bridgit
Published: May 2014

This article explores what rights persons other than the patient have to access health records which come under the Data Protection Act and other statutory provisions. These other persons could include the relatives of a patient, the parents of a child and those concerned with the estate of a deceased person. In addition there are other rights of disclosure recognized by the common law and these will be considered in a later article.
Six nursing essentials for the over sixties
Authors: Castledine George
Published: May 2014

There are possibly no worse sights on a ward then an older person struggling to sit up to breath and drink. What makes this situation so bad is that the person may have severe arthritis, can't hold things very well, has poor coordination, eyesight, hearing and their mouth and lips are cracked and dry, resulting in them having difficulty in swallowing.
Community matrons' rounds: the unbroken thread
Authors: Cook Rosemary
Published: May 2014

The article on the return of ‘matrons’ rounds' (Castledine and Close, 2005) describes a triple role for the new matrons. It is an exemplar role in relation to standards of care (demonstrating hand-washing and auditing cleanliness), a supervisory role (regarding nurses' progress and workload), as well as a public relations role for the benefit of patients and relatives (finding out their perceptions of care, ‘being visible’ and educating them). This is an interesting contrast to the new role of community matron, which is a clinical (care giving) and case-management role evolving directly from the existing district nurses' rounds.
Physiological and general health effects of chlamydia on men
Authors: Peate Ian
Published: May 2014

While chlamydia is a sexually transmitted infection that predominately affects females, this article concerns men and chlamydia. This article discusses the epidemiology, aetiology and signs and symptoms associated with a chlamydia infection. An outline of the consequences following infection will be presented along with the recommended treatment regimen. Chlamydia has the potential to become the interface between men's health and women's health. Most cases of chlamydia in women are a result of sexual contact with an infected man, and nearly all cases of chlamydia in the male, therefore, are the result of sexual contact with an infected woman. Addressing the sexual healthcare needs of men in relation to chlamydia has the potential to prevent the detrimental effects chlamydia may have on the female.
Consent to treatment records
Authors: Dimond Bridgit
Published: May 2014

This article analyses the use of documentation to establish that consent has been given to treatment and that the necessary information about the possibility of significant risks of substantial harm has been given. The Department of Health has provided guidance as to when consent should be obtained in writing and also provided specimen forms which could be adapted for use by adults and young persons over 16 years; parents on behalf of children; procedures where no loss of consciousness is involved and for those situations where adults lack the capacity to give consent. The amendment of the forms is also considered together with discussion over the retention of the records.
Matron of a residential home who failed to manage staff or patients
Authors: Castledine George
Published: May 2014

Being the matron in charge of a nursing home comes with responsibilities very different from those in the NHS.
The `Been There, Done That' attitude
Authors: Castledine George
Published: May 2014

The ‘been there, done that’ attitude is reducing nursing care to a series of physical tasks on patients. More and more these days one hears care assistants, students and senior nurses referring to clinical nursing practice as something which one goes through, does the work and moves on to better things or higher salaries.
Clinical Corner: medication-induced hyponatraemia
Authors: Jones Anne , Pegram Anne
Published: May 2014

In this scenario the interrelationship between a client's medication and the reason for his admission to hospital is identified. Tom is a 75-year-old man with a long-term mental illness and a history of falling at home. On initial assessment, direct observation indicated that, although Tom was able to mobilize, transfer from bed to chair and negotiate a flight of 15 stairs independently, he appeared to be slightly unsteady. Tom was unable to give possible reasons for his previous falls and his carer was also unable to identify a pattern.
Property: procedures for nurses to follow after a patient has died
Authors: Dimond Bridgit
Published: May 2014

A patient was brought into hospital following a heart attack at a garden centre and was found to be dead on arrival. His widow realized that he was carrying the house keys in his pocket and asked for them so that she could return home. The nursing sister stated that the keys had to be left in the safe until after the postmortem, even though the widow told her that she would not be able to get into her house without them. She returned to the house with her daughter, but was unable to get in and had to hire a locksmith the next day (Wright, 2000). What is the law?
Colostomy irrigation: are we offering it enough?
Authors: Woodhouse Fran
Published: May 2014

This article discusses the use of irrigation for suitable colostomists and reasons why it can have a very positive effect on lifestyle. While it is evidence-based it also includes anecdotal tips from patients who irrigate. The suitability of patients to irrigate and ways to ‘get started’ with irrigation are discussed.
Health and safety records
Authors: Dimond Bridgit
Published: May 2014

Records relating to health and safety risk assessments are vital in informing staff of inherent risks and securing the safety of colleagues, patients and the general public. In addition, since many of the statutory duties in health and safety laws must be complied with ‘as far as is reasonably practicable’ often the only way in which the employer can prove, on a balance of probabilities, that he did all that was reasonably practicable is by refeÆrring to the records relating to risk assessments, etc. If prosecuted by the Health and Safety Executive, the employer would find it very difficult to achieve an acquittal in the criminal courts, if the records are not present.
Leg ulcers: mental capacity of a difficult patient
Authors: Dimond Bridgit
Published: May 2014

This article explores the legal issues which arise for community nurses when patients fail to comply with their instructions. It looks at the importance of determining the mental capacity of the patient and the different situations which can arise, depending upon the outcome of the assessment of mental capacity. It discusses the nurse's responsibility to her patient and identifies the steps needed to have someone committed without their consent. It also considers the possibility of a patient having to be admitted to hospital compulsorily under the Mental Health Act 1983.
Clinical teaching and support for learners in the practice environment
Authors: McBrien Barry
Published: May 2014

The purpose of planned clinical experience for students of nursing is primarily to provide students with the opportunity to develop their clinical skills, integrate theory and practice, and assist with their socialization into nursing (Wong and Lee, 2000). Nursing, in the main, is a practice-based profession. To this extent, it is essential that nurse education continues to have a strong practical element despite its full integration into higher education institutions (Department of Health, 1999). However, providing adequate support and supervision for learners is challenging. Undoubtedly, exacerbated by increasing numbers of learners, staff shortages and mentors training deficits (Aston and Molassiotis, 2003). This article aims to critically analyse several strategies, which can be used to promote clinical learning.
Topical photodynamic therapy: an introduction for nurses
Authors: Oliver Paula
Published: May 2014

Non–melanoma skin cancers are the most common cancers in the UK. Although an estimated 50000 cases were registered in 1999 across England and Wales, there is likely to be significant under-reporting of cases. However, the cancer registries do not include pre-cancerous lesions of the skin and therefore the number treated will greatly outnumber the cancers (National Institute for Health and Clinical Excellence, 2006). Topical photodynamic therapy (PDT) is one of several effective treatments for pre-malignant and malignant non–pigmented skin cancers. The treatment is non-invasive and can be administered by nurses in a clinical setting. PDT is a two-step process involving the application of a light-activated substance followed by exposure to light to activate this substance. The treatment results in the elimination of tumour cells while leaving the healthy skin unharmed. This article provides an introduction to PDT for nurses who may in the future be involved in setting up a PDT service within their practice area.
Integrating simulation training into the nursing curriculum
Authors: Wilford Amanda , Doyle Thomas J
Published: May 2014

The use of simulation is gaining momentum in nurse education across the UK. The Nursing and Midwifery Council is currently investigating the use of simulation in pre-registration nursing. This article gives a brief history of simulation, discusses competence issues and why simulation is best placed to teach nurses in today's health service. An innovative approach to implementing simulation into the nursing curriculum is introduced.
Does the NHS need more physician's assistants?
Authors: Castledine George
Published: May 2014

The closing date for consultation on the future of medical care practitioners concluded this month. In so doing it left many people, including patient representative groups, confused as to the role and responsibilities of such assistants to the doctor.
Leg ulcers
Authors: Dimond Bridgit
Published: May 2014

This article considers the law which applies to the standard of care when patients are being treated in the community for persistent ulcers. It considers the importance of expert opinion in determining the reasonable standard of care and the significance of the guidelines of the National Institute for Health and Clinical Excellence.
Reduction and management of perioperative anxiety
Authors: Stirling Laura
Published: May 2014

Patient anxiety is a normal part of the surgical patient's ‘career’ and would be anticipated by nurses in a variety of settings. Anxiety causes a number of undesirable effects which may place the patient at greater perioperative risk. Factors that mitigate against the nurse being able to devote adequate time to this important aspect of patient care will not disappear overnight and arguably, without quality psychological care, patients are being placed at greater risk. This article considers the issue of perioperative anxiety with the aim to revise the concept and highlight the serious implications of giving it a lesser priority within patient care. Alternative strategies should be sought that might also help patients take back some control over their own challenging situations. Practitioners must acknowledge that there is a need to investigate their current practice and that they have a responsibility to address patient anxiety effectively.
Taking a stand and making a difference
Authors: Fox Jane
Published: May 2014

The Royal College of Nursing recently published a ‘Working Well – At breaking Point’ survey (RCN, 2005) which in summary indicated that:
Discussion on wound care in the 21st century
Authors: Harrison Mary
Published: May 2014

In June of this year, Liverpool John Moores University was the venue for the Advancing Wound Care conference. Experts in wound healing from both the university and from the Royal Liverpool and Broadgreen University Hospital NHS Trust gave keynote speeches aimed at informing, improving and advancing healthcare knowledge on such topics as: wound healing in the 21st century; evidence-based practice for superficial burns; infected and complex wounds; and the use of silver in wound care. This paper introduced the conference and considered some of the complex issues involved in clinical decision making for wound management.
Nurses training doctors: evaluation of a fifth year medical school pilot
Authors: Brian Sergeant Alison , Jackson Flight Sergeant Deborah , Kenward Gary
Published: May 2014

In October 2004 a request was made to the Royal Centre for Defence Medicine to support a pilot project for a leading Midlands medical school. The aim of the project was to standardize clinical skills training for medical students prior to House Officer jobs. Experienced military emergency nurses provided clinical training including cannulation, catheterization and phlebotomy in a simulated environment. All fifth year medical students attending clinical skills training were invited to complete post-training evaluation questionnaires. The project was evaluated positively and there was an excellent response to nurses training doctors. There was a statistically significant improvement in post-training confidence. All medical students passed their practical assessment following the training programme. This pilot project has been highly successful and has subsequently been extended to all fifth year students at the medical school. The range of clinical skills taught by nurses has also been widened.
Balancing recognition and bureaucracy
Authors: Karstadt Lyn
Published: May 2014

Nursing and midwifery education has evolved over the past few decades, making many in the profession — as well as education — slightly confused as to what is going on. In this fourth column, Lyn Karstadtdiscusses the general practice nurse education summit, an event designed to engineer open and productive debate and produce a blueprint for future action in general practice.
Abuse by care professionals. Part 5: implications for nurses
Authors: Barber Christopher
Published: May 2014

The fourth article in this short series of five articles focused on the support resources for those care professionals who abuse and on the support needs of, and resources for, a person abused by a care professional when she was younger. The view that such resource needs could become a ‘wish list’ devoid of financial contexts was briefly mentioned. This final paper in the series will use information gathered from previous articles to formulate some general suggestions for future practice and will discuss such a ‘wish list’ in terms of its implications for nurses and nursing practice, although as this series has aimed to highlight abuse by all care professionals and not just nurses, such practice implications can apply equally to all healthcare professionals and even beyond to include social, educational and religious professionals.
Condemned or curious? Don’t believe the hype
Authors: Bailey Asa
Published: May 2014

Everybody knows that children and teenagers like to experiment in their early years, be it with alcohol, tobacco, drugs, sexual relations – or indeed any activity that is generally thought to be the domain of the adult and has the potential to harm them in some way or another. Unfortunately, these most damaging of activities are often the most enticing and appealing to young people, not least because of the way these activities, their effects, and consequences are portrayed in the media and hence acquire an almost taboo status.
Using therapeutic groups to support women with faecal incontinence
Authors: Chelvanayagam Sonya , Stern Julian
Published: May 2014

In this paper, the authors describe the use of facilitated patient groups, in the management of women with faecal incontinence (FI). Two types of groups are discussed – a psychoeducational group and a psychotherapy group. Detailed descriptions of some of the themes which emerged in these groups are provided. The effectiveness of such groups is described, with regard to both psychological and physical functioning. Further investigation into the use of groups for this patient population is recommended.
History taking in the Australian outback: haematuria
Authors: Bentley Jenny
Published: May 2014

History taking is a major part of patient assessment, particularly in establishing differential diagnoses and to identify the organ (or organs) responsible for symptoms. The history can also clarify the pathological processes present (Ford et al, 2000).
Motivation is the key between quality and mediocrity
Authors: Castledine George
Published: May 2014

During the recent severe snow and ice problems which brought major chaos to Birmingham and the West Midlands, I was most impressed with the attitude and commitment of some of the nursing staff I worked with. Not only did some of them stay on to cover staff who could not make it in to work, but many stayed overnight in hospital accommodation to be sure of being present the next morning. It is at times such as these that you really get an insight into the character of your nursing staff and their willingness to stretch or put themselves out for the good of their patients and their organization.
Dealing with death: first encounters for first-year nursing students
Authors: Terry Louise M , Carroll Jo
Published: May 2014

End-of-life care, particularly for older people, is often sub-optimal in England, and the Government has introduced several initiatives to improve this care. The authors believe the twin frameworks of emotional labour and ethics of non-abandonment underpin the provision of high-quality care. This article discusses a research project that investigated first-year nursing students’ encounters with patient deaths. The research found that, to the student, every death in clinical practice is a learning experience and potentially a source of emotional distress; some students reported experiencing flashbacks afterwards and were developing avoidance behaviours. Students sometimes felt unsupported by mentors and also felt that sometimes dying patients and families were inadequately cared for. The theme of abandonment was evident in the students’ stories. The authors conclude that there is still room for improvement in end-of-life care. Good role modelling and pastoral care by mentors is vital to student development. Link lecturers and mentors need to be alert to student distress.
Breast cancer. Part 1: awareness and common benign diseases
Authors: Harmer Victoria
Published: May 2014

Breast cancer is the most common cancer for women in the United Kingdom and topic on which there is much information. This article discusses the principles behind breast awareness and breast health, detailing common benign breast diseases that cause disproportionate anxiety. The NHS Breast Screening Programme is celebrating 20 years of screening this year, and in all randomized controlled trials of women aged 50 and over, mortality from breast cancer is reduced in those offered screening compared with unscreened controls (although the reduction is not statistically significant in all trials). Once a breast cancer is diagnosed, the different characteristics and stage of the disease can be identified through histopathology and scans. These factors will be discussed later in this article, including illustrating if a cancer is hormone sensitive or HER-2 positive, for example. These factors enable clinicians to recommend a treatment pathway suitable for each individual.
Travel health. Part 2: advising travelers visiting friends and relatives abroad
Authors: Wong Claire S , Behrens Ron H
Published: May 2014

International travel has become more accessible and affordable, and travel, particularly to tropical and malaria regions, has increased by up to 8% annually. This change in travel has surprisingly not resulted in an increase in imported diseases. Surveillance reports of hepatitis A and enteric fever have not increased and a significant and sustained fall in malaria over the decade has been described. Nurses in primary care are the predominant providers of pre-travel health services and they have an important and influential role in preventing travel-associated illness. This is the second article in a 3-part series on the spectrum of health issues associated with travel. Part one discussed pre-travel health advice, including risk assessment and educating travellers. This article explores the highest risk group of traveller, those visiting friends and relatives (VFRs). The article highlights the specific disease risks for VFRs and how these may be influenced by their health beliefs. The article explores ways in which nurses can optimize the travel health consultation to ensure that the specific needs of VFRs are met and that they receive accurate and achievable advice .