bluuebunny/crossref_metadata_2025 huggingface dataset:
Fathers' experiences accompanying labour and birth
Authors: Shibli-Kometiani Miriam , Brown Anna M
Published: May 2014

This study aimed to explore the role of first-time fathers during the birthing process and to ascertain their perceptions and experiences within the multi-cultural setting of Nazareth, Israel. Eight fathers participated in retrospective semi-structured interviews 2–6 weeks after the birth of their child. Despite their cultural and religious beliefs, most fathers reported similar experiences concerning their supporting role. Data revealed that all fathers were willing to attend labour and birth, yet expressed feelings of fear and helplessness during the event due to unrealistic expectations, deficiency in antenatal preparation, lack of midwives' guidance, communication and flexibility regarding fathers' freedom of choice.
The use of naltrexone in pregnancy in opiate-dependent mothers
Authors: Geraghty Sadie , Dixon Carly
Published: May 2014

There is an absence of sufficient evidence regarding naltrexone use in pregnancy due to the limited range of human studies. Naltrexone implants are being used in Western Australia as a treatment for opioid dependency, and although contraindicated for insertion during pregnancy, there are a number of women who conceive while undergoing treatment. A review of the available data revealed that naltrexone is associated with improved maternal and fetal outcomes. Extensive research into this area in the form of large, multicentre trials is required to confirm the results of the current research.
Antenatal comorbidity of mental health and substance use: Assessment and engagement
Authors: Hamilton Ian
Published: May 2014

It is acknowledged that women who use substances in a problematic way are more likely to have co-existing mental health problems ( Grella, 1996 ; Kelly et al, 2001 ; Neale, 2004 ; Teesson et al, 2012). Likewise, there is evidence that women are more likely to experience certain mental health problems such as depression ( Melville et al, 2010 ). Given that both substance misuse and mental illness have an increased incidence during the childbearing years ( Kelly et al, 2001 ), there is a paucity of research in the area of pregnant women who have comorbid mental health and substance use problems. This paper explores the ways in which this group of women can be engaged and assessed in practice.
Papanicoloau smear uptake among substance-using mothers in Western Australia
Authors: Geraghty Sadie , Bayes Sara , McLaurin Renate , O'Connor Angela
Published: May 2014

Background:

Papanicoloau (Pap) smear screening has helped to reduce cervical cancer rates significantly through the detection of premalignant cells ( Bray et al, 2005 ). Uptake among women who use alcohol and other drugs (AOD) is known to be low ( Chau et al, 2002 ) so they are at increased risk of being under-represented in the adequately screened population. AOD-using women experience disproportionately increased morbidity and mortality from cervical dysplasia and cancer ( Nogara et al, 2013 ). Pregnancy may provide the midwife an opportunity to offer this vital screening test.

Objective:

The audit investigated Pap smear uptake and results among AOD-using pregnant women.

Setting:

Pregnant women cared for by an obstetric AOD service based in a tertiary hospital in Perth, Western Australia, were eligible for inclusion in the study.

Results:

Across a period of 12 months, 333 childbearing-aged AOD-addicted women were audited: 142 had a Pap smear in the previous 3 years; 80 had not had a Pap smear in the previous 3 years; 80 declined a Pap smear; and 31 were either illegible or no record was available.

Conclusion:

This audit emphasises the importance of Pap smears being offered and followed up among the population of AOD-using pregnant mothers. Encouraging early booking and access to early antenatal care with midwives who are proficient in Pap smear collection is essential in order to provide optimal care.
A qualitative evaluation of women's experiences of the Mellow Bumps antenatal intervention
Authors: Breustedt Sarah , Puckering Christine
Published: May 2014

Mellow Bumps is a group-based intervention which draws on psychological and practical techniques to reduce anxiety and promote wellbeing in vulnerable pregnant women. This study explores participants’ experiences of taking part in Mellow Bumps. a small sample of mothers who had participated in Mellow Parenting groups in Glasgow were invited to discuss their experiences in a non-directive, unstructured interview. Interview transcripts were then processed using interpretative phenomenological analysis (IPA). several strengths of the antenatal intervention were identified; these included the facilitator’s provision of support, the social aspect of meeting other mothers-to-be, learning about infant development and practical strategies. Barriers to engagement identified were negative preconceptions about antenatal support, fear of being judged and feeling pressured by services to participate. No fundamental issues concerning the validity of the intervention were identified; however, a need for greater promotion of and referral to the Mellow Bumps groups among health professionals was noted.
Undiagnosed breech: Towards a woman-centred approach
Authors: Walker Shawn
Published: May 2014

The unexpected diagnosis of breech presentation upon admission in labour affects approximately 1 in 100 women and presents an ethical dilemma for health professionals involved, particularly when this occurs in the context of midwifery-led care. This article critically examines current guidelines recommending caesarean section on the basis of available evidence, outlines factors which must be considered in order to provide safe care, makes recommendations for women-centred counselling and explores the role of the midwife in this situation.
Calculating patients risk of deep vein thrombosis
Authors: Autar Ricky
Published: May 2014

Deep vein thrombosis (DVT) constitutes a serious threat to patients' general recovery. DVT in postoperative and bedridden patients is usually preventable and a thromboprophylaxis protocol based on risk assessment categories is strongly recommended. The Autar DVT risk assessment scale was developed to separate risk into no risk, low, moderate and high risk categories. Founded on Virchow's triad in the genesis of DVT, the scale is composed of seven categories of risk factors. When the scale was tested on a trauma/orthopaedic unit a cut-off score of 16 yielded 100% sensitivity, 81% specificity and a correlation coefficient of 0.98. The DVT scale is designed to allow application in diverse clinical specialties. It is recommended that nurses using the Autar DVT scale should evaluate for themselves the best cut-off score to achieve maximum predictive accuracy.
Infusion devices: risks and user responsibilities
Authors: Morling Simon
Published: May 2014

The Medical Devices Agency of the UK Department of Health continues to receive and investigate reports of incidents that arise from the use of infusion devices. In 1996, the Medical Devices Agency received some 4300 reports of incidents, over 400 of which were classified as infusion-, transfusion-, or dialysis-related. There is, however, a trend towards more active management of medical devices focusing on aspects such as purchasing, training, clinical use, and maintenance, and clearly, nursing staff have an important role in developing such policies. Also, nurses with the responsibility for setting up and overseeing infusions should be aware of some of the problems that can arise during routine use, as an awareness of potential hazards allows users to manage the risks more effectively. This article examines some of the risks asociated with the use of infusion devices; in particular, problems that arise while loading the administration set or syringe into the pump, the risks of fluid free flow and syringe siphoning, and the risks from air embolism, flow rate accuracy and infusion pump pressure.
Helping clients in their sexual expression
Authors: Scott Helen
Published: May 2014

At the RCN Congress the RCN Learning Disabilities Forum (LDF) put forward the resolution that the Council should develop a nursing code of practice to guide professionals who assist clients with disabilities towards expressing their sexuality in an appropriate and non-harmful way. The resolution was passed by 89% indicating that nurses are at least concerned about this issue and require guidelines to clarify their position regarding this matter.
3M Cavilon No Sting Barrier Film in the protection of vulnerable skin
Authors: Williams Clare
Published: May 2014

Skin often becomes vulnerable in incontinent patients or following the use of aggressive adhesive tapes and dressings. Until recently the only products available for use on such skin have been ointments, creams and alcohol-based products. 3M Health Care has launched a range of no sting barrier film applicators that provide skin protection in many scenarios, but in a product that does not sting or cause pain on application.
Substance use and mental health problems: meeting the challenge
Authors: Holland Mark
Published: May 2014

Dual diagnosis is a term used to describe co-existing substance misuse and mental health problems. Although mental health workers have encountered people with a dual diagnosis in the past, the need to address the problems in the context of community care has never been greater. Literature from the USA suggests that specialist services, which pool resources and skills, are required to provide the specialized support for this client group needs. Existing services in the UK remain specifically focused on substance misuse or mental health, yet the growing body of research indicates the efficacy of providing both services simultaneously, preferably as one discrete service. Finding a pragmatic approach to working with dually diagnosed clients and their families is a challenge to all mental health and drug/alcohol workers and this article describes the efforts of specialist teams to deliver such a service.
Acute surgical wound care 1: an overview of treatment
Authors: Moore Peter , Foster Lorraine
Published: May 2014

The first article in this series of articles on acute surgical wound care traces the history of surgical wound care, from primitive dressings and techniques of closure used in the past to the present-day approach. The history of surgical wounds is discussed together with a classification of the different types of surgical wound closure. Nowadays, it is recognized that the management of surgical wounds has to be planned carefully to achieve adequate exposure to the area of surgery. At the same time the surgeon has to be conscious of how the wound will heal to ensure optimal postoperative function and cosmetic results. To do this an understanding of the principles underpinning surgical incisions, and of alternative techniques for their closure, drainage and wound dressing, is needed. The role of the nurse in preparing patients preoperatively and supporting and caring for them postoperatively is paramount.
Interventions for confusion and dementia 4: alternative approaches
Authors: Woodrow Philip
Published: May 2014

While reality orientation and reminiscence are useful therapies, recent years have seen a growing awareness of other approaches to caring for people with dementia. This article discusses some of the less established, but potentially valuable, approaches — validation therapy, resolution therapy and multisensory environments. Validation therapy seeks to help care givers understand the thoughts and feelings of care receivers. In contrast to the confrontational approach of reality orientation, it encourages empathy between giver and receiver. Resolution therapy develops aspects of validation therapy, adopting a less structured, more psychodynamic and individualistic approach. Multisensory environments use sensory stimulation to achieve pleasure for the individual. All three approaches have a limited knowledge base, but share a humanistic philosophy that enables them to contribute to a person's quality of life.
District nurses' knowledge and practice of wound assessment: 2
Authors: Kennedy Catriona , Arundel Dawn
Published: May 2014

The first article in this series reported a study that examined the wound assessment practices of 20 district nurses in one healthcare trust. The most common method of assessing wounds was found to be a combination of observation and experience (Vol 7(7): 380–6). This article, the second part, describes the subsequent establishment of a forum to develop a research-based wound assessment tool. The issues surrounding changing practice are complex. It is clear that the process of basing practice on evidence is the responsibility of all those who are involved in healthcare. However, there is an urgent need to bring the practice, research and education agenda closer with organizational and managerial commitment to change. This work suggests that a short-term increase in resources will result in possible long-term benefits for patient care.
Family carers 3: coping strategies among family carers in Sweden
Authors: Lundh Ulla
Published: May 2014

This is the third of four articles considering various aspects of family care giving in Sweden. The previous articles (Vol 8(9): 582–588; Vol 8(10): 647–652) have looked at the difficulties carers face and their sources of satisfaction from what they do. This, the final empirical article, presents data from the same group of carers on the coping strategies and tactics that they use. It demonstrates that carers often employ a complex range of coping behaviours and it is suggested that healthcare professionals, particularly nurses, must be aware of and seek to complement carers' coping patterns if more appropriate and sensitive services are to be developed.
The benefits of preparing children and parents for day surgery
Authors: Murphy-Taylor Cathleen
Published: May 2014

Hospital admission for children inevitably provokes feelings of anxiety for both parent and child. The development of day surgery has in some respects eased many of these anxieties; however, without the support of both verbal and written information and the development of quality preparation from children’s nurses anxiety will continue to exist. This article seeks to explore the benefits of preparing children and parents for day surgery using preadmission education, and suggests how improvements may be made to practice, education and research.
Instillagel: an anaesthetic antiseptic gel for use in catheterization
Authors: Doherty Willie
Published: May 2014

Instillagel is a prefilled syringe containing lignocaine 2% and chlorhexidine 0.25% in a sterile lubricant gel. It is available in two sizes, 11 ml and 6 ml, for male and female catheterization respectively, and for intermittent self-catheterization. It has been used successfully for these purposes for many years, and its usage in the community setting is increasing. It is used for surface anaesthesia by many UK urologists. It is easily applied by both nurse and patient and remains the product of choice when performing indwelling catheterization. It also has an important role in stricture therapy where patients require extra lubrication for the passage of a catheter or an anaesthetic effect to provide patient comfort following the procedure. Instillagel has the added benefit of an antibacterial effect due to its chlorhexidine content.
Tracheostomy care: tracheal suctioning and humidification
Authors: Buglass Edith
Published: May 2014

Tracheostomy care is a complex nursing activity and has many potential complications. However, aspects of tracheostomy care appear to be carried out without uniformity and with some confusion as to correct techniques, especially outside the ear, nose and throat and intensive care environments. Some aspects of the literature appear contradictory, leaving nurses to make individual judgments about correct procedures. It is the nurse who is accountable for the care given; therefore, with the wealth of evidence available, it is important that the nurse is adequately trained and fully competent in the care of a patient with a tracheostomy. This article discusses particular aspects of tracheostomy care: assessment; tracheal suctioning; suction pressure; suction catheters; and humidity.
Understanding physiology of wound healing and how dressings help
Authors: Russell Linda
Published: May 2014

One of the most fascinating features of the human body is its ability to repair damaged tissue. When the skin is injured a complex process occurs. The natural healing process can be divided into four distinct stages: inflammatory, granulation, epithelization and maturation. This process can take up to 2 years. Brunner and Suddarth (1992) classified wound healing into three stages: primary; secondary; and tertiary. Many factors affect how long a wound will take to heal, e.g. concurrent illnesses, nutritional status and the dressing used. A holistic approach to wound care is the key, and if all the factors are not addressed then wound healing will not prevail.
Fit for purpose? promoting the human side of mental health nursing
Authors: Cutcliffe John R
Published: May 2014

Currently, preparation of mental health (MH) nurses appears to emphasize tangible, highly visible skills acquisition. While few credible MH nurses would argue with the need for some acquisition of skills during nurse training, it is the emphasis on this acquisition of skills at the expense of the development of certain other qualities that is questionable. This article argues that the ‘human side’ of MH nursing should not be forgotten or ignored and draws attention to evidence of the invisibility of some aspects of MH nursing. It also draws attention to how ‘human-focused’ MH nursing practice may be inhibited by market forces, the pressures of economic restraints and the current preoccupation with ‘quick-fixes’. It points out that within the field of psychiatry and MH care, there is evidence that some nurses have returned to 1930s neo-Darwinian perspectives of the mind. The article suggests that it is unlikely that current MH nurse training, with its emphasis on neurobiology and masculine approaches to care, adequately prepares MH nurses for ways of working which are described in this article as the ‘proper focus of nursing’. Additionally, the article points out that a view of the development of MH nurse training that includes more training in psychotherapeutic approaches to care is not evidence of a fanciful, unrealistic or Utopian view of MH nurse preparation.
The relative influence of personal and workplace descriptors on stress
Authors: Bryant Charmaine , Fairbrother Greg , Fenton Penny
Published: May 2014

A survey canvassing self-reported workplace stress levels and personal/workplace demographics was conducted among a sample of Australian nurses. Stress ratings and demographics were cross-sectionally analysed. Quantitative and qualitative analyses of survey responses suggest that excessive workload is the likely dominant predictor of workplace stress. Personal and workplace demographics are shown to be relatively unimportant in comparison with workload-related factors. Regular exercise habit was shown to be correlated with reduced workplace stress ratings. The findings support a previously unreported view that nurses are unlikely to bring their personal stress with them to the workplace — rather the workload characteristics of the workplace itself are the principle stress determinants.
Intrasite Gel and Intrasite Conformable: the hydrogel range
Authors: Vernon Tracy
Published: May 2014

Wound management can be a confusing area of nursing practice. Even when an holistic patient assessment has been undertaken healthcare professionals frequently ask for guidance when faced with choosing the most appropriate wound management product. This article reviews two hydrogels from Smith & Nephew Healthcare — Intrasite Gel and Intrasite Conformable, which is the latest addition to the hydrogel range.
Improving pain management: breaking down the invisible barrier
Authors: Mann Eileen , Redwood Sabi
Published: May 2014

There is compelling evidence that despite growing research into the complex neurophysiology of pain, the development of acute pain services, increasing educational interest in pain management and the proliferation of literature, many patients continue to suffer from unrelieved acute pain while in hospital. Educational efforts to bring about a change in practice have been relatively unsuccessful or slow to have real impact. Although it is still recognized that poor knowledge of pain control by all healthcare professionals is the major barrier to improving pain management, contemporary studies show that other, more subtle barriers can just as effectively inhibit a timely and effective response to patients' reports of pain. These barriers are not just the ones created by poor knowledge, myth and misconception; the most powerful barriers to change may be the invisible institutional barriers that can be entrenched within hospital policies and nursing rituals.
The use of clinical supervision in secure environments
Authors: Storey Les , Minto Christopher
Published: May 2014

It is probably still fair to say that clinical supervision is not widely implemented throughout the nursing profession. Indeed, Butterworth (1998) has implied that the notion that clinical supervision is widespread in mental health nursing is an assumption. This article draws upon the findings of two recent studies which examine the availability and acceptance of clinical supervision in forensic mental health settings. The findings indicate that there is a low level of acceptance of clinical supervision both within the prison service and also in forensic settings. Following an exposition of the findings, this article will discuss some of the practical difficulties encountered in the systematic implementation of clinical supervision across this professional group who work within conditions that test their professional resilience.
Safe use of medical gases in the clinical setting: practical tips
Authors: Peate Ian , Lancaster Jerry
Published: May 2014

For a variety of reasons, nurses, midwives and health visitors may have to be involved in administration of many types of medical gases. In order to provide safe and effective care the nurse must be aware of the implications of his/her practice. This article discusses and describes the many types of medical gases available in clinical practice. The article focuses on four commonly used gases: oxygen, air, nitrous oxide and entonox. Practical tips are offered and the focus is made on the safe and effective use of the gases. Details regarding the storage and administration of medical gases are outlined. Finally, some of the potential dangers associated with the gases are discussed.
Male patients with lower urinary tract symptoms 2: Treatment
Authors: Dorey Grace
Published: May 2014

The first part of this article (Dorey, 2000) described the subjective and objective assessment of men with lower urinary tract symptoms (LUTS). This article will examine treatment protocols for stress incontinence, urge incontinence, post-prostatectomy incontinence, post-micturition dribble, overflow incontinence, reflex incontinence and functional incontinence. Pelvic floor muscle exercises, biofeedback, electrical stimulation, urge suppression techniques, and fluid intake are discussed. It is concluded that men with LUTS can benefit from conservative treatment.
SuperSkin: the management of skin susceptible to breakdown
Authors: Hampton Sylvie , Collins Fiona
Published: May 2014

Few studies have been undertaken in the area of skin protection, even though maintaining tissue viability in the event of incontinence, shear forces and the potential for exudate to macerate periwound areas remains a challenge for any nurse caring for patients. This article outlines and discusses the problems associated with overhydrated tissues and shear forces and the potential for SuperSkin liquid film dressing, marketed by CliniMed, to provide a solution.
Back pain management: a patient satisfaction study of services
Authors: Layzell Mandy
Published: May 2014

The objectives of this study were to assess patient satisfaction with the current services provided for back pain, and to increase the level of understanding from the patients' perspective on beliefs about their back pain and how it affects their daily life. The study was conducted in two parts combining both quantitative and qualitative methodology. The main findings in the study revealed a high level of satisfaction with the services provided by the physiotherapy department and mixed levels of satisfaction with the GP. The GP was seen to be an expert yet failed to exhibit up-to-date knowledge about the causes and treatments for back pain. The issue of locus of control was a dominant theme throughout the study and those with stronger internal beliefs had a more positive outlook. The study revealed gaps in the current service provided, and the need for a more easily accessed service was desired.
Review of home paediatric parenteral nutrition in the UK
Authors: Holden Christine E
Published: May 2014

Home parenteral nutrition (HPN) is an expensive technological development which has given life to children with chronic intestinal failure. However, HPN is a complex therapy which carries life-threatening risks. The British Artificial Nutrition Survey (BANS), launched in 1996, monitors and audits HPN in the UK. It is the largest ongoing survey in the world, reviewing patients receiving enteral and parenteral nutrition. Data collated from health professionals between June 1996 and September 1999 identified 81 children who were registered. The commonest diagnosis for starting HPN was short-bowel syndrome, with 41% of the children being under the age of 1 year. Readmission rates of children to hospital were reported as less than 2%, suggesting that most of the burden of care is placed on families. Questionnaire data received from families (response rate 38%) identified that sleep disturbance was common. Families also experience a deterioration in their family life. This relates to poor social life activities and overall quality of life after the child had started HPN. Further qualitative research data are required to review the ongoing psychosocial issues for families.
Improving the nutritional status of people with dementia
Authors: Biernacki Claire , Ward Lathkil , Barratt Janice
Published: May 2014

The attention given to the nutritional needs of older adults receiving hospital care has been the subject of research over recent years. It has been suggested that older people are suffering from malnutrition as a result of poor nursing care. Those involved in care of persons with dementia are faced with considerable difficulty when trying to respond to their nutritional care needs and there is concern that there may come a time when the care team will withdraw food and fluid. However, in Southern Derbyshire we believe that we now have a set of standards for nutritional care of older adults with dementia that can ensure adequate and good nutrition despite the numerous and complex problems posed by dementia. This article discusses the progress of a sample of 20 residents of a long-stay ward over a period of 6 years and shows how a multidisciplinary team accessed, developed and applied an evidence base to practice to the benefit of the sample group. The outcomes show that malnutrition can be reversed, and that people who are considered to be in the final stages of dementia can improve their nutritional status.
Discussing cardiopulmonary resuscitation with patients
Authors: Attwood Sandra , Anderson Kate , Mitchell Theresa
Published: May 2014

The British Medical Association and the Royal College of Nursing acknowledge that patients should be involved in the decision-making process regarding cardiopulmonary resuscitation (CPR) in order to gain compliance with any decision made on their behalf. In the past, it was apparent that decisions concerning the eligibility of patients for CPR were being made arbitarily and older people were being treated unfairly in respect of their consideration for this intervention. This article reviews literature associated with patient involvement in decision making regarding CPR and ‘do not resuscitate’ orders and how an assessment and rehabilitation unit promoted this activity as usual practice. In order to enhance partnership with patients and promote best possible practice in respect of CPR decision making the authors suggest a strategy that includes (1) evaluating documentation (2) development of a patient information leaflet and (3) an education programme for healthcare personnel.
Continuing care after discharge from hospital for stoma patients
Authors: Pringle Wendy , Swan Elaine
Published: May 2014

The purpose of this study was to monitor the progress of patients given a permanent colostomy for colorectal carcinoma and to evaluate the need for nursing interventions or referral. A pretested semistructured interview schedule was used. Interviews were conducted at 1 week, 1 month, 6 months and 1 year after discharge. Complete data sets were obtained for 112 patients. In this study it was found that survival was strongly related to Dukes’ staging system. More than half of those surviving to 1 year suffered fatigue, one in 10 had severe pain and one in five had parastomal hernia. At each interview approximately one in four people required intervention and one in 10 were referred. This study demonstrates the need for home visits and sustained patient contact. High priority should be given to a full benefit analysis of screening programmes, including the considerable costs of aftercare.
Phantom bladder sensations: a new concern for stoma care workers
Authors: Biley Francis C
Published: May 2014

The phenomena of phantom limb pain and sensations are well recognized in the medical literature. However, historically, there has been little more than passing reference to phantom pain and sensations of visceral organs. In particular, phantom bladder pain has been barely recognized. This article describes the result of a small survey of urostomists (n = 50) who experienced bladder pain and sensations that were described by the respondents as being a perpetuation of the pain and sensations that they experienced before cystectomy or urinary bladder diversion surgery. Respondents reported a varied frequency of sensations, unhelpful healthcare professional responses and a range of strategies that they employed to deal successfully with the pain and sensations. The findings of this study are important because they have identified significant issues for stoma care patients that need to be addressed by those involved in stoma care and which could lead to significant quality of life improvements. This research has shown that stoma care workers need to include the possibility of the occurrence of phantom bladder sensations in preoperative counselling, acknowledge and support postoperative patients by confirming the validity of their experience and by using interventions, identified in this study, that can minimize the effects.
Pathways for continence care: the validation process
Authors: Bayliss Valerie , Cherry Maggie , Locke Rachel , Salter Liz
Published: May 2014

This article is the third in a series of three describing a collaborative project between continence advisers in Loddon NHS Trust, Basingstoke, East Wiltshire Healthcare Trust, Swindon, and Salisbury Healthcare Trust to develop and implement care pathways to improve continence care provided to patients. The first article described the issues facing the continence advisers and the background to the decision to develop evidence-based care pathways (Vol 9(9): 590–6). The second covered the literature search and described how each pathway evolved (Vol (17): 1165–72). This article outlines the mechanisms by which the care pathways were subjected to a process of content validation.
Reflection: possible strategies to improve its use by qualified staff
Authors: Williams Gaynor R , Lowes Lesley
Published: May 2014

Reflection is now a prerequisite for all nurses, midwives and health visitors (UKCC, 2001). It is the method endorsed by the UKCC to promote the development of informed, knowledgeable and safe practice, and qualified practitioners are required to maintain a personal professional profile containing evidence of reflection on practice. The aim of this article is to examine why qualified practitioners may be reluctant to reflect formally, to speculate on the possible barriers to reflection, and to suggest how reflection can be promoted positively as an integral part of nursing practice. The article begins with an examination of definitions of reflection, reflective theory and the purpose of reflection, and continues by questioning whether the concept of reflection has been embraced as eagerly by nurses at ‘grass roots’ as it has by academia, the nursing press and the UKCC. It is suggested that several barriers to effective reflection may create a division between practitioners and the professional hierarchy regarding the conceived common practice of reflection, and strategies are proposed that may help to overcome these barriers. The discussion concludes by prioritizing the need for a clear definition and concept analysis of reflection, supported by long-term investment into research that explores the effect of reflection on clinical practice and patient care.
Issues emerging from the London Learning Disability Plan
Authors: Hallawell Bob
Published: May 2014

This article gives an overview of the draft of the London Learning Disability Plan developed by the Department of Health, Social Services Inspectorate and the National Health Service Executive. The London Plan is founded on a social model of disability in which there is not only a strong focus on health and social care, but also an integration with housing, education, employment, leisure and other relevant organizations. It advocates integrated commissioning and delivery of specialist learning disability services that will require both health services and nurses to change existing structures and interventions. New forms of workforce development will emerge and clarification will be required about the future role of learning disability nurses within London. Information specific to the Plan is gathered from the Department of Health’s learning disabilities Web site. The Plan is laid out in four booklets, one of which (Booklet 2: ‘Services to Improve People’s Lives’) was not available at the time of writing. The article thus contains information and proposals that may be altered by subsequent publication.
Diagnosing diabetes: blood glucose and the role of the laboratory
Authors: Higgins Chris
Published: May 2014

The hallmark of untreated diabetes mellitus is a raised blood glucose concentration (hyperglycaemia), associated with many other disturbances of blood chemistry, including acid-base and electrolyte imbalance. This has ensured a central role for clinical laboratories in both diagnosis of diabetes and lifelong monitoring of the diabetic patient. That role is the subject of this article. The aim is to explain how blood glucose concentration test results are used to diagnose diabetes. Central to this will be consideration of the new World Health Organization (WHO) criteria for the diagnosis of diabetes, which were introduced to UK diabetic practice in June 2000. The significance of blood glucose and other laboratory blood tests for monitoring the diabetic patient after diagnosis are also discussed.
Assessing pain in people with profound learning disabilities
Authors: Davies Dee , Evans Lynwen
Published: May 2014

People with profound learning and multiple disabilities are at risk of pain because they experience complex and severe health conditions and frequently undergo surgical procedures that cause pain. Pain assessment in this client group requires a skilled approach, although there is little evidence available to guide nursing practice. In the absence of pain assessment measures specifically designed for use with people with profound learning disabilities, the nurse will need to rely on careful observation and interpretation of the client's communicative behaviour, clinical judgment and knowledge of the person during assessment. Intuition is also an important attribute and can be a valuable source of knowledge when assessing clients who are unable to verbalize their experience of pain. These issues, along with implications for nursing practice, are explored.
Mouth care in cancer nursing: using an audit to change practice
Authors: Honnor Amanda , Law Annie
Published: May 2014

Patients with cancer face an assault on oral health from their disease and accompanying treatment options and are vulnerable to developing oral problems; therefore, the maintenance of oral health is particularly important. A study was carried out in one oncology unit within a large teaching hospital to measure the extent of oral problems in cancer patients, current mouth care practices, and staff knowledge. The findings showed that oral problems were common, but were: (1) underreported by patients (2) underdiagnosed by doctors and nurses (3) inadequately treated, and (4) inadequately documented. Nursing staff were found to have knowledge deficits. Changes to practice as a result of these findings included the development and implementation of an oral assessment tool and the development of oral care guidelines; additionally, patient information leaflets and posters were produced and a staff education programme was introduced. A further audit found that there had been significant improvements in the diagnosis and treatment of oral problems and increased reporting of previously ignored problems by patients.
Nursing care of patients with nasogastric feeding tubes
Authors: Cannaby Ann-Marie , Evans Lysette , Freeman Amanda
Published: May 2014

Nasogastric tubes are commonly used for patients as a short-term method of providing continuous, prepacked liquid feed. In order to explore how evidence-based practice is being incorporated into care, we conducted a survey investigating the views and practices of nutrition specialist nurses in acute trusts across the UK. A postal questionnaire comprising 35 questions considered the role of the nutrition specialist nurse, care of patients with nasogastric tubes, and training and education of nurses in the care of these patients. Results of this small study indicate differences in the education and practice of nursing care for patients with nasogastric tubes. Therefore, it is vital that evidence and good practice is disseminated both locally and nationally by benchmarking practice and by sharing knowledge and experiences in both journals and conferences. Nurses also need support in practising their skills to ensure they feel confident in caring for patients with nasogastric tubes.
Actico: a short-stretch bandage in venous leg ulcer management
Authors: Williams Clare
Published: May 2014

Actico compression bandage system (Activa Healthcare) completes the prevention and treatment regime of venous leg ulcer management. Actico gives the patient comfort by being a simple two-layer compression bandage system that is also effective and which stays in place because of its cohesive nature. This product focus looks at the impact of venous leg ulcers, the use of compression and focuses on short-stretch bandages and the Actico bandage system.
Lymphoedema 3: the available treatments for lymphoedema
Authors: Board Jane , Harlow Wendy
Published: May 2014

The third article in this series describes the treatment available to sufferers of Iymphoedema in the UK. Lymphoedema is a condition that cannot be cured and requires lifelong treatment to control symptoms which, if left untreated, would progressively worsen. The aim of treatment is to stabilize the oedema and empower the patient with the necessary skills to undertake self-care. Four components of treatment are used to achieve this goal: care of the skin, compression and support, Iymphatic massage and exercise. The purpose of each treatment will be explained and supported with research findings. Examination of the literature reveals a weak evidence base supporting treatment practice in this country. The majority of evidence relates to vascular insufficiency and findings from abroad. A brief account will be made of the reasons for this and how the trend is changing.
The development of the role of the clinical nurse specialist in the UK
Authors: Castledine George
Published: May 2014

The modern development of specialist nurses started in the early 1970s. This article provides a brief history of their evolution and in particular outlines some of the key factors in their emergence as a key care provider in health care today. There is a constant threat that their clinical nursing background and key nursing skills will be sacrificed or substituted by a more medical-oriented approach. The future, therefore, is one of striking the right balance between nursing and medicine sub-specialism and holistic patient care.
Lymphoedema 4: research priorities in lymphoedema care
Authors: Sitzia John , Harlow Wendy
Published: May 2014

This article, the last in the series on lymphoedema, presents a survey of priorities in lymphoedema research conducted among lymphoedema treatment practitioners in the UK. Using a two-stage survey method, members of the British Lymphology Society were asked to identify areas lacking in a good evidence base which were crucial for informing clinical decision making and service developments. Nine priority research questions were identified by the practitioners, with general agreement among respondents of the ranking order. The highest ranking questions were: (1) What are the risk factors associated with lymphoedema? (2) How do we best treat skin infection/inflammation? (3) How effective is manual lymphatic drainage compared to other treatments?
Metronidazole gel in managing malodorous fungating wounds
Authors: Clark Jane
Published: May 2014

Historically, the incidence of fungating wounds is not well documented. This article looks at the limited up-to-date information on the impact and incidence of fungating wounds in the UK. As fungating wounds generally signal palliative care and rarely heal, the ability to manage their unpleasant symptoms is increasingly important. One of the most distressing symptoms identified by patients is malodour; therefore, this article will review the limited research available on the use of metronidazole preparations to manage malodorous wounds.
The effect of containment on the properties of sterile maggots
Authors: Thomas Stephen , Wynn Karen , Fowler Tony , Jones Mary
Published: May 2014

A laboratory-based study undertaken to examine the effect of confinement in net bags upon the feeding mechanisms and growth rate of maggots of Lucilia sericata showed that free-range maggots survived better and grew significantly faster than maggots in bags (P<0.005). In a separate study it was also demonstrated that maggots in bags could survive on wound fluid that passed through the net without their having access to any form of solid food. This finding was consistent with clinical experience that suggests that although there may be some aesthetic advantages to the use of maggots in bags, their ability to combat infection or remove necrotic tissue from wounds is greatly reduced.
Are wound care assessments real or imaginary and what can be done?
Authors: Maylor Miles E
Published: May 2014

In wound care, nurses expect to assess, record and report descriptions of patients' wounds or pressure ulcer risk levels. When asked why they have to do this, answers could include: ‘To ensure continuity of care’; ‘To monitor progress’; ‘To improve treatment’, etc. However, I suspect that the key to improving wound care might be found hidden in the unspoken answers. For example: ‘Because it is hospital policy’; ‘Risk levels need a score to be totted up’; ‘It shows somebody did something’; ‘It is part of the job’, etc.
Early experiences of patients waiting to be accepted for CABG
Authors: Screeche-Powell Clare , Owen Suzanne
Published: May 2014

Studies of patients on coronary artery bypass graft (CABG) waiting lists have revealed emotional disturbances (Underwood et al, 1993; Fitzsimons et al, 2000a). Patients may wait up to several months, following angiography, before being accepted on to the waiting list. To date, their needs, at this time, have been largely overlooked. A qualitative research design, using in-depth interviews, was used to identify the main concerns of six such patients. Thematic content analysis affirmed the existence of anxiety/fear, uncertainty and frustration among patients awaiting CABG surgery. These themes have been identified previously among patients on the CABG waiting list (Fitzsimons et al, 2000a). Other themes identified, unique to patients who had been referred for CABG surgery but not yet accepted on to the CABG waiting list, were confusion related to treatment plans, guilt, shock, avoidance and acceptance related to the need for surgery or their diagnosis. Consideration should therefore be given not only to providing additional support to patients actually on the waiting list but also to those patients who are in the process of being referred for CABG surgery.
The nursing care of a patient with enterocutaneous faecal fistulae
Authors: Burch Jennie
Published: May 2014

This article discusses the nursing care given to a patient with a large abdominal, enterocutaneous faecal fistula. It highlights classification, signs, symptoms and some causal factors related to fistulas. Fistulas are rare and there is minimal evidence-based knowledge on the subject. However, incorporating knowledge from other specialties, such as tissue viability, can assist in caring for this client group. Diagrams illustrate the extent of the problems and assist with understanding the appliance technique. There are many problems that may be encountered in the care of fistulas that are not encountered with planned stomas. Difficulties may include containment of the faecal matter within a wound, problems associated with skin care, leakage and dietary issues. The author's methods of confronting and coping with these problems in this case study are discussed, with the aim of assisting other nurses in similar situations.
Results of a fatigue management programme in multiple sclerosis
Authors: Ward Nicki , Winters Sarah
Published: May 2014

Fatigue in patients with multiple sclerosis (MS) is a complex symptom that is notoriously difficult to treat, not least because it is extremely subjective and is experienced differently by each patient. Owing to the prevalence of this symptom, most patients with MS who are seen in outpatient settings complain of fatigue and experience the disabling effect it can have upon day-to-day living. Managing and treating this symptom is a challenge, although there is some evidence that applying fatigue management principles can potentially reduce the debilitating effect fatigue has on patients (Welham, 1995). This article reviews the evidence base surrounding the management and treatment of fatigue that is applied in clinical practice. It describes the fatigue management programme that has been introduced for people with MS at the authors' workplace, and evaluates whether applying fatigue management principles can make a difference to people's ability to self-care. The effect this symptom has upon people's quality of life will also be explored.