bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessing NHS trusts’ compliance with child health policy standards
Authors: Coles Leslie , Glasper Alan , Battrick Cath , Brown Sara
Published: May 2014

An audit tool to undertake a baseline assessment of NHS trust compliance with contemporary healthcare polices was designed collaboratively by senior children’s nurses across one English strategic health authority (SHA). Children’s units in hospitals across the SHA were benchmarked against the audit tool standards throughout 2009. The aim was to identify good and less optimum compliance with best practice policy-driven benchmarks of care, using a 1–5 scale. Each NHS trust within the SHA was contacted to make arrangements with members of the interprofessional team to complete the baseline benchmarking exercise. The audit was conducted over 1 or 2 days. The majority of the evidence sourced comprised documented evidence and verbal affirmation of the individual perceptions of key informants with regard to how the range of clinical areas scored against the best practice benchmarks. Scores of policy compliance in some trusts audited ranged from 1 (non-compliant) to 5 (full compliance). The results demonstrate that many trusts are making good efforts to ensure full compliance to policy guidelines and mandates. However, there are some aspects of policy standards that trusts have yet to fully embrace. This initial benchmarking exercise on behalf of an English SHA has revealed many areas of outstanding and good practice which have the potential to be shared
Prevention of central venous catheter-related infection: update
Authors: L Casey Anna , SJ Elliott Tom
Published: May 2014

Central venous catheters (CVCs) are an essential part of modern-day healthcare, but infections associated with these devices continue to cause significant morbidity and mortality. There are many approaches for the prevention of CVC-related infection and these are outlined in national guidelines. The Department of Health Saving Lives campaign has developed a care-bundle for the prevention of CVC-related infections that focuses on the fundamental actions to be undertaken during the catheter insertion process and ongoing care. If the rate of catheter-related infection remains high despite the implementation of these infection prevention strategies, the use of novel antimicrobial technologies and practices may be considered. These include CVCs that contain antimicrobial agents, such as antiseptics or antibiotics, needleless intravenous (IV) access devices coated with silver and/or chlorhexidine, IV dressings incorporating chlorhexidine, and the use of antimicrobial catheter lock solutions, such as antibiotics, chelators or ethanol. This article outlines the different types of CVCs available, the risk of infection associated with their use and established and novel measures for prevention of these infections.
Central venous access devices Part 1: devices for acute care
Authors: Scales Katie
Published: May 2014

This two-part article provides an overview of central venous access devices (CVADs) for acute and longer-term use. Part 1 reviews the classifications of vascular access devices before focusing on CVADs for the acute care setting. The rationale for selecting the central route is explained. Clinical indications for the use of CVADs in acute care are discussed and an overview of the related therapies is provided. The practical procedure for insertion of an acute care CVAD is explained using a step-by-step approach. Infection control aspects of device insertion are highlighted and recommendations from epic2 are incorporated into the practical procedure. Key aspects of CVAD care are discussed and the procedure for removal of non-tunnelled central catheters is presented. Part 2 focuses on the use of CVADs for longer-term care.
The effects of music therapy for older people with dementia
Authors: Wall Michelle , Duffy Anita
Published: May 2014

The aim of this literature review is to explore how music therapy influences the behaviour of older people with dementia. Background: Music therapy is often informally used in residential care units to enhance communication, emotional, cognitive and behavioural skills in elderly patients diagnosed with dementia both nationally and internationally. However, in Ireland the benefits of music therapy have not been fully recognized. Many studies have been carried out to establish the effectiveness of music therapy on the behaviour of older people with dementia with positive findings. Music therapy should be welcomed into care of the elderly settings in Ireland and elsewhere; however, more research is required to validate the effects of this therapy as a holistic tool to build altruistic connections between carers and clients. Method: A comprehensive review of nursing literature using the online databases CINAHL, PsycINFO and MEDLINE were carried out. The search was limited to articles in the English language and peer-reviewed journals dating 2003–2009. Results: Thirteen studies were reviewed and the majority of these studies reported that music therapy influenced the behaviour of older people with dementia in a positive way by reducing levels of agitation. The research further identified a positive increase in participants’ mood and socialization skills, with carers having a significant role to play in the use of music therapy in care of the elderly nursing. However, methodological limitations were apparent throughout each of the studies reviewed. Recommendations: With reference to clinical practice, the authors recommend the undertaking of further research to explore the effects of music therapy on the behaviour and wellbeing of older people with dementia
Being open with patients and learning how to apologize
Authors: Tingle John
Published: May 2014

This article outlines the National Patient Safety Agency’s ‘Being Open’ policy and argues that it has the potential to create a much more patient-centred NHS. However, it is very easy to say the word ‘sorry’, but much harder to say the word effectively and in a meaningful way. The NHS should not underestimate the task that lies ahead in implementing the ‘Being Open’ policy; ingrained defensive cultures do not change overnight.
Critical care: assessing blood pressure, circulation and intravascular volume
Authors: Jones Bridie , Higginson Ray , Santos Andrew
Published: May 2014

All nurses should possess core critical assessment skills in order to appropriately assess critically ill patients. It is anticipated that the possession of these core skills will enable nurses to appropriately assess and identify those patients who are at risk of deterioration. By comprehensively assessing individual patients and identifying problems early, nurses can initiate specific interventions that may stabilize and improve patient outcomes and help prevent unnecessary intensive care unit admission.
Nurses’ understanding of patient-centred care in Bhutan
Authors: Pelzang Rinchen , Wood Beverley , Black Simon
Published: May 2014

Aim The purpose of the study was to explore nurses’ perceptions and understanding of patient-centred care (PCC) in Bhutan. Background Nurses’ perceptions and understanding of PCC in Bhutan are unknown. MethodsA non-probability convenience sample was taken and a mixed method (quantitative and qualitative descriptive) used. Survey questionnaires were administered to 87 Bhutanese nurses in three types of hospitals – the National Referral Hospital, the regional referral hospital and the district hospital. Descriptive statistics including frequency distribution, mean and standard deviation (SD) were used for analysis. Spearman’s correlation coefficients were used to investigate relationships between demographic variables. Results The nursing labour force in Bhutan knows which behaviours are considered necessary for practising PCC. The mean (SD) rating of behaviours considered critical for practising PCC was 4.29 (0.22), five being the highest score. Bhutanese nurses described PCC, according to qualitative descriptive analysis, as being based on individual patient assessment (22/87 or 25% of respondents), using a holistic model of care (38/87 or 44%) that was based on evidence (38/87 or 44%). A higher level of education (79/87 or 91%) was found to be the main factor that would facilitate the development of PCC, while inadequate staffing, in terms of insufficient numbers of staff and lack of advanced practitioners (56/87 or 64%), was revealed as the main factor that hinders development of PCC. Conclusion Bhutanese nurses believed certain behaviours were critical to PCC. Reform of higher nursing education, putting an emphasis on PCC, would improve nursing practice and increase its scope.
Bowel problems and coping strategies in people with multiple sclerosis
Authors: Norton Christine , Chelvanayagam Sonya
Published: May 2014

Multiple sclerosis (MS) is a common neurological disease, estimated to affect 100,000 people in the UK. Bowel symptoms are reported to be common in MS, with constipation affecting 29-43% and faecal incontinence affecting just over 50%. Both have an impact on quality of life. Very little is known about how people with MS manage their bowels and the effectiveness of different interventions. We conducted a 2-part survey of people with MS and bowel problems. MS Society members were invited to participate in an online survey: 155 replied. 47 people additionally filled in a more detailed postal questionnaire. In this self-selected sample, 34% spend more than 30 minutes a day managing their bowel. Managing bowel function was rated as having an impact equal to mobility difficulties on quality of life. Respondents used a wide range of strategies to manage their bowel but few were rated as very helpful. There is a need for high quality research on all aspects of managing bowel dysfunction in MS in order to improve patients’ quality of life.
The art and rationale of applying a compression dressing
Authors: David Michael , Gogi Nitish , Rao Jay , Selzer Gunther
Published: May 2014

Compression dressings are commonly used by medical and nursing staff to arrest bleeding in a trauma or first aid situation. Their use on surgical wounds may reduce blood loss, wound ooze and infection risk. We have seen variation in the techniques used by staff in our Orthopaedic department, often resulting in no compression being achieved. In this article we explore the mechanical rationale underlying a compression dressing, in order to facilitate the technique of its application. We believe better practice will improve wound management, reduce rates of haematomas and persistent wound ooze, and lower infection rate following surgery
Young adults’ experience of stroke: a qualitative review of the literature
Authors: Lawrence Maggie
Published: May 2014

Stroke is a life-threatening event that has a devastating impact on young adults and their families. The author conducted a systematic review of the qualitative literature to explore the experience of stroke from the perspective of young adults. Four primary research ‘papers’ were analyzed using the Qualitative Assessment and Review Instrument; 60 findings were extracted from the papers and merged into 13 categories, from which three synthesized findings were developed — disorientation, disrupted sense of self, and roles and relationships. Many of the effects of stroke are ‘invisible’ but have significant impact on social participation, including the ability to return to work and to enjoy an active social life. Young adults feel the same and yet different following stroke, which may have a profound effect on relationships. Effective communication between patients, families and health professionals is crucial to all aspects of recovery
The use of advanced physical assessment skills by cardiac nurses
Authors: Edmunds Linda , Ward Susan , Barnes Rhian
Published: May 2014

Aims To establish what advanced physical assessment skills are being used by cardiac nurses after they undertook a clinical patient assessment module; and to explore the factors that influence their use of these skills. Method A longitudinal descriptive approach using convenience sampling was employed. Qualitative data was obtained from individual interviews, non-participant observation within the participants’ clinical environment and self-reported activity logs. Findings Five key themes emerged: use of advanced physical assessment skills varied; use and development of skills was linked to personal characteristics; use influenced by perceptions of role boundaries, permission and cooperation; use influenced by participants’ perception of nursing and the development of their own nursing practice; and use influenced by the physical environment and the human support within it. Discussion and conclusion Cardiac nurses selectively use physical assessment skills, predominately related to the cardiorespiratory systems. Organisational structure, professional relationships and the professionalism of the individual nurse appear to play a significant part in the use of physical assessment skills. Although the findings from this qualitative study cannot be generalized, they concur with findings from recent research into physical assessment skills used by a variety of UK nurses. The implications identified are: first, for those who provide the education, in terms of what should be taught and facilitated; and second, for organizations, in ensuring staff have assessment skills relevant to their role and that systems are in place to enable the development of a supportive and progressive culture that embraces modernization congruent with healthcare policy.
The nine rights of medication administration: an overview
Authors: Elliott Malcolm , Liu Yisi
Published: May 2014

Nurses are responsible for ensuring safety and quality of patient care at all times. Many nursing tasks involve a degree of risk, and medication administration arguably carries the greatest risk. Unfortunately, patients are frequently harmed or injured by medication errors. Some suffer permanent disability and for others the errors are fatal. Nurses have traditionally followed the five rights of medication administration (patient, drug, route, time, dose) to help prevent errors, and more recently, the seven rights (including documentation and reason). This article identifies nine rights of medication administration.
Pharmacological treatment of combatinduced PTSD: a literature review
Authors: Lynn Debra
Published: May 2014

Historically, soldiers have returned from war changed men. Over the years there has been an increase in awareness of post-traumatic stress disorder (PTSD) and the impact of diagnosis. Treatment of PTSD presents a challenge on every level. This literature review provides some insight into the risks and benefits of three groups of drugs commonly prescribed for combat-induced PTSD: beta-blockers, selective serotonin reuptake inhibitors (SSRIs) and benzodiazepines (BZDs). When prescribed in conjunction with other nonpharmacological treatments, these drugs help to minimize, and in some cases eliminate, the signs and symptoms of PTSD. Combination therapy would ideally result in better compliance and eventual completion of treatment programmes provided for PTSD sufferers. Healthcare professionals strive to provide patients with holistic care. Patients present with unique mental and physical intricacies, and nurses and health professionals must peel away the layers to uncover the nature of the PTSD. While there are many aspects to PTSD treatment, this literature review focuses on pharmacological treatment, specifically beta-blockers, SSRIs and BZDs.
The Stafford Report
Authors: Castledine George
Published: May 2014

The publication of the inquiry into the treatment of patients at the Stafford hospital raises further serious questions about the state of nursing in this country. This has not been the first scandal to hit the headlines, but when you read the report you get a feeling of unease and exasperation over the quality of nursing care
Illustrations of bad nursing
Authors: Castledine George
Published: May 2014

In my last column on The Stafford Report, I mentioned that the chairman, Robert Francis QC, was particularly moved by the accounts of bad care that were received by the enquiry team. The following are extracts taken from these case, which not only deserve to be read in their entirety in volume 2 of the repor, but illustrate to all nurses the terrible impact that poor nursing care can have on people’s lives. I have grouped these comments under headings which will be familiar to all registered nurses as they indicate some of the essential key concepts of nursing.
Dependency Needs And Dependency Care Are Changing
Authors: Sullivan Polly
Published: May 2014

Have your say: send your letter to bjn@markallengroup.com today
Assessment of psychosocial problems in primary care COPD patients
Authors: Upton Jane , Madoc-Sutton Hazel , Loveridge Christine , Sheikh Aziz , Walker Samantha , Fletcher Monica
Published: May 2014

The emphasis placed on assessing psychosocial needs in nurse-led practice based consultations for chronic obstructive pulmonary disease (COPD) has not been reported. We investigated the frequency with which nurses performed a range of tasks, and explored if the types of tasks performed were related to levels of training or the setting of clinical consultations. Participants were lead COPD nurses based at 500 randomly selected UK general practices. Respondents completed a questionnaire between February and June 2006. The frequency with which key task were performed – never, sometimes, often or always – was recorded. Follow up consultations were conducted by 349 of the 368 nurses who responded (74% response rate). Of these, 51% (95% confidence interval (CI):45–56%) reported often or always assessing psychosocial needs, in comparison to 98% (97–99%) who reported often or always checking inhaler technique and 86% (82–89%) who often or always recorded spirometry values. Frequent assessment of psychosocial needs was associated with post registration COPD education and consultations taking place in designated respiratory clinics. Nurses focus on objective tasks, possibly to the detriment of assessing psychosocial needs. To raise the profile of these aspects of care: updates of the COPD section of the GMS contract should encompass the assessment of patient’s psychosocial status and potential impact of this on quality of life; and appropriate education should be provided.
ANTT v2: An updated practice framework for aseptic technique
Authors: Rowley Stephen , Clare Simon , Macqueen Susan , Molyneux Rebecca
Published: May 2014

Aseptic Non Touch Technique (ANTT) version 2 is an updated theoretical and practice framework expanding on the foundations set by ANTT v1, which was first published almost a decade ago, and has been adopted widely. ANTT v2 rationalizes an alternative and contemporary approach to aseptic practice, rather than the historically hierarchal paradigm of sterile, aseptic and clean techniques. To reflect current practice and reduce unnecessary complication, v2 introduces the theory and consolidates the practice of using micro aseptic fields to protect key-parts. It is advocated that micro aseptic fields are optimal and should be used whenever practically possible. Version 2 is intended as a principle approach to all aseptic practice no matter how simple or complicated clinical procedures may be. In other words, the principles of ANTT are as applicable to the surgeon as they are to the nurse or phlebotomist
Barrier dressings in surgical site infection prevention strategies
Authors: Downie Fiona , Egdell Sharon , Bielby Alistair , Searle Richard
Published: May 2014

Healthcare-associated infections (HCAIs) are a matter of priority for the NHS. They are associated with significant morbidity, and frequently lead to increased length of hospital stay, pain and discomfort for the patient, and in some cases even permanent disability. It is estimated that surgical site infections (SSIs) constitute around 14% of all HCAIs. Any break in the skin affords a portal of entry for microbial pathogens, and hence places the patient at an increased risk of infection. To address the issue, a multi-factorial strategy for the prevention of SSIs is essential, with postoperative dressings playing a key part alongside universal precautions such as hand hygiene and aseptic technique. The available guidance specifies the need for a postoperative dressing which provides an effective physical barrier and a moist environment for optimal wound healing. Vapour-permeable barrier dressings appear to be effective in meeting both of these criteria and also offer additional advantages both to patients and practitioners, such as patient comfort and the ability to stay in place whilst the patient showers. However, regular wound assessment must be carried out to ensure the vapour-permeable postoperative dressing is the right choice for a specific patient at a given time.
An evaluation of a silicone adhesive shaped heel dressing
Authors: Hampton Sylvie
Published: May 2014

Tissue breakdown is complex and involves many factors. Pressure ulcer development in the heels is subject to extrinsic factors such as pressure, shear, friction and moisture. The heels are the most common sites for friction and shear damage, which can lead to blistering, skin erosion and tissue breakdown (Grey et al, 2006). To address the issues of wounds that are painful on dressing removal and friable skin, Smith & Nephew has introduced a soft silicone adhesive dressing to its Allevyn dressing range. Silicone does not adhere to wounded areas and can be removed gently without trauma to the periwound area. This paper discusses the findings of a 20-patient multi-site evaluation examining the performance and acceptability of Allevyn Gentle Border Heel dressing in the management of heel wounds
Prevention and management of air in an IV infusion system
Authors: Jürgensonn Silke von
Published: May 2014

When air enters the circulatory system of the human body it can cause an air embolism. Air in the venous circulation will enter the right side of the heart where it may cause right ventricular outflow tract obstruction and acute pulmonary hypertension from pulmonary vasoconstriction. This compromises the pulmonary venous return to the left side of the heart, resulting in significant reduction in cardiac output and cardiovascular collapse. Air can pass into the left side of the heart via a patent foramen ovale or a septal defect. From the left side of the heart air will then enter the arterial circulation where it may embolize cerebral or coronary arteries with fatal consequences. Prevention of air embolism is therefore of utmost importance.
Does honey have a role in paediatric wound management?
Authors: Bittmann Stefan , Luchter Elisabeth , Thiel Michael , Kameda Genn , Längler Alfred , Hanano Ralph
Published: May 2014

Topical honey treatment has been shown to possess antimicrobial properties, promote autolytic debridement, stimulate growth of wound tissues to hasten healing, and to start the healing process in dormant wounds, stimulating anti-inflammatory activity that rapidly reduces pain, oedema and exudate production. This article provides an overview of the use of honey as a medicinal substance, particularly its use in wound treatment, and reviews the published data concerning honey as a form of complementary and alternative medicine in paediatric wound management. The literature reviewed was found by searching the PubMed, BIOSIS, and ISI Web of Science databases for the term honey. Exclusion criteria were articles where honey was used in a mixture with other therapeutic substances.
Management of COPD using the Roper-Logan-Tierney framework
Authors: Elsherif Mirna , Noble Helen
Published: May 2014

This article reviews the health condition of a patient with chronic obstructive pulmonary disease (COPD). It discusses the use of the Roper-Logan-Tierney activities of daily living framework model, in conjunction with the nursing process to identify the patient’s main priorities for nursing care. COPD is the fifth most common cause of morbidity and mortality in the UK. It is a chronic illness often caused by smoking. The disease is a life-long illness and can affect all aspects of the person’s life. Furthermore, exacerbations are often poorly controlled resulting in more frequent admissions to hospital, placing more pressure on patients, nurses and healthcare services. Aspects of care related to breathing, eating and drinking, and maintaining a safe environment are explored. The nursing process, as a systemic tool, can help in identifying and understanding the individual needs of patients and aid in establishing patient-centred therapeutic care.
Prisoner health: HIV infection and other blood-borne viral infections
Authors: Peate Ian
Published: May 2014

All prisoners should be entitled to the same standards of health care as the general population. This is the principle of equivalence. Inmates who are physically or mentally ill, addicted to substances, or disabled should receive equivalent care to what is expected of the NHS. There are a number of variations and inequalities in the health services that prisoners receive across the UK. A number of prisons have no policies in place for HIV, hepatitis C or sexual health. The prevalence of HIV is significantly higher in the prison population than it is in the wider community. This article considers and outlines the important principle of equivalence and the needs of the prison population in relation to HIV infection and other blood-borne virus infections. Methods used to minimize risk are described and the importance of development, implementation and evaluation of harm minimization strategies are discussed.

The term ‘prison’ in this article is used to identify all places of detention in England and the term ‘prisoner’ is used to describe all adults who are held in such places. Prison services and healthcare provision in other UK countries are also outlined.
Reforming health research regulation: an incomplete solution
Authors: McHale Jean
Published: May 2014

Following the 2011 Budget, the UK Government has announced that as part of its reform of the NHS it will be establishing a new special health authority which will have the task of regulating research. This article considers these proposals and suggests that while a strong health regulator may be in itself a praiseworthy initiative, the current proposals simply do not go far enough and there is a need for radical reconceptualization of research regulation as a whole.
International patient safety experience: sharing the lessons
Authors: Tingle John
Published: May 2014

John Tingle discusses two recent patient safety reports from Canada and Australia that contain important lessons for health professionals worldwide.
Selecting the right urinary leg bag drainage system for patient needs
Authors: Mangnall Joanne
Published: May 2014

There are many clinical reasons why a patient may require indwelling urinary catheterization. Selecting the most appropriate closed drainage system to be used in conjunction with an indwelling cathete is essential to reducing the patient's risk of developing catheter-associated urinary tract infection (CAUTI). Leg bags are one of the options available, however, evidence suggests patients may find these products problematic during daily activity. Careful assessment of patients' needs when selecting a leg bag enables the nurse to identify the individual's specific product needs, thereby reducing the risk of difficulties for the patient during daily use. This article focuses on key areas for consideration when selecting a leg bag.
Latent tuberculosis: concordance and duration of treatment regimens
Authors: Clerk Nigel , Sisson Kelly , Antunes George
Published: May 2014

Over the past century, the UK has made significant progress in combating tuberculosis (TB) through improved health care and better preventative measures. However, it has now been identified as a new threat that needs concerted action. An important component in dealing with this threat is identifying and treating people with latent infection. This will prevent active disease and thwart the spread of tuberculosis infection. The aim of the study was to determine whether treatment concordance was affected by length of treatment regimen in the UK and to identify factors that may impact upon treatment completion. The audit was spread over a two-year period and looked at all patients on treatment for latent infection using the UK recommended regimens of either three months of dual therapy or six months using monotherapy. The results indicated that the 3-month regime had not improved concordance, as expected, with a slightly better completion rate in the 6-month group. However, the study did highlight a ‘lost-to-follow-up’ group of patients, who failed to present themselves following presumed completion.
The development of clinical nurse specialist roles in Ireland
Authors: Doody Owen , Bailey Maria E
Published: May 2014

While the term specialist in nursing can be traced to the turn of the 20th Century, it is only since 2001 that a framework was developed for a clinical career pathway in Ireland. This framework has promoted the development and expansion of the clinical nurse/midwife specialist (CNS/CMS) throughout Ireland over the past 10 years guided by the National Council for the Professional Development of Nursing and Midwifery (NCNM). To build upon the achievements of the NCNM and advance nursing practice, it is imperative that CNS/CMSs adopt and fulfil the components of their role. Since CNS/CMS practice is relatively new to Ireland, there is the opportunity to learn from experiences of other countries. This article outlines the development and challenges of the CNS role in Ireland.
Roles and responsibilities of the student nurse mentor: an update
Authors: Casey Deborah C , Clark Liz
Published: May 2014

Facilitating the learning of student nurses in the workplace is an integral role of the registered nurse. This article aims to provide an overview of the role and responsibilities of the mentor in supporting pre–registration nursing students in clinical practice. The professional obligations for the mentor to meet the Nursing and Midwifery Council (NMC) standards ( NMC, 2008a ) will be explored, including the ongoing requirements to keep up to date in mentoring practices. Some of the challenges within the role will be identified, including the importance of recognizing and supporting the failing student. Recent changes to the preparation requirements for sign-off mentors will be discussed. The article concludes by presenting the potential benefits to both the individual and the practice placement provider.
Emergency and intensive care: assessing and managing the airway
Authors: Higginson Ray , Jones Bridie , Davies Kevin
Published: May 2014

Airway assessment and management skills are vital in an emergency department (ED) as they are the most sensitive indicator of patient deterioration. Problems as common as head injury or alcohol intoxication are associated with an inadequate airway or diminished respiratory function and can cause a patient's condition to decline rapidly. Maintaining a patient's airway and facilitating breathing is the main priority in any emergency situation, although achieving airway control can be difficult. All health professionals need to be able to safely undertake airway management. The key is a thorough assessment to determine whether the airway is patent or not. This paper will discuss the importance and practicalities of airway management and assessment in the emergency and intensive care.
Patient safety and healthcare-associated infection
Authors: Cole Mark
Published: May 2014

Healthcare-associated infection (HCAI) has become a major patient safety issue in National Health Service (NHS) hospitals. The UK has an HCAI prevalence rate of 8.2% which equates to an annual incidence of approximately 300 000 patients ( Hospital Infection Society, 2007 ). HCAI is a safety issue because it is associated with increased morbidity and mortality as well as increased healthcare costs (National Audit Office (NAO), 2009). In 2000, the NAO identified cultural change as a requirement if the NHS is to get a grip of infection prevention and control. This article has taken a ‘conceptual culture of safety model’ that has been previously described in the literature and applied it to the organization of infection control. It is clear that while there are many areas of good practice, in relation to infection prevention and control, there is still much to do if the NHS is to invoke the type of paradigm shift that will result in a mature sustainable safety culture.
The snapshot pre-registration assessment tool. Part 1: Background, literature and research
Authors: Tolley Kim , Ooms Ann , Marks-Maran Di , Acton Lesley , Rush Sue
Published: May 2014

This is the first of a two-part article that presents a new assessment tool – the snapshot - for pre-registration nurses in clinical practice, that is being used at Kingston University/St George's University of London during year 3 of the Diploma and BSc programmes. A pilot study of the use of the snapshot in a simulation environment had previously been undertaken and as a result of this, the snapshot was piloted as part of continuous clinical assessment in practice on two cohorts of third-year pre-registration student nurses. An evaluative study was undertaken. This article describes the background to the project, the literature and the research methods used to undertake the evaluative research study. Part 2 will focus on the findings and a discussion of these findings mapped against the literature.
Myocardial infarction: a turning point in meaning in life over time
Authors: Baldacchino Donia
Published: May 2014

Finding meaning in illness appears to give individuals purpose in life, which may motivate them to maintain a healthy lifestyle. Research to date has mainly used cross-sectional designs in the acute phase of recovery. This article describes a longitudinal exploratory study which explored patients’ search for meaning in life across the first 5 years following myocardial infarction (MI). Interviews were conducted between 2000 and 2007 on patients with first MI («=70; mean=61.9 years; SD=12.1). The qualitative data underwent thematic analysis guided by the analysis framework of Burnard (1991) . Finding meaning appeared to increase patients’ awareness of their current holistic state of life, and to provide impetus for making lifestyle changes. In the immediate aftermath of MI, patients restructured and re-evaluated their attitudes towards self, life, religious beliefs and others. However, from the third year onwards, as time passed patients lapsed in their behaviour, tending to become non-compliant with treatment and less aware or concerned about the risk of another heart attack. Further education on the spiritual dimension in care may guide nurses and health professionals in order to promote patients’ rehabilitation process and persevere with a long-term healthy lifestyle. Further longitudinal comparative research with mixed method approach on various groups of patients is recommended to support these findings.
A right to die or a right to live? Discontinuing medical treatment
Authors: McHale Jean
Published: May 2014

This article explores the decision in the case of W v M, S and an NHS Primary Care Trust [2011] EWHC 2443 (Fam) in which an application to withdraw feeding from a woman in a minimally conscious state was rejected by Baker J in the Court of Protection. The article places the case in the context of the development of case law concerning the withdrawal of treatment from patients lacking decision-making capacity, where death will be the inevitable consequence of the withdrawal of treatment after the decision in Airedale NHS Trust v Bland. It questions whether nearly two decades after the Bland decision there is scope for the boundaries of the decision to withdraw treatment from patients in (futile) conditions to be reconsidered by the Supreme Court.
The use of MRI scanning to triage patients
Authors: Abu Victor Kpandemoi
Published: May 2014

The rise in the incidence of prostate cancer is mainly attributed to the increasing use of the serum prostate-specific antigen (PSA) blood test as a screening tool. Regardless of doubts over its sensitivity and specificity, PSA remain a key mechanism in the diagnosis and management of prostate cancer. The Department of Health (DH) in the UK recommends urgent specialist referral for patients presenting with age-elevated PSA. This national guideline, known as the National Cancer Wait Times (NCWT) system, aims at monitoring the process of referral, investigation and management of new suspicious prostate cancer cases. The use of transrectal ultrasound (TRUS) guided prostate biopsy is the gold-standard specialist investigation for prostate cancer. However, there is growing interest in the use of imaging techniques like magnetic resonance imaging (MRI) as first-line specialist investigation for suspicious prostate cancer.
Oxygen saturation and secretion weight after endotracheal suctioning
Authors: Giakoumidakis Konstantinos , Kostaki Zoi , Patelarou Evridiki , Baltopoulos George , Brokalaki Hero
Published: May 2014

Endotracheal suctioning is a common aspect of nursing care to mechanically-ventilated patients. The aim of this study was to investigate the effects of two suctioning techniques on oxygen saturation (SaO2) and the amount of drained secretions. A quasi-experimental study of 103 mechanically-ventilated patients was conducted from two tertiary hospitals in Greece. Two suctioning techniques were applied to each patient: with normal saline instillation and without. Normal saline instillation was associated with increased secretions' weight (p<0.001) and no significant differences in SaO2 values compared with no instillation. In examining each suctioning technique separately, the use of normal saline instillation was associated with a decrease in SaO2 levels 1 minute (p<0.001) and 15 minutes (p=0.002) after this procedure. In addition, suctioning without normal saline instillation was associated with a decrease in SaO2 1 minute (p<0.001) after the suction. In conclusion, normal saline instillation is related with a negative outcome on patient oxygenation for a prolonged period after the suction and causes the removal of a greater amount of secretions than the applied technique with no instillation. Comparing the two techniques, none is superior to the other resulting from the statistically insignificant comparative differences in SaO2 values.
Investigation and management of an A. Baumannii outbreak in ICU
Authors: Adams Debra , Yee Lian , Rimmer Jo-Anne , Williams Ruth , Martin Helen , Ovington Colin
Published: May 2014

Acinetobacter baumannii infection is responsible for a wide range of infections, including pneumonia, bacteraemia, meningitis, wound infections, and urinary tract infections. During June 2010, two patients on an intensive care unit in an acute hospital in the UK had multi-resistant A. baumannii identified in samples obtained from a variety of specimens. A further case was identified 31 days following confirmation of the first outbreak. The investigation and management of this outbreak included the introduction of enhanced infection prevention and control precautions; the establishment of an Outbreak Control Team; epidemiological investigations; and the decontamination of equipment and the environment. Isolate typing by the Health Protection Agency Centre for Infections laboratory confirmed the three cases had identical A. baumannii strains: European clone II lineage encoded with an OXA-51-type carbapenemase. This suggests that there was a patient-to-patient spread of multi-resistant A. baumannii.
The dimensions of interprofessional practice
Authors: Burzotta Louise , Noble Helen
Published: May 2014

Caring for patients requires an interprofessional approach. The purpose of this article is to reflect on a specific experience of interprofessional working encountered while working as a nurse in clinical practice. A critical analysis and evaluation is offered with a focus on the extent to which interprofessional collaboration can enhance a patient's journey through the healthcare system. Gibbs' reflective cycle (1988) is used to guide the discussion, taking into account a description of the event, feelings encountered, the positive and negative aspects of the experience, an analysis of the event, and a conclusion of the overall experience. An action plan for future practice is offered. The unique role and contribution that nursing makes within the interprofessional team will be discussed.
Use of compression hosiery in chronic oedema and lymphoedema
Authors: Lay-Flurrie Karen
Published: May 2014

The management of chronic oedema is a continuing partnership between patient and practitioner and accurate diagnosis and treatment planning are essential to control the condition in order to prevent complications and optimise the patient's quality of life. A paucity of funding, lack of knowledge and confidence on the part of practitioners and widely varying access to services means that many patients face barriers to gaining appropriate treatment. Nurses in many spheres will come across patients with some form of chronic oedema. The following article describes the types and causes of chronic oedema and lymphoedema and explores the use of compression hosiery as one facet in management of the condition. Patient education and the role of the practitioner are also highlighted to develop awareness of the need for adequate preparation of a patient to facilitate concordance and self-management of their condition.
Safety of clinical systems: Health Foundation finds cause for concern
Authors: Tingle John
Published: May 2014

John Tingle discusses a report by the Health Foundation on the safety of clinical systems. This identifies the prevalence of problems, many of which have serious implications for patient safety, and the points at which they occur. Problems include missing patient information, incorrect medication dosages, poor communication and missing or faulty equipment. Staff often consider system failure to be the norm; instead, they should raise problems to keep patients safer.
The ongoing challenges with renal vascular access
Authors: Murphy Fiona
Published: May 2014

Renal vascular access is pivotal in the care of the haemodialysis patient; however, it remains a significant challenge to maintain vascular access in the dialysis population. There are a number of renal vascular accesses in use: arteriovenous fistula, arteriovenous graft, and central venous catheter, with the arteriovenous fistula being the ideal choice. Poor vascular access can lead to serious consequences for patients, resulting in morbidity and even mortality. There are also significant cost implications for healthcare providers in terms of hospital admissions, and other associated costs for patients who are admitted late for vascular access referral or as a result of associated complications of vascular access. The nurse and other members of the healthcare team are fundamental in the management of a patient's renal vascular access.
Peristomal skin care and the use of accessories to promote skin health
Authors: Burch Jennie
Published: May 2014

Stomas are frequently encountered by nurses. Common complications include problems with the peristomal skin—the skin around the stoma. It has been reported that up to 80% of people with a stoma, who are termed ostomates, are affected. The three main types of stomas are colostomy, ileostomy and urostomy; all these come with a risk of sore peristomal skin. These stomas pass faeces or urine, which are collected in a stoma appliance that adheres to the peristomal skin. It is essential to ensure that this skin is free from breaks or soreness as this might lead to appliance leakage. This article is aimed at ward nurses and will focus on some of the stoma accessories that are used to treat, protect or ‘level’ peristomal skin. Accessories, such as barrier creams or films, can be used to protect skin. Filler paste, seals and convex appliances, for example, can be used to resolve creases in the skin or to treat a retracted stoma. The situations in which stoma accessories might be useful in resolving peristomal skin problems or retaining its integrity are numerous.
In pursuit of excellence in diabetes care: trends in insulin delivery
Authors: Meetoo Danny , McAllister Gillian , West Adele , Turnbull Mandy
Published: May 2014

Diabetes mellitus has been estimated to affect 2.9 million people in the UK. Large-scale clinical trials conclusively demonstrate that elevated blood glucose levels are associated with an increased risk of micro-and macrovascular complications. The high rates of morbidity and mortality associated with this condition demonstrate how important effective glycaemic control is. Subcutaneous insulin injection continues to be the mainstay of therapy for all people with type 1 diabetes mellitus and the majority of individuals with type 2 diabetes mellitus. However, there are a number of barriers to insulin therapy. For example, conventional insulin delivery is arguably time consuming. Furthermore, it has been associated with common errors, such as inaccurate dosing and administration ( National Patient Safety Agency, 2010 ). Insulin pen devices have various advantages over conventional delivery. Their ease of use and incorporation into busy lifestyles may improve diabetes control with much less effort, while maintaining adherence and quality of life. Research in insulin delivery shows there is a prospect of needle-free delivery in the near future. Despite such progress, the role of the healthcare professionals in involving, assessing, supporting and educating people having insulin therapy, including the attainment of the agreed blood glucose levels, cannot be overestimated.
iCare advanced blood glucose monitoring system
Authors: King Sus
Published: May 2014

Health professionals working in the field of diabetes have a wide choice of blood glucose meters to offer patients, with different meters offering different options for monitoring and recording blood glucose results. Self-monitoring of blood glucose levels can be helpful to people with diabetes in helping to maintain day-to-day control, adjusting insulin doses, detecting hypoglycaemia, assessing control during intercurrent illness and helping to provide information that can be used in the prevention of long-term complications. The newly released iCare Advanced Blood Glucose monitoring System is an easy-to-teach and use blood glucose meter using the latest technology to provide people with diabetes with easy and comfortable testing, producing accurate blood glucose test results in just 6 seconds using a small blood sample of only 0.7ul. In the current NHS climate, the iCare Advanced blood Glucose meter offers patients and health professionals the latest technology alongside cost savings by providing a test strip that is low cost but does not compromise on quality.
Critical care: the eight vital signs of patient monitoring
Authors: Elliott Malcolm , Coventry Alysia
Published: May 2014

Nurses have traditionally relied on five vital signs to assess their patients: temperature, pulse, blood pressure, respiratory rate and oxygen saturation. However, as patients hospitalised today are sicker than in the past, these vital signs may not be adequate to identify those who are clinically deteriorating. This paper describes clinical issues to consider when measuring vital signs as well as proposing additional assessments of pain, level of consciousness and urine output, as part of routine patient assessment.
Climbing the walls: prison mental health and community engagement
Authors: Caie Jude
Published: May 2014

Until recently, treatment for mental health conditions has focused on medical and psychological therapy. The role and significance of social and community interventions and initiatives in fostering recovery, resilience and a sense of ‘flourishing’ is now being recognised. This paper seeks to explore how these principles, which are usually community-based, can be successfully applied within a prison setting, and how such interventions may have a positive effect on the mental health of prisoners through successfully engaging them with the communities they are set to return to after release while still in custody.