bluuebunny/crossref_metadata_2025 huggingface dataset:
Why do women use Tens equipment and how effective is it?
Authors: Bedwell Carol
Published: May 2014

TENS is a popular method of non-pharmacologic pain relief used by women in labour. However, the means by which it works is unclear, with various theories proposed relating to physiological mechanisms and the influence of the placebo effect. Despite its apparent popularity, good quality evidence regarding its effectiveness is lacking and guidance from the National Institute for Health and Clinical Excellence (NICE) (2007) does not recommend TENS as a pain-relieving measure. However, a recent Cochraine review has found that a majority of women using TENS were satisfied ( Dowswell et al, 2009 ). This article will discuss the theories behind TENS, consider its application and briefly consider the evidence and its popularity with women.
Effects of Syntocinon use in active management of third stage labour
Authors: Rogers Cathy , Villar Rose , Pisal Pradnya , Yearley Carole
Published: May 2014

Following the publication of guidance from the National Institute for Health and Clinical Excellence (NICE) (2007) , Syntometrine was withdrawn in practice for routine use as part of the active management of the third stage and replaced with Syntocinon 10 international units (iu). While it was recognized that these guidelines related to the care of low-risk women, from the evidence reviewed there did not appear to be any reason not to recommend the use of Syntocinon for the majority of women. Concern about perceived increase in major postpartum haemorrhage (>100 ml) resulted in a retrospective comparative study of primary postpartum haemorrhage (PPH) rates and blood transfusion rates. This study found a statistically significant increase in estimated blood loss (EBL) above 1000 ml from 2008 to 2010 (0.59% vs. 1.74%). Nevertheless, there was no statistically significant increase in blood transfusion rates. Possible reasons for this increase are suggested, including: the limitations of the present study compared to previous studies; the experience of staff using Syntocinon 10iu; as well as the attitude of staff toward this practice change. In view of these issues, the researchers do not believe that these results provide robust evidence to revert to using Syntometrine, contrary to the recommendations of the Centre for Maternal and Child Enquiries (CMACE) (2011) .
Challenges facing a community health and development centre in Kenya
Authors: Deadman Alice
Published: May 2014

In November 2010, I spent 3 weeks volunteering as a midwife in a community health and development centre, which will shortly be acquiring a maternity wing, in rural western Kenya. The aim of my trip was to identify and suggest areas for improvement at Osani Community Health and Development Centre (OCHDC), teach the community health workers, traditional birth attendants and local childbearing women, and encourage women to attend OCHDC. During my visit, I discovered many problems facing the community of Osani and the charities supporting OCHDC, including a limited number of skilled birth attendants, a lack of antenatal and postnatal care resulting in problems going undetected, scarce availability of resources and complications involved in transporting people to alternative health care facilities. The purpose of this reflective account is to convey these difficulties, alongside the highlights of my experience.
The role of the midwife in improving normal birth rates in obese women
Authors: Swann Lynne , Davies Sarah
Published: May 2014

Obesity in pregnancy is widely recognized as being associated with an increased risk of adverse outcomes for both mother and baby. While the increased risks are well documented, most of the evidence to date has arisen from a medical perspective, with little midwifery or consumer-focused research available. A mindset that obesity inevitably equates to a reduced chance of normality may adversely affect care, increasing interventions and reducing the woman's chance of a normal delivery. This article argues for individualized holistic care for obese women. It considers the role of the midwife and examines midwifery interventions during antenatal and intrapartum care that may be of value in improving rates of normal delivery for this group of women. Further midwifery research is required to establish which aspects of care are effective at reducing the rates of intervention for obese women and subsequently improving outcomes.
Confidence and performance in objective structured clinical examination
Authors: McClimens Alex , Ibbotson Rachel , Kenyon Charlotte , McLean Sionnadh , Soltani Hora
Published: May 2014

Introduction: The objective structured clinical examination (OSCE) is commonly used as a standard assessment approach in midwifery education. Student's confidence may impact on the OSCE performance but the evidence on this is very limited. Objectives: This study aimed to evaluate the relationship between confidence and OSCE performance in midwifery students. Methods: 103 pre-registration midwifery students (42 year one students: 61 year three students) from Sheffield Hallam University took part in this study as part of their routine OSCE assessment. They completed pre- and post-exam questionnaires, which asked them to rate their confidence in the clinical skills being assessed on a scale from 1 to 10 (1=not confident; 10 =totally confident). Results: The results showed significant increases in mean confidence levels from before to after OSCE for both first and third year students (5.52 (1.25) to 6.49 (1.19); P=0.001 and 7.49(0.87) to 8.01 (0.73); P <0.001, respectively). However, there was no significant correlation between confidence levels before undertaking the OSCE and the final OSCE test scores (r= 0.12; £=0.315). Conclusions: The increased level of confidence after the OSCE is important but how this is transformed into improved clinical skills in practical settings requires further investigation. The lack of significant correlation between OSCE results and student's confidence, may indicate additional evidence for the objectivity of the OSCE. This, however, may be due to the inherent complexity of assessing such relationships. Larger studies with mixed methodology are required for further investigation of this important area of education and assessment research.
When a baby dies: Motherhood, psychosocial care and negative affect
Authors: Nordlund Ewa , Börjesson Astrid , Cacciatore Joanne , Pappas Carissa , Randers Ingrid , Rådestad Ingela
Published: May 2014

Background:

The process of giving birth to a baby who has died is a significantly traumatic experience for the mother and her family and also for health professionals. Support, or even the perceived lack of support, from professionals often influences whether or not the parents choose to see and hold their baby. Psychosocial clinical care may also affect long-term psychiatric sequelae. The purpose of this study is to explore the lived experiences of mothers following the death of a baby and their interaction with healthcare professionals.

Methods:

Through a web-based survey, a content analysis of this open-ended question was conducted: ‘Do you currently feel sad, hurt, or angry for something health professionals did in connection to the birth of your baby?’

Results:

Mothers reported feeling sadness when they perceived too little support from professionals, particularly related to bonding time with the baby. They reported feelings of disappointment when health professionals neither acknowledged nor validated their motherhood. Mothers reported anger in response to professionals they perceived to be indifferent or callous toward their loss. They also reported that they felt hurt when health professionals lacked respect and when they felt abandoned by the personnel.

Conclusions:

There are crucial implications for practice; it is important for women who experience a stillbirth to have their motherhood actively acknowledged and validated and to have the humble, empathic presence of their health professionals.
Use of homeopathic Arnica among childbearing women: A survey
Authors: Carter Jenny , Aston Gillian
Published: May 2014

Background: Anecdotal evidence suggests some childbearing women self-prescribe the homeopathic remedy Arnica, but not necessarily according to established homeopathic principles. This could, theoretically, lead to lack of benefit or adverse effects.

Objectives: To explore childbearing women's use of homeopathic Arnica and need for further information.

Method: A literature review was carried out prior to a cross-sectional survey of maternity service users of a large inner-city teaching hospital between December 2008 and March 2009. In addition to establishing prevalence, a judgment was made as to whether Arnica users had taken the remedy according to homeopathic principles using a novel method developed for this study.

Findings: Of 373 women who agreed to participate, 228 returned questionnaires— a response rate of 61%. Of the 27 respondents (12%) who reported using Arnica, 22 (81%) were judged to have ‘possibly’ or ‘probably not’ taken it correctly. Of those using Arnica, n = 16 (59%) would have liked more information.

Conclusion: Findings suggest a need for maternity services to provide information to childbearing women who self-prescribe homeopathic remedies.
Exclusive breastfeeding practice in Indonesia
Authors: Afiyanti Yati , Juliastuti Dyah
Published: May 2014

This grounded theory study aimed to explore the cultural practices and behaviours, which lead to unsuccessful exclusive breastfeeding in Indonesian mothers. Data were obtained through semi-structured interviews carried out with 8 key participants (breastfeeding mothers) and 10 general participants (family members and health cadre). Four categories: the initial breastfeeding practice following delivery, the decision making surrounding the efforts to maintain breastfeeding, when to wean the baby onto other types of milk or food, and the consequences of weaning the baby, and two corresponding subcategories: external and internal factors that influence the decision making to wean the baby emerged from comparative analysis. Results from this study confirmed that women believed that they produced insufficient breast milk, which led them to wean their babies before the reccomended age of 6 months. This belief arose from a complex process and was strongly affected by various biopsychosocial factors. The results of this study will be useful in designing culturally sensitive nursing care and health programmes to support optimal breastfeeding for women of Indonesian origin.
Management of obstetric anal sphincter injury
Authors: Wickham Amanda
Published: May 2014

Obstetric anal sphincter injury (OASIS) and the long-term morbidity associated with it can have a devastating impact on the lives of women and their families. Although the majority of women will not sustain a third or fourth degree tear there is the risk of long-term morbidity if these more severe injuries go unrecognised or mismanaged. With the aid of current guidelines every attempt is made to maintain normal function after birth. However, current research suggests that deficiencies in training for the recognition and management of OASIS are resulting in preventable sequelae. Skills and training are highly variable both trust-and nationwide and recommendations to improve practice include standardised evidence-based perineal assessment and management training.
Continuous professional development, friend or foe?
Authors: Lucas Amanda
Published: May 2014

This article demonstrates processes used by managers to identify learning needs including the attainment of competencies, self assessment and appraisal. Key learning methods are reviewed as the author reflects on the importance of continuous professional development within her organisation.
Early onset jaundice in the newborn: understanding the ongoing care of mother and baby
Authors: Turnbull Victoria , Petty Julia
Published: May 2014

Neonatal hyperbilirubinaemia or jaundice is a relatively common condition in newborn babies presenting with changes to eythrocyte metabolism after day 3 of life. Early onset jaundice is less common and arises on day 1 from a pathological process. This paper outlines a case study of a baby presenting with this condition due to ABO blood group incompatibility who was admitted from the postnatal ward to the neonatal unit (NNU). The article will focus on the period after initial interventions on admission to the NNU and the ongoing care issues thereafter. Both clinical and psychoemotional care issues for the baby and family are raised. It is important that midwives understand what care is delivered during the neonatal unit stay so that they can empathise and assist with family coping strategies following the separation of the baby from the parents at an often emotionally charged time.
A midwives' guide to Turner syndrome
Authors: Hollins Martin Caroline J , Smyth Arlene
Published: May 2014

Turner syndrome (TS) is a cross-cultural genetic disorder that affects around 1 in 2500 women and is predominately associated with short stature and infertility. Classic TS occurs when one sex chromosome is missing (written as 45, X). In mosaic TS, there is a mix of cells, some with 45 chromosomes—missing one X chromosome, and some with all 46 chromosomes—missing part of the X chromosome. TS is characterised by short stature and non-functioning ovaries, which leads to impaired pubertal development and infertility. The majority of women with TS present with no behavioural or physical attributes that would distinguish them as different to the general population, and can be expected to live long and healthy lives. A midwife may have to care for a woman whose fetus has been diagnosed with TS, recognise and manage a newborn with TS, or manage a woman with TS who is pregnant with a donor ovum. To equip midwives with relevant knowledge, the objectives of this paper are to explain what TS is, how it may be recognised, and discuss medical and midwifery management of events.
The accuracy of symphysis fundal height measurement
Authors: Henry Michelle
Published: May 2014

Fetal growth anomalies are correlated with an increased risk of perinatal morbidity and mortality, including unexplained stillbirth. Identification of the small for gestational age (SGA) and large for gestational age (LGA) fetus, especially during an otherwise uncomplicated pregnancy requires effective antenatal screening methods, and involves input from midwives and obstetricians. Measuring fetal growth by serial symphysis fundal height (SFH) measurement using a tape measure and plotting the measurement on a customised growth chart, is the current recommended method. This article compares and presents the findings of recent research literature, and critiques elements of the methodology surrounding the main studies.
Factors influencing multiparous women who choose a home birth—a literature review
Authors: Ashley Sarah , Weaver Jane
Published: May 2014

In the UK there continues to be an ongoing debate about home birth. Limited research is available to determine what influences multiparous women who chose home birth after a previous hospital birth. This paper is the first of a two-part series exploring these influences. This paper will explore the existing literature around the topic and evaluate the key themes. Six databases were searched for relevant literature, and 20 relevant papers were identified. The majority of available research did not differentiate between primiparous and multiparous women, and the predominant focus was on the perception of risks associated with home birth. Persistent themes in the literature were related to control of the birth, negativity about a previous birth, risks and safety, home birth as a lifestyle choice and the influence of midwives. The second paper will report the findings of a phenomenological study in which eight multiparous women were interviewed about the factors that influenced their decision to home birth after a previous hospital birth.
Pregnant women's knowledge about the prevention of gestational diabetes mellitus: A qualitative study
Authors: Poth Megan , Carolan Mary
Published: May 2014

Background:

Rates of gestational diabetes mellitus (GDM) have been steadily increasing over the last two decades ( Ferrara, 2007 ). A diagnosis of GDM has major implications for a woman's pregnancy and care management. At the same time, a healthy lifestyle and diet may significantly reduce the risk of GDM in pregnancy.

Aim:

This study explores the ‘knowledge’ of at-risk pregnant women about the role of lifestyle and diet in the prevention of GDM.

Setting:

A large hospital that provides secondary-level medical care as well as having a large midwifery group practice in Australia.

Methods:

The methodology used for this study is qualitative and was informed by phenomenology. A purposive sample of six women over 30 years old participated in a conversational interview using an interview guide.

Results:

Transcripts were analysed thematically and four broad themes emerged from the study: knowledge of GDM; effect of GDM on mother and baby; diet and exercise as part of a healthy lifestyle; and prevention of GDM. These findings indicated a range of gaps in the women's understanding of how lifestyle and diet can reduce the risk of GDM. Gaps included misconceptions about the cause of GDM, an incomplete understanding of lifestyle risk factors, limited awareness of the effect GDM has on mother and baby, incomplete knowledge of a healthy diet, inconsistent views of recommended physical activity and frequency, and limited understanding of GDM preventative measures.

Conclusion:

The lack of dietary and lifestyle knowledge demonstrated in this study may suggest that women need more appropriate health information on diet and exercise during their antenatal care.
Anxiety, bonding and attachment during pregnancy, the transition to parenthood and psychotherapy
Authors: Steen Mary , Jones Alun , Woodworth Barbara
Published: May 2014

Although becoming and being a parent are considered happy life events, parents can suffer from varying degrees of anxiety and variable mood. Anxiety and mood changes can be missed and this can lead to mental health problems if not recognised at an early stage. An insecure attachment in a parent's early infanthood can contribute to increased levels of anxiety and emotional problems when becoming and being a parent themselves, which can influence mother and child bonding as well as wider difficulties within family relationships. In many instances, attachment styles can be passed on to the infant causing a range of emotional and intellectual difficulties. In certain circumstances, these parents may benefit from psychotherapy. Psychotherapy is a method of addressing troubling emotions along with life difficulties and relationship struggles. Using psychological methods, a psychotherapist can help a person change his or her life for the better by becoming more effective in work or personal relationships. Local community support and befriending approaches have been shown to be beneficial in alleviating anxiety and depression. This article briefly describes what psychotherapy is and demonstrates ways in which interpersonal attachment styles established early on in life can bring difficulties to adult relationships. Two disguised scenarios referring to actual psychotherapy consultations are included to illustrate how plans can be put in place to address interpersonal difficulties related to attachment styles.
Perinatal bereavement care: Are we meeting families’ needs?
Authors: Hughes Katherine Hannah , Goodall Una A
Published: May 2014

The death of a child is often considered a tragedy and would usually provoke a greater emotional response in the general population than that of someone who has lived a long and fulfilled life. However, until recently, the loss of a baby before or shortly after birth has received little recognition and remains largely unacknowledged or underemphasised today ( Kohner and Henley, 2001 ; Mottram, 2004 ; Stillbirth and Neonatal Death Society (SANDS), 2012 ), despite approximately 75% of child deaths being stillbirths or early neonatal deaths ( SANDS, 2012 ). The care received at this time can have a significant and lasting impact on families and thus it is imperative that professionals are able to offer effective care that meets families’ individual needs. In order to do this, practices, policies and guidelines need to be reviewed critically, questioning why things are done as they are and ensuring that quality, up-to-date evidence is the foundation of care.
Women’s experiences of acupuncture during labour
Authors: Gisin Martina , Poat Angela , Fierz Katharina , Frei Irena Anna
Published: May 2014

This study explores the experiences of women treated with acupuncture during labour, to identify factors relevant to midwifery care. An exploratory qualitative approach was used. Seven healthy women who had been treated with acupuncture during normal labour in a maternity unit of a tertiary hospital in Switzerland participated in semi-structured interviews in the first postnatal month. Qualitative data was analysed using thematic analysis. Women treated with acupuncture during labour reported enhanced birthing experiences and satisfaction with regard to pain relief and positive progress in labour, suggesting that acupuncture could be considered an additional support for women during childbirth. This suggests that midwives should discuss acupuncture with women during the antenatal period and offer it as an option during labour. The findings provide a better understanding of this topic by midwives and other health professionals, and contribute to the further development of acupuncture practice during labour.
Fathers' mental health during the ante-and postnatal periods: Knowledge, recommendations and interventions
Authors: Wee Kim Yiong , Pier Ciaran , Milgrom Jeannette , Richardson Ben , Fisher Jane , Skouteris Helen
Published: May 2014

This paper discusses what we know about paternal depression during the perinatal period and if there are any effective interventions for it. Available prevalence estimates suggest that depression experienced by men perinatally may be elevated and specific and/or related to this significant life stage. Currently, there is a paucity of research evaluating how depression during the perinatal period manifests differently in men than women and if men cope with their depression in ways different to women. There is also a lack of studies comparing the risk factors of paternal depression during the perinatal period and the risk factors for general depression in men. Studies showed that paternal perinatal depression not only affects the men, but their children as well. On reviewing the studies on interventions, it is clear that further randomised controlled trials (RCTs) of interventions are needed to establish efficacious and cost-effective treatment protocols for men.
Use of maternity surveys in improving the care experience – a review of the evidence
Authors: Fowler Grace , Patterson Dorothy
Published: May 2014

The use of surveys and direct feedback from women as a measurement of their maternity experience is seen as a means of stimulating quality improvement. Underpinning the overall rationale behind national maternity surveys is the acknowledgement that there is a need to document women's views of maternity services to inform policymakers with a view to enhancing the delivery of quality care to women. The evidence suggests that using maternity surveys to improve maternity care experience is central to UK health policy. It is also evident that qualitative input from women has the power to highlight mismatches of experience between women and professionals. Trusts are required to look to the future and invest in qualitative methodologies, which elicit rich and detailed information on women's experiences. The aim of this literature review is to critically analyse the use of maternity surveys and their validity in improving the care experienced by users of maternity services.
Care of the woman with sickle cell disease in pregnancy
Authors: Esegbona-Adeigbe Sarah
Published: May 2014

Women with sickle cell disease (SCD) constitute a high-risk pregnancy group. SCD is an autosomal recessive inherited blood disorder. The most common and severe form of SCD is sickle cell anaemia (SCA). Knowledge of SCD and its effects on pregnancy is essential for midwives who work in areas which have a high prevalence for sickle cell disorders (>1.5 pregnancies per 10 000 births). This ensures that appropriate woman-centred care is provided. The midwife has an important role in working in partnership with the multidisciplinary team to co-ordinate individualised care and surveillance in pregnancy. This paper provides an overview of care required for women with SCD in pregnancy and the midwife's role in facilitating a positive and safe experience.
Using reflection to enhance the teaching and learning of midwifery students
Authors: Velo Karen , Smedley Alison
Published: May 2014

Preceptorship is a vital role in the development of both undergraduate and postgraduate midwifery students who require input and guidance from more experienced midwives. The preceptor acts as a professional role model to the student: teaching and supporting; providing a learning environment that enables confidence to develop through supervised safe practice; and assisting them to develop knowledge and skills, and adapt to new contexts and new roles within an ever-changing midwifery environment. Using reflection and critical analysis within clinical scenarios is a useful way to provide effective teaching and learning for students. This can also assist the preceptor to develop alternative teaching strategies and develop confidence to try new teaching approaches with students in future encounters. As the role of preceptor comes with great responsibility, the need for flexibility in teaching approaches, according to varied student learning styles, promotes new teaching approaches and confidence in the preceptor. This paper analyses a clinical teaching and learning scenario within a midwifery context and critiques the various teaching strategies utilised to recommend alternative approaches for the registered midwife preceptor.
Non-invasive prenatal testing for Down's syndrome—Where are we now?
Authors: Daley Rebecca , Hill Melissa , Lewis Celine , Chitty Lyn
Published: May 2014

Non-invasive prenatal testing (NIPT) using cell-free fetal DNA (cffDNA) is an area of development in screening for Down's syndrome (DS) that has generated great interest. Analysis of cffDNA found in the maternal blood circulation from 4-weeks gestation is a more accurate screening blood test than is currently available on the NHS. The implementation of NIPT for DS in the NHS has the potential to increase the number of DS cases detected while reducing the number of invasive tests needed and their associated miscarriages. This article will provide an overview of NIPT for DS, the current evidence and what questions need to be answered before implementation within the NHS.
Nurse occupational stress research 5: sources and determinants of stress
Authors: Wheeler Herman H
Published: May 2014

This article, the fifth in a six-part series, reviews the major sources and determinants of nurse stress. The reviewer identifies a wide range of stress determinants, including work overload, interpersonal relationship problems, role conflict and ambiguity, work vs home, resource shortages and pressure from patients, among others. He makes the point that since successive pieces of research keep highlighting the same nurse stress determinants, it would appear that either those who are responsible for addressing the problems and finding solutions are ignoring the research findings or, if interventions are being implemented, they are not working.
The impact of change on the tissue viability nurse specialist: 1
Authors: Flanagan Madeleine
Published: May 2014

Tissue viability nurse specialists in the UK have experienced difficulty in articulating their role, and this has led to a poor understanding of what they do. This article, the first of two parts, presents a literature review which examines the development of specialism in nursing and explores the factors that have influenced the development of tissue viability specialist nurses in the UK. The study described in the second part of the article uses focus group methodology to examine the practices and experiences of tissue viability nurses working in a changing healthcare environment.
Developing clinical guidelines: present and future legal aspects
Authors: Tingle John
Published: May 2014

This article provides a legal update by discussing Department of Health advice on the legal aspects of clinical guidelines and a recent House of Lords' clinical negligence case. These have important implications for developers of clinical guidelines particularly when discussed in the context of recent government initiatives in legal aid and civil justice reform which will result in the development of increasingly specialist clinical negligence lawyers.
As entries into nursing fall questions must be asked
Authors: Scott Helen
Published: May 2014

Statistics relating to applications for entry into higher education in the academic period 1997–98 have been released by the Universities and Colleges Admission Service which show a 2.4% decrease in the number of people applying for entry onto nursing degree courses, combined with a 15% drop in mature student applications to nursing (Gulland, 1998). There is also a parallel shortfall in applications for entry onto nursing diploma courses. In the academic period 1996–97 there were 15 400 applications for 16 100 nursing diploma places. Students appear to be opting for more lucrative and socially prestigious careers in business, engineering and marketing (Gulland, 1998).
Factors influencing tissue viability nurse specialists in the UK: 2
Authors: Flanagan Madeleine
Published: May 2014

The literature review presented in the first part of this article (Vol 7(11): 648–57) revealed a lack of empirical data on specific contextual issues concerning the current practice of tissue viability clinical nurse specialists (CNSs) in the UK. This descriptive study utilizes focus groups to explore the experiences of tissue viability CNSs. It highlights the development of a facilitative style of expert practice within this group of nurse specialists and makes recommendations for successful role implementation. The findings suggest that specialist nurses are evolving a style of practice in congruence with the UKCC's vision of specialist practice (UKCC, 1994) and that these characteristics are likely to become more apparent over the next decade.
Caring for patients with morbid obesity in hospital
Authors: Green Sue M , Gillett Angela
Published: May 2014

Caring for the patient with morbid obesity may require adaptation of routine nursing care; however, as with all patients, care should be tailored to individual needs. This article aims to highlight the specific needs of patients with morbid obesity and discusses ways of addressing these needs. The activities of living model is commonly used to assess, plan, implement and evaluate nursing care. This model, used to identify the potential needs of a patient with obesity, will provide the framework for the article. Documentation of procedures used for patient care, e.g. lifting and bathing, must be made in the patient's care plan enabling other nurses caring for the patient to identify quickly the most appropriate and safe way to care for the patient.
Radiology nursing: legal issues surrounding the expanded role
Authors: Dimond Bridgit
Published: May 2014

The annual conference for the Royal College of Nursing's Forum of Nurses in Radiology and Cardiology took place in Birmingham last year. Participants were asked to consider the ways in which their professional practice could develop within The Scope of Professional Practice (UKCC, 1992a) guidelines and the possible problems they feared could arise. The legal issues which arose from their answers were then analysed. The aim of this article is to examine, in the light of the legal issues, the chosen areas of expansion within the nurse's role and the concerns felt by the participants in order to draw up lessons for nursing generally.
Syphilis: signs, symptoms, treatment and nursing management
Authors: Peate Ian
Published: May 2014

The rise in the number of cases of syphilis reported over the last 3 years (Communicable Disease Report, 1997) suggests that some individuals are not practising safer sex and/or that health education programmes are ineffective. The increasing incidence could also be a consequence of more people attending for sexual health checks. Syphilis is primarily a sexually transmitted disease, although a pregnant woman may pass the disease to her fetus via the placenta, and rarely healthcare professionals may acquire the disease through open lesions. If allowed to run its full course the disease can have devastating effects on the individual. Regular screening of at-risk groups, screening at antenatal clinics and genitourinary medicine clinics, promotion of safer sex activities and health education may aid prevention. The nurse is ideally placed to provide patients with information that may prevent infection or help to minimize its severity.
Interventions for confusion and dementia 1: quality of life
Authors: Woodrow Philip
Published: May 2014

This series of articles examines some of the more commonly used interventions for confusional states/dementia. This article explores issues around quality of life. Quality of life is a subjective and potentially undefinable concept. Yet in recent years it has been used widely in the nursing literature. However it is defined, it is fundamental to humanity and underpins all the interventions discussed in the later articles. When continuing health care fails to offer hope of a medical cure, the focus necessarily shifts to care. Good care and quality of life are inextricably linked. This article raises awareness of some key issues to guide readers when deciding whether or not to adopt a particular intervention; a prescriptive approach to quality of life is deliberately avoided. Later articles in this series will discuss reality orientation, reminiscence, validation, and multisensory environments.
Ethical dilemmas in clinical supervision 1: need for guidelines
Authors: Cutcliffe John R , Epling Mike , Cassedy Paul , McGregor Jane , Plant Nigel , Butterworth Tony
Published: May 2014

In this article, the first of two parts, the authors focus on ethical dilemmas in cllinical supervision. Given that there may be several factors that contribute to the limited uptake of clinical supervision, the authors suggest that one reason might be the clinician's concern and confusion regarding the potential ethical dilemmas that could arise when providing clinical supervision. Most issues do not produce ethical dilemmas, but some do. Therefore, this article offers a brief description of the purpose and alleged benefits of supervision, and examines the current position of the law in regard to ethical dilemmas within supervision. It then provides six vignettes where supervisors are faced with ethical dilemmas. These will be discussed in the second part of this article.
Clinical Governance
Authors: Wilson Jo
Published: May 2014

Clinical governance has marked a significant shift towards involving clinicians in the assurances of both quality and accountability in healthcare delivery. The White Paper (Department of Health (DoH), 1997) stated that: ‘The Government will require every NHS trust to embrace the concept of clinical governance, so that quality is at the core, both of their responsibilities as organizations, and of each of their staff as individual professionals.’ In order to achieve this the Government will bring forward legislation to give NHS trusts a new duty for maintaining quality care. Under these arrangements, chief executives will carry ultimate responsibility for assuring the quality of the services provided by their NHS trust, just as they are already accountable for the proper use of resources. In ‘A First Class Service Quality in the NHS’ (DoH, 1998), clinical governance is defined as ‘a framework through which NHS organizations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish’. The principles of clinical governance apply to all those who provide or manage patient care services in the NHS. It requires staff to work in partnerships, breaking down boundaries by providing integrated care within health and social care teams (Wilson, 1996), and between practitioners and managers and between the NHS, patients and the public.
An ethical investigation into the provision of pain relief in infants
Authors: Kenny Gerard
Published: May 2014

This article examines issues relating to the pain experienced by infants and the nursing care they receive in the context of universal ethical principles. The intention is to show that ethics is not a remote intellectual pursuit but has the potential to directly affect and enhance the care given to infants in pain. The author maintains that the consequence of using an ethical approach is that the relationship between infant and carer is infused with improved communication and greater self-awareness.
Review of the STM range of pressure distribution products
Authors: Moody Marion
Published: May 2014

STM Healthcare is a division of the Recticel Group which has been actively involved in the production and use of polyurethane foams for the past 40 years, and is now one of Europe's leading manufacturers of polyurethane foam for insulation, packaging, filtration, aerospace, the automotive and furniture industries, domestic and specialist bedding and seating products. STM Healthcare is able to draw upon the wealth of experience and expertise of the manufacturing facilities, enabling products to be developed using the latest environmentally friendly specification foams best suited to the requirements of pressure-reduction technology. All STM Healthcare mattresses, cushions and Linknurse mattresses are manufactured with Safeguard® combustion modified high resilience foams. (Linknurse is a licensed product name; products are manufactured by Recticel and distributed by STM).
Patient's experiences of varicose vein and arthroscopy day surgery
Authors: Fitzpatrick Joanne M , Selby Theresa T , While Alison E
Published: May 2014

A small-scale telephone survey of day surgery patients' (n = 30) experience of pain, nausea and vomiting, wound healing and fatigue during the 7 days following discharge and their views of the service is described. Respondents who had undergone either varicose vein stripping (n = 15) or arthroscopy (n = 15) were interviewed using a semi-structured interview schedule. The findings indicated that most respondents expressed satisfaction with their recovery despite some evidence of postoperative morbidity. The majority of the sample indicated that they had received adequate information to enable them to cope at home and qualified nurses on the day unit were identified as a primary source of information. Following discharge, GPs or the day unit were key points of contact. The findings of this study, together with previous research, highlight important areas for further action by health professionals if this service is to be delivered effectively and efficiently.
Urinary catheters: selection, maintenance and nursing care
Authors: Stewart Elisabeth
Published: May 2014

Catheterization is often undertaken without sufficient assessment, and the high rates of bacteriuria (1020%) occurring in catheterized patients seem to be accepted (Ward et al, 1997). This article reviews catheter selection, maintenance and nursing care, highlighting problem areas and suggesting measures that may be taken to reduce the risk factors. A problem-solving approach, based on research evidence relating to catheter care, is presented. Often there is a simple solution to a problem, but treatments based on traditions or myths appear to be the first choice in many situations. This article aims to provide nurses with the evidence base required to establish and maintain a urinary drainage system safely.
Patient safety and the reuse of single-use medical items
Authors: Nye Philip , Wilson Jo
Published: May 2014

Trusts owe a duty of care to patients, staff, the public and the environment. This article considers the risk issues associated with the reuse of medical devices. The practice of reusing medical devices labelled by the manufacturer for single-use only must be carefully considered by managers and clinicians responsible for patient safety, to ensure that account has been taken of outcomes which may adversely affect clinical procedure and be harmful to the patient.
Obtaining the evidence for clinically effective wound care
Authors: Dealey Carol
Published: May 2014

In tissue viability, as in other aspects of health care, there is increasing recognition of the need for healthcare interventions to be supported by good research evidence. The randomized controlled trial (RCT) is considered to provide the most accurate evidence of effectiveness. This article discusses some of the problems that arise when researchers attempt to obtain the relevant evidence. They include funding, sample selection, sample size, recruitment of patients, and mortality and attrition rates. These points are illustrated by means of a case study. In this study an RCT was undertaken to compare two dressings for the management of pressure sores. Problems arose with recruitment of patients to the study. Relevant issues associated with this are discussed and recommendations for future recruitment are presented.
Falls in elderly people: is the risk suitably assessed?
Authors: Willis Sharon
Published: May 2014

Results of the annual screening of people over the age of 75 years were used to determine whether the risk of falling in this age group is adequately assessed. The study group comprised primary healthcare professionals employed within six counties throughout England and Wales. Three per cent of respondents indicated that they use formal risk assessment tools when undertaking screening of people over 75 years. Analysis of the answers provided by these respondents, and of their assessment tools used, indicates that none of the tools are suitable for identifying those people at risk of falling within the home environment. Ninety-seven per cent of respondents indicated that they did not use a formal risk assessment tool for this age group. Analysis of the data provided by these respondents identified that the information gathered did suitably identify those people at risk of falling within the home.
Adherence and compliance in the management of asthma: 1
Authors: Conway Alison
Published: May 2014

This article explores the issues surrounding compliance with treatment in patients with asthma. Epidemiological data (Pendleton, 1991) suggest that although overall mortality rates from asthma are falling, this is not the case in the adolescent and young adult age groups. Also, there has been little impact on morbidity figures for the disease. All of this is set against an expenditure of £430 billion per annum on asthma medication. It would appear that patients are not complying with the prescribed treatment. This article examines the reasons for possible non-adherence with therapy and suggests that healthcare professionals must review their attitudes to this problem. The next article will examine in more detail issues relating to patients' adherence.
Government launches new recruitment campaign
Authors: Scott Helen
Published: May 2014

The latest phase of the Government's nurse recruitment campaign has just been launched by the Department of Health (DoH). The £50 000 recruitment resource pack Sharing Ideas, part of a £2.5 million ongoing national campaign, is aimed at helping trusts to recruit and retain nurses. The pack contains a video for use in schools and careers offices, a cassette of advertisements for local radio and a computer disk for printing promotional posters. It addresses employment issues such as family-friendly policies, equal opportunities, professional and personal development and selection and recruitment programmes. Baroness Jay, Minister for Health, voiced the Government's intention to ‘support familyfriendly policies which include…flexible shifts or nursery provision’ (DoH, 1998).
A review of the development of isolation precautions
Authors: Gammon John
Published: May 2014

Isolation precautions are crucial to the effective control of infection in healthcare settings. Isolation practices have developed considerably over the last 150 years; current systems and procedures of isolation are rational and scientifically-based. Epidemiological patterns of various diseases develop and change and isolation precautions aim to prevent their spread. Many historical developments originated in America, at the Centre for Disease Control (CDC). Isolation techniques and the more recent two-tier system of isolation were among these developments. This article reviews the development of various Isolation precautions and examines the impact of CDC recommendations on UK practice.
Compression therapy for lymphoedema from Vernon-Carus
Authors: Williams Clare
Published: May 2014

Lymphoedema is a chronic condition which, if untreated, becomes progressively worse. It cannot be cured, but it can be monitored, treated and maintained to give the patient a relatively normal quality of life (Barrett, 1997). This product focus looks at lymphoedema, its treatment and the role of a compression system from Vernon-Carus.
Exploring the NHS executive document Signposts for Success
Authors: Parrish Alan , Kay Brian
Published: May 2014

The recent document ‘Signposts for Success’ (Department of Health (DoH), 1988a) offers an extensive blueprint for the strategic development of services for people with a learning disability in the next decade. This article discusses the key issues raised and some of the controversial aspects that have to be addressed.
Enteral feeding: an overview of indications and techniques
Authors: Reilly Helen
Published: May 2014

Most patients requiring nutritional support can be successfully managed using enteral feeding, i.e. the provision of nutritional support via the gastrointestinal tract. Various routes of access are available and patients should be assessed on an individual basis by the multidisciplinary team to select the most appropriate method and decide on a suitable regimen. Careful management and regular monitoring of enteral feeding are required in order to ensure safe and cost-effective nutritional support; the use of standard protocols and guidelines is recommended. With appropriate training, monitoring and support, enteral feeding is best provided in the community for many patients, and the use of home enteral feeding is rapidly increasing.
A systematic approach to self-medication in older people
Authors: Ryan Assumpta Ann
Published: May 2014

This aim of this study was to evaluate the effectiveness of an individualized education programme on older patients' knowledge of prescribed medication. A questionnaire for assessment of medication knowledge was used to collect data from 15 patients before and after an individualized education programme which lasted approximately 2 weeks. Following the collection of pre-intervention data, an individualized education programme was developed for each patient. In addition to verbal instruction, each patient was provided with written information on his/her drug regimen. As part of the education programme each patient also had an opportunity to self-administer his/her medication. The results of the study showed that all participants scored higher in the post-test than the pre-test, although the degree of improvement varied between participants. The average increase in knowledge was 26%. Patient satisfaction with the education programme was also assessed using a questionnaire. Results suggested that there was a very high level of satisfaction with the programme.