bluuebunny/crossref_metadata_2025 huggingface dataset:
Cardiorespiratory physical assessment for the acutely ill: 2
Authors: Docherty Brendan
Published: May 2014

The second of this two-part article aims to develop advanced cardiovascular and respiratory knowledge to enhance practice for the nurse caring for an acutely ill patient on a general ward. The first part dealt with the core aspects of care in respiratory and cardiovascular physical assessment, including respiratory function and failure, pulse oximetry, oxygen therapy, fluid therapy, pulse measurement, blood pressure and electrocardiogram monitoring (Vol 11(11): 750–8). As the use of critical care beds within trusts becomes more difficult to manage, with ever-increasing patient dependency, and occupancy figures remaining high, critically ill patients are likely to remain in wards longer, or be discharged from a critical care environment earlier. These patients will require more frequent, direct, non-invasive and invasive monitoring to ensure that they do not deteriorate, and that any deteriorations are detected early and managed effectively. The skills and information discussed here will help nurses advance their practice and improve the quality of their care.
Reporting of injuries, diseases and dangerous occurrences
Authors: Dimond Bridgit
Published: May 2014

Clematis, a staff nurse in an orthopaedic ward, injured her back when lifting a patient with another nurse from the bed to a wheelchair. She was admitted to hospital and was off sick for many weeks. When she returned to work she noticed that the accident form which she had completed was still on the ward and copies did not appear to have been circulated. What is the law and what is her responsibility?.
Wound healing/product selection for a critically ill obese patient
Authors: Thompson Geoff
Published: May 2014

The selection of wound management products by nurses can be an area of confusion. Healthcare professionals involved with tissue viability issues have to make choices from a wide range of commercially available products to suit wound conditions. This article recounts the challenges facing a specialist nurse and his selection of a range of Smith & Nephew Healthcare products, when he was asked for expert advice to promote granulation in a massive wound following debridement for extensive abscess formation in the lower abdominal, perineum and ischial areas.
Web Watch
Authors: Redmayne Jon
Published: May 2014

This edition of Web Watch looks at sites relating to mental health nursing. While we have been careful to list only sites that have been recommended by specialists in the field, we re-emphasize our usual warning about evaluating any material you get from the internet in the same way that you would with materials you find anywhere else.
The relevance of the Consumer Protection Act 1987 to health care
Authors: Dimond Bridgit
Published: May 2014

Primrose is a staff nurse on a surgical ward. On one shift she was injecting Dora, a patient, with a pain killer when the needle broke, and the top part became embedded in Dora's arm.
Decontamination of reusable instruments in primary care
Authors: Curran Evonne T , Riley Jackie , Fletcher Ann W
Published: May 2014

Staff who undertake effective decontamination in non-centralized settings, such as general practices, must be provided with training and easy-to-follow guidance. In this article we present a distillation of the current guidance in an industrial quality control format of fishbone charts. A fishbone chart (or cause-and-effect chart) depicts all the causes of an outcome in a logical way to facilitate the identification of a specific problem. We developed our fishbone chart to include instructions that, if followed, would achieve safe and effective cleaning and sterilization. A survey of those given the charts showed high user acceptability: 76% found the fishbone better than existing guidelines — although the response rate was low at 46%. The charts will enable those involved in decontamination of instruments, including managers and infection control staff, to audit the facilities, equipment and practices. The use of industrial quality control tools may assist other specialties that require complicated and comprehensive guidelines to be presented in a more user-friendly design.
Web Watch
Authors: Redmayne Jon
Published: May 2014

This edition of Web Watch looks at sites relating to infection control. While we have been careful to list only sites that have been recommended by specialists in the field, we re-emphasize our usual warning about evaluating any material you get from the internet in the same way that you would with materials you find anywhere else.
Students must be treated better in clinical areas
Authors: Castledine George
Published: May 2014

The UK is going through its worst nurse shortage crisis for some time. With nurse recruiters too preoccupied with attracting overseas nurses, there has been too little emphasis and focus on the need for developing home-grown talent. Autumn is traditionally the time of year when there are large intakes of nursing students on preregistration programmes. We should be doing whatever possible to make our profession welcoming and attractive to new learners. Unfortunately, there is often too much negativity and lack of respect for students when they enter clinical placements.
Nurses from EU may not have to register with the NMC
Authors: Scott Helen
Published: May 2014

A draft European directive which would, if passed, allow healthcare professionals to work in member states for up to 4 months without having to register with the host state's regulatory body has caused a storm of protest among the regulators of health professions. An umbrella organization of regulators, the Alliance of UK Health Regulators on Europe (AURE), of which the Nursing and Midwifery Council (NMC) and the General Medical Council are members, is opposed to the directive as it believes that the proposal will compromise the safety of patients and service users.
Establishing breach of the duty of care in the tort of negligence: 2
Authors: Tingle John
Published: May 2014

This article discusses the law surrounding breach of the duty of care in negligence. A mistake or error does not necessarily mean legal fault and negligence. Judges look at risks and benefits in determining what would have been the appropriate standard of care to be exercised in the circumstances and may decide that the defendant's conduct was reasonable. There are a number of interrelated factors which judges have to balance and these can be categorized as foreseeability of harm, magnitude of risk, burden of taking precautions, utility of the defendant's conduct and common practice.
Improving continence service standards within midwifery
Authors: Mackenzie Rona
Published: May 2014

Within west Essex, any woman that has difficulty in passing urine or problems controlling her bladder in the immediate postnatal period is referred to the Continence Advisory Service (CAS) and liaison takes place with the midwife, or with the woman if she is at home. A small working party from midwifery and the CAS has developed, introduced and reviewed guidelines and standards for bladder management during and following labour. These are based on informing women of the importance of regular bladder emptying, especially if they have had epidural analgesia. Regular bladder emptying is by normal voiding or intermittent catheterization, if necessary. The contact with the CAS enables women sustaining anal sphincter trauma to have a better understanding of the injury and the ways in which problems can be treated or prevented. It provides continuity of contact with the same practitioner, and a suitable environment to discuss a potentially embarrassing subject. In-house education of all healthcare professionals involved with women who are planning or have had babies has resulted in the early detection of women with voiding difficulties, and has led to an improved and efficient service.
The nursing profession must be more assertive over pay
Authors: Scott Helen
Published: May 2014

The time has come once again for negotiations over nurses' pay. This year nursing unions are demanding a substantial rise for nurses in an endeavour to recruit people into the nursing profession. According to the nursing unions, in their submission to the pay review body, the disparity in pay compared to similar public sector workforces is creating low morale among nurses because they do not feel that they are valued. At present, a newly qualified nurse's salary (£16 005) is 10% less than teachers and 14% less than police. Nursing unions are also asking for increased pay for nurses working at higher grades.
The professional standard of care in clinical negligence
Authors: Tingle John
Published: May 2014

The general principle of law relating to breach of duty in the tort of negligence has been discussed during this series of articles. This article continues that discussion in relation to healthcare professionals such as nurses and doctors, and how the law affects their case. The issue of the expanded role of the nurse is also discussed.
Modernization of the NHS is shrouded in spin
Authors: Castledine George
Published: May 2014

The use of the terms ‘modern’ and ‘modernization’ usually refer to the current state of thinking in fashion, music, art and design. They relate to up-to-date situations and not antiquated traditional views. The present Government in the UK is using these terms to drive forward changes to the NHS, which it hopes will not only improve the service, but also bring about an evolutionary shift in today's healthcare system.
Outcome measures for erectile dysfunction 2: evaluation
Authors: Dorey Grace
Published: May 2014

This article, the second of two parts, discusses and evaluates the range of outcome measures for erectile dysfunction (ED) identified from the literature review in part one (Vol 11(1): 54's64). The literature review identified 14 subjective and 12 objective measures. These outcome measures are needed for the components: rigidity, vascular flow, nerve conductivity, intracavernosal pressure, ischiocavernosus muscle power, partner satisfaction and quality of life. Instruments selected should provide good validity, reliability and responsiveness. Quick, simple, inexpensive and efficient outcome measures can be used by nurses.
New initiative to provide evidence-based IV care
Authors: Castledine George
Published: May 2014

The practice of inserting an intravenous (IV) cannula into a patient is fast becoming routine in many hospitals throughout the UK. Recent estimates suggest that 80% of all patients who enter the health service each year receive IV therapy (Wilkinson, 1996). Inserting an IV cannula is often a precautionary move aimed at providing quick and efficient access in an emergency. The danger of this practice, however, is that healthcare professionals such as nurses become complacent and fail to follow the appropriate guidelines. The complications associated with IV cannulas are infection, extravasation, trauma and thrombophlebitis. Therefore, this area of patient management is potentially life threatening and carries significant patient morbidity.
The future direction of nurse education is being debated
Authors: Glasper Edward A
Published: May 2014

The Nursing and Midwifery Council's (NMC's) consultation on the establishment of a new national professional register for nurses, midwives and health visitors (NMC, 2002) has been set against the backdrop of the outgoing RCN President Roswyn Hakesley-Brown's position paper on nursing education (RCN, 2002).
Perioperative care is failing patients in need of surgery
Authors: van Limborgh Melanie
Published: May 2014

A report by the National Confidential Enquiry into Perioperative Deaths (National CEPOD) has brought perioperative care to the forefront of the healthcare agenda.
Risk assessment and management to ensure health and safety at work
Authors: Dimond Bridgit
Published: May 2014

Mammet, the charge nurse on a surgical ward, was asked to carry out a risk assessment on health and safety. He had never been taught such an activity and needed to seek advice.
The professional standard of care in clinical negligence
Authors: Tingle John
Published: May 2014

Clinical guidelines are important healthcare quality management tools which have become more widely known and accepted in the NHS today. There are some problems with the terminology used regarding clinical guidelines and sometimes they are confused with protocols. Clinical guidelines have a number of legal implications and they could be influential in determining the standard of care to be expected in a particular case. The Bolam case shows that a number of care approaches are acceptable as long as they are reasonable. The developers of clinical guidelines should develop an audit trail of their work and build in review dates.
Web Watch
Authors: Mangan Paul
Published: May 2014

This edition of Web Watch looks at sites relating to continence. While we have been careful to list only sites that have been recommended by specialists in the field, we re-emphasize our usual warning about evaluating any material you get from the internet in the same way that you would with materials you find anywhere else.
Government offers nurses ‘strings attached’ pay award
Authors: Scott Helen
Published: May 2014

The Government has recently announced that it will be reforming NHS pay systems and is prepared to give nurses and other NHS health workers a minimum 10% basic pay rise over 3 years. However, the proviso for this increase is that nurses will have to ‘modernize’ their working practices and take on expanded role responsibilities. To progress through the new pay bands staff must demonstrate that they possess the knowledge and skills required to expand their role. The proposals for these current reforms were set out in Agenda for Change (Department of Health, 1998) and the final recommendations are now out for wider consultation with NHS staff organizations.
ARTICLE
Authors: Cutcliffe John JR , Jones Julia , Jackson Ann
Published: May 2014

This article reported on a survey which was designed to measure aspects of community psychiatric nursing (CPN) education in the UK. Thirty-two of the 39 course leaders who ran postqualifying programmes in CPN responded to a nine-page postal questionnaire. Findings indicated that the majority of courses are now run at degree level, and that most appear to include education in key areas of specialist content pertinent to contemporary CPN practice (e.g. collaborative working with service users). Overall, however, the article reported that courses for CPN appeared to be characterized by considerable variation in specialist content. The article concluded by offering possible explanations for this variation and some suggestions for future research.
Uncertainty in the next era of professional regulation
Authors: Castledine George
Published: May 2014

Nursing regulation has always centred around the importance of protecting the public. In the early days, the battle for regulation was between the Royal British Nurses’ Association, which stood for high professional standards irrespective of the staffing needs of hospitals, and the College of Nursing, later to become the Royal College of Nursing, which was allied with hospital management and was prepared to pay attention to the staffing needs of the hospitals. Both groups wanted to influence any new council which was to be set up to regulate nursing. The Nurse Registration Act in 1919 did not create any greater unity between these professional organizations, but it officially established nursing as a recognized profession (Abel-Smith, 1960).
The law relating to teenage pregnancy needs to be clearer
Authors: Dimond Bridgit
Published: May 2014

In the children's supplement the topic of teenage pregnancy is addressed (Pp. 257–60). The legal issues which arise from this are immense and encapsulate many of the conflicts in the law which can arise in health care.
The role of nurses with regard to health and safety at work
Authors: Diamond Bridgit
Published: May 2014

No practitioner could have failed to notice the media hype and publicity given to every reportable wrong within the NHS: dirty wards, high rates of cross-infection, poor food, repeated errors in the administration of medicines, violence to staff, patients dying on trolleys after waiting hours for admission, and so on. But who should be held responsible for such poor practices, blunders and mistakes?. Is any of this the concern of the registered nurse practitioner or midwife and what is the situation if the nurse reports his/her concerns but there is no response or change?. Can health and safety laws be left to the health and safety officer?. The answer to these questions is clearly negative.
Contractual responsibilities of both the employer and employee
Authors: Dimond Bridgit
Published: May 2014

Violet was a staff nurse working on a ward at Roger Park Hospital with patients with infectious diseases. She claimed that there was inadequate equipment to ensure safe practices in preventing cross-infection between patients and staff. She then discovered that she had contracted hepatitis B and it seemed likely that she had been infected by a patient. She wishes to obtain compensation.
A review of children's nursing: but does it have a future?
Authors: Glasper Edward Alan
Published: May 2014

With less than 35 000 registered children's nurses in the UK it is timely in the 10-year anniversary issue of the British Journal of Nursing to examine the progress of children's nursing. This article explores the ramifications of the outgoing UKCC's ‘Fitness for Practice and Purpose’ document (UKCC, 2001) and its legacy to the incoming Nursing and Midwifery Council. The argument as to whether preregistration nurse training should become generic with specialization occurring as a postregistration activity will be debated.
Developments in learning disability nursing over the last 10 years
Authors: Aylott Jill
Published: May 2014

This article aims to reflect upon the changes in the learning disability nursing profession over the last 10 years. It highlights the nurses' role in supporting a change of culture within the field of learning disability from one of oppression and restriction of individual rights to one where the principles characterized in the White Paper — civil rights, independence, choice and inclusion — are being increasingly supported by learning disability nurses. It concludes by examining the key issues that face the learning disability profession over the next 10 years.
An examination of the last 10 years of mental health nursing
Authors: Russell Ashmore , Cutcliffe John , Collier Elizabeth
Published: May 2014

This article offers an examination of the mental health nursing articles published in the British Journal of Nursing during the last 10 years, and a commentary on how these reflect developments within this specialism. It identifies a number of clinical and professional issues, which have emerged over the last decade, including: community care; concerns over the quality of acute inpatient services; clinical supervision; and the integration of schools of nursing into higher education. Finally, the article identifies some clinical areas which it suggests warrant attention in the next decade such as child and adolescent mental health and mental health care for older people.
Hospitals are to be given standards of cleanliness
Authors: Castledine George
Published: May 2014

The push to improve the cleanliness in our hospitals continues to gain momentum with the publication of the NHS Estates (2002) guide National Standards of Cleanliness for the NHS. This comprises a set of tools that should be used by matrons, ward sisters/charge nurses and both inhouse and contracted service providers to monitor and improve their cleaning services.
Nurse who failed to recognize the serious condition of a patient
Authors: Castledine George
Published: May 2014

Nurses' roles in certain frontline services such as accident and emergency are expanding at a rapid pace. The reasons for this vary from shortages of medical staff to the desire of some nurses to take on more medical tasks and expand their role into medicine. Strict controls need to be in place to monitor and evaluate what is happening and to assess the effectiveness of using nurses to cover for doctors.
Violence: the duty of the employer and remedies by the employee
Authors: Dimond Bridgit
Published: May 2014

May, a ward sister in the accident and emergency department, was on duty at the weekend when a patient was brought in by two friends. It was clear that they had all been heavily drinking. It appeared that the patient had serious injuries following a fall. She attempted to arrange for the patient to be taken into a cubicle, but in so doing was struck by one of the friends and suffered a serious blow to her face. What rights does she have in law?.
Multiple sclerosis: the Treetops model of residential care
Authors: Flynn Sheila
Published: May 2014

Treetops is a high-dependency centre for physically disabled adults. It was opened 10 years ago by John Grooms as a national charity for the disabled, and it has gradually evolved as a specialist centre for the care of people with multiple sclerosis (MS).
Giving and serving are key elements in nursing
Authors: Castledine George
Published: May 2014

National Nurses' Day (12 May) is an appropriate time to reflect about and celebrate nursing. However, just what are we actually celebrating and does it still hold with the past traditions of nursing?.
Improtec R Barrier: a mattress cover which does not break down
Authors: Kingsley Andrew
Published: May 2014

Mattress cover material breakdown in the clinical setting has been a recognized problem for over 10 years. Shortly following disruption to the surface integrity, mattresses become contaminated with body fluids, which leads to bottoming-out of the foam, putting patients at increased risk of infection and pressure ulcer formation. Collaboration between manufacturers and clinicians has produced a product that should stand up to the rigours of the healthcare market, providing safety for patients and value for money as a result of extended mattress life.
Best practice statement for the prevention of pressure ulcers
Authors: Cooper Pam , Gray David
Published: May 2014

The Nursing and Midwifery Development Unit, Scotland, has developed a range of best practice statements one of which relates to the prevention of pressure ulcers. The development of the statement involved achieving a consensus as to what constituted best practice in this field among the 30 nurse specialists in tissue viability working within Scotland. The statement aims to provide practical, relevant and factual information to guide pressure ulcer prevention practice.
Clinical practice benchmarking: implications for tissue viability
Authors: Morris Louise
Published: May 2014

Healthcare provision has been described as a ‘lottery’, reflecting a deficiency in equity of care (Ellis, 2000). Recent Department of Health (DoH) publications (DoH, 1998, 1999) attempt to overcome this disparity and assure quality care by quality assessment and continuous quality improvement (Ellis and Morris, 1997). These documents advocate clinical benchmarking as a means to supporting this practice. This article provides an overview of the benchmarking process, with particular focus being applied to the pressure ulcer element. It reflects on the coalescence that appears to exist between implementing clinical benchmarking and the characteristics of specialist practice. It also analyses the effects of establishing the process on an existing tissue viability service.
Pressure ulcers: are they inevitable or preventable?
Authors: Fox Carolyn
Published: May 2014

Are pressure ulcers inevitable or preventable?. This is a modern day dilemma that faces all nurses. Pressure ulcers remain common and investment does not necessarily guarantee a reduction in their incidence. Some would argue that pressure ulcers are an inevitable consequence of immobility whereas others believe that the development of a pressure ulcer is a sign of inadequate nursing. So are pressure ulcers still a nursing problem or has increased awareness placed them firmly on the doorstep of the multiprofessional team?
Pressure ulcer classification: defining early skin damage
Authors: Russell Linda
Published: May 2014

This article is the second of a two-part series. The first part (Russell, 2002) looked at various systems and pitfalls of pressure ulcer classification systems. This article focuses on the difficulties of defining early skin damage. Patients' quality of life suffers significantly with a pressure ulcer. The smell of the exudate may be an embarrassment to the patient. The pain and the distress the patient will experience will not easily be forgotten, i.e. the number of dressings required for a deep pressure ulcer, even after the pressure ulcer has healed, will be a memorable intrusion to the patient's daily routine. Early detection of pressure ulcers and timely intervention are essential in the management of patients with pressure ulcers. Controversy exists over the definition of the first three stages of pressure ulcers, but there is consensus on the definition of deep tissue damage. If the pressure ulcer is covered with black necrotic tissue it is difficult to establish depth of the tissue damage. Intact skin can cause problems, as a sacrum may be purple but intact. There is still considerable debate with regard to reactive hyperaemia, as the exact time parameters for persistent erythema to occur are unknown. Little is understood with regard to the exact pathophysiology of reactive hyperaemia and this area requires further investigation. Blistered skin and skin tone also cause confusion in grading of pressure ulcers. The problems associated with classification of pressure ulcers, using colour classification systems, are discussed and the implications for practice are considered. The confusion surrounding early classification of pressure ulcers is discussed and it is hoped that such confusion can be addressed by standardizing training using one national classification system.
Evidence-based surgical wound care on surgical wound infection
Authors: Reilly Jacqueline
Published: May 2014

Surgical wound infection is an important outcome indicator in the postoperative period. A 3-year prospective cohort epidemiological study of 2202 surgical patients from seven surgical wards, across two hospitals, was carried out using gold standard surveillance methodology. This involved following patients up as inpatients and postdischarge surveillance to 30 days by an independent observer. The results led to the development of a mathematical model for risk of clean, elective surgical wound infection. Risk of surgical wound infection was increased by smoking, higher body mass index, presence of malignancy, haematoma formation, increasing numbers of people in theatre, adherent dressing usage, and higher times to suture removal (P<0.05). The results show that this type of surveillance is an effective way of collecting accurate data on wound infection rates. It was noted that patient care practices affected the surgical wound infection rate and the surveillance was used to facilitate the adoption of evidence-based practice, through recommendations for clean surgery, to reduce the risk from extrinsic risk factors for wound infection. As a result of the implementation of this evidence-based practice there was a significant reduction (P<0.05) in the clean wound infection rate.
Teaching bandaging and Doppler usage for venous ulcer treatment
Authors: Maylor Miles E
Published: May 2014

This article describes how an assessor's guide and a student learning contract about compression and Doppler therapy was presented to community nurses and practice nurses in an NHS acute and community trust. The objectives were to provide potential assessors with standardized practice in the application of compression bandaging and the use of Doppler-assisted diagnosis in the treatment of venous leg ulceration. This was achieved by a teaching session using two checklists, one for the assessor and the other for the ‘student’. Role play was used to allow experience of assessing or being assessed in a classroom setting. References to key pertinent articles were provided to support the learning contract, and the development of a resource file was proposed. In recognizing their own limited knowledge and experience, a small number of practitioners felt unable to assess ‘officially’ other members of their staff.
The management of a pilonidal sinus and its follow-up care
Authors: Tinsley Philippa
Published: May 2014

This article describes the care of a young man following surgery for a pilonidal sinus and the follow-up care after removal of the sutures from the wound. Unfortunately, the wound became infected and dehisced on removal of the sutures, causing the patient to have problems with both wound healing and body image
We need to value those with nursing experience
Authors: Castledine George
Published: May 2014

Being part of the recent British Journal of Nursing Clinical Practice Awards and experiencing Nancy Roper receive her Lifetime Achievement in Nursing Award was very special. Not only did she get three standing ovations, but also she made many of us think how important it is to acknowledge and celebrate our own British nursing pioneers.
NHS should take staff health and safety more seriously
Authors: Tingle John
Published: May 2014

Nurses form the biggest professional group in NHS trusts and they should be concerned by the latest report from the National Audit Office (NAO) on improving the management of health and safety risks to staff (NAO, 2003). The report highlights serious shortcomings in staff health and safety matters in NHS trusts, and makes a number of important recommendations to improve matters.
The QUATTRO ACUTETM mattress and pressure ulcer prevention
Authors: Hampton Sylvie
Published: May 2014

There are a plethora of mattresses on the market and nurses are not always sure which mattress to select for each individual patient. This article outlines the issues in preventing and understanding pressure ulcers and the performance of the QUATTRO ACUTE™ mattress, manufactured by Talley Medical.
Role of the stoma care nurse: patient with cancer and colostomy
Authors: Comb Jean
Published: May 2014

This case study describes the physical, psychological and emotional problems of a female patient suffering from rectal cancer, who required the formation of a colostomy. It highlights the role of the stoma care nurse from diagnosis, through staging of the disease, to treatment and recovery in hospital and at home, and discusses the problems of altered body image and the need for effective communication to enable the patient to achieve a good quality of life.
A multidisciplinary follow-up clinic after patients' discharge from ITU
Authors: Crocker Cheryl
Published: May 2014

Follow-up clinics following discharge from intensive care are not a new phenomenon — Whiston Hospital in Liverpool has been running a clinic since 1990. Its pioneering work has set a precedent and has inspired Nottingham City Hospital to set up its own clinic. The Department of Health (2000) recommended that all NHS trusts ‘review the provision of follow-up services and ensure there is appropriate provision for those patients who will benefit’. Nottingham City Hospital set up a multidisciplinary follow-up clinic without funding, with great success, over a year ago. This service has been extremely valuable to patients and their carers and has helped staff understand the needs of patients once they have left intensive care. This article will describe the clinic's work and case studies are utilized in order to illustrate key points.
Nurses' role in the developments in learning disability care
Authors: Parrish Alan , Styring Lesley
Published: May 2014

This article looks at the changes in the attitude of society towards people with a learning disability over the last 20 years. Their status in the world as well as their right to be recognized as individuals will be discussed. Nurses have had to move away from the medical and dependence model of care and adjust their practice and behaviour to practice in a more relaxed and domestic style, in which risk taking, decision making, choice and opportunity for the clients are key features of the service. This article will highlight the role that learning disability nurses have played in these changes and the adjustments that they have had to make to their clinical practice. Within the new culture of independence and rights for people with a disability, it emphasizes the need for nurses to ensure that they address their own accountability and responsibility. Strategies that have been developed to address social discrimination and exclusion will also be explored.
A history of diabetes: from antiquity to discovering insulin
Authors: King Kathryn M , Rubin Greg
Published: May 2014

This article, the first of a three-part series, gives a historical account of events for diabetes, dating from antiquity and its first recording in the Ebers Papyrus — an Egyptian document circa 1500BC. This article describes initial thoughts that diabetes was linked to an alimentary complaint, and concludes with the discovery of it being a chronic systemic disease. It highlights the discoveries and also includes details of the failed attempts to locate the cause and identify a solution to the ancient mysterious disease which became known to all as diabetes mellitus. Early remedies and treatments are included. The article tells how for many centuries individuals suffered from the debilitating complaint with very little offered in terms of treatment or relief. Eventually the pancreas was identified as the causative organ and, some time later, animal experimentation resulted in the abstraction of the substance insulin. The article concludes with Frederick Banting and John Macleod being awarded the Nobel Prize in 1923 for their revolutionary discovery of insulin.
Management of cystic fibrosis-related diabetes in adolescence
Authors: Azzopardi Kathryn , Lowes Lesley
Published: May 2014

Cystic fibrosis (CF) and type 1 diabetes are two of the most common chronic childhood conditions in the UK; the management of each comprises demanding and perpetual daily regimens. As the life expectancy of patients with CF has improved, there has been a corresponding increase in the number of patients developing CF-related diabetes (CFRD), some of whom are teenagers. For a number of reasons, non-adherence to treatment is a recognized problem in chronically ill teenagers, a problem exacerbated when CF and diabetes co-exist. There is a scarcity of literature concerning CFRD management, particularly in relation to adolescence, with recommendations often being based on anecdotal evidence. In this article, the aetiology, incidence, diagnosis and management of CFRD are outlined. Chronic illness in adolescence and the problem of non-compliance are explored and considered in the context of CFRD. Recommendations for practice for health professionals caring for teenagers with CFRD are offered.
Design and development of novel bandages for compression therapy
Authors: Rajendran Subbiyan , Anand Subhash
Published: May 2014

During the past few years there have been increasing concerns relating to the performance of bandages, especially their pressure distribution properties for the treatment of venous leg ulcers. This is because compression therapy is a complex system and requires two or multilayer bandages, and the performance properties of each layer differs from other layers. The widely accepted sustained graduated compression mainly depends on the uniform pressure distribution of different layers of bandages, in which textile fibres and bandage structures play a major role. This article examines how the fibres, fibre blends and structures influence the absorption and pressure distribution properties of bandages. It is hoped that the research findings will help medical professionals, especially nurses, to gain an insight into the development of bandages. A total of 12 padding bandages have been produced using various fibres and fibre blends. A new technique that would facilitate good resilience and cushioning properties, higher and more uniform pressure distribution and enhanced water absorption and retention was adopted during the production. It has been found that the properties of developed padding bandages, which include uniform pressure distribution around the leg, are superior to existing commercial bandages and possess a number of additional properties required to meet the criteria stipulated for an ideal padding bandage. Results have indicated that none of the mostly used commercial padding bandages provide the required uniform pressure distribution around the limb.
Clinical skills: a practical guide to working out drug calculations
Authors: Trim Jo
Published: May 2014

With the publication Building a Safer NHS for Patients (Department of Health (DoH), 2004), the importance of ensuring safe medication administration has returned to the NHS agenda. Over the last 10 years, nurses' deficiency in accurate drug calculations has been highlighted. A number of proactive strategies have been employed, including increased focus on the topic during undergraduate training programmes, drug calculation tests and, more recently, providing information via hospital intranet sites. This article attempts to describe the basic drug calculation formulae required to calculate medication doses safely and accurately and administration rates, giving working examples to apply theory to clinical practice.
Role of the ‘ordinary' nurse: boundaries need to be set
Authors: Fulbrook Suzanne
Published: May 2014

The subject of precise ordering, or identification of the components of a nursing role, can be found in the document Agenda for Change: The Knowledge and Skills Framework (Department of Health, 2003). In this document each nursing grade will be evaluated in terms of what is expected. Competency in each of the areas will allow the nurse to apply for promotion. This point has been identified by Colin Adkins, Health and Safety Officer for Amicus Health, speaking at a recent conference, when he said: ‘The Government is committed to improving the public sector by linking pay movements through the pay system to performance or competence.’ What is not explicit is the consequence of a nurse undertaking a task not defined within a specific competency. What happens when a practitioner undertakes a task asked of him/her by a colleague, maybe someone with an advanced role?.
People with learning disabilities who engage in self-injury
Authors: Lovell Andrew
Published: May 2014

This article represents some of the findings of the author's research into the relationship between self-injury and learning disability. It identifies the key theoretical discourses associated with the phenomenon, before elaborating on the main principles of each and identifying resultant intervention strategies. These interventions, psychotropic medication, mechanical restraint, and the behavioural approach are subsequently described. Case-study methodology was employed since this enabled the examination over time of these intervention strategies in the lives of individuals fulfilling the necessary criteria of persistent self-injury and significant communication difficulties. The findings of the research suggest a frequently piecemeal approach to self-injury, with arbitrary selection of behavioural intervention approaches, a continued reliance on powerful medication, and ambivalence concerning the use of mechanical restraint. Nurses were often skilled in working from a behavioural perspective, but were hindered by complex family circumstances and a failure to gain the confidence of direct care staff. There was also a lack of appreciation about the relationship between the individual and his/her self-injury, and recognition of the nature of the intransigence.
The quality of life of carers of patients with severe lung disease
Authors: Brewin Adrienne
Published: May 2014

Severe lung disease is known to affect the lives of not only the sufferer but also his/her family. This qualitative phenomenological study identified seven patients with severe lung disease and studied the quality of life of their carers (five female, two male) who were not fully employed, living in the same house or nearby. In a semistructured interview, the carers were asked about looking after their spouse or relative, whether they had support and the effect of caring on their health and finances. The findings showed the carers' lives to be severely restricted, all carrying a heavy emotional burden of frustration, depression and isolation: part-time jobs were important both financially and to reduce isolation. Family support was vital to their coping, but few had received professional help. All were affected by reduction in income, but claiming allowances was confusing; unpredictability of the disease complicated much-needed recreation and holidays. Findings were similar to previously published data.
From vocation to profession: the quest for professionalization of nursing
Authors: Yam Bernard MC
Published: May 2014

This article examines some of the complex factors in the transition of nursing from vocation to profession. These factors include university education, knowledge, gender, and workplace environment. It argues that the conventional definitions and characteristics of the professions and knowledge are tainted with gender bias. The uniqueness of nursing knowledge lies in the combination of scientific and holistic knowledge required for patient care, which is different from other healthcare professions. It suggests an alternative means of recognizing the clinical expertise of frontline nurses so that their contribution to patient care can be acknowledged. Together with the extended and expanded role of specialist nurses and nurse managers, nurses can impose their presence and consolidate their power base in the quest for professionalization.
Nursing leadership must keep its roots in nursing
Authors: Castledine George
Published: May 2014

One of the key trends to emerge in health care is the emphasis on working together in multiprofessional teams. Sometimes referred to as patient-focused care, patient-centred care, or interprofessional pathway planning, the aim is the provision of care for one or more patients/clients by a group of healthcare providers. This is not a new concept in psychiatric, geriatric or palliative care nursing. In these specialties, an interdisciplinary team has met to plan and implement care for patients/clients for the past several decades. In other areas of nursing, however, this may not be the case.
Challenges for care homes: education and training of healthcare assistants
Authors: Fitzpatrick Joanne M , Roberts Julia D
Published: May 2014

The spotlight is increasingly on all care homes, including those catering specifically for older people, to deliver on quality targets in an attempt to drive up the standards of care provision. These targets include the education, training and supervision of care staff. Representing a major component of the care staff workforce in care homes are healthcare assistants and they play a key role in care provision and will continue so to do. However, pivotal to their effective role performance is preparation and support — the provision of which has been patchy to date. For care homes that provide nursing care the challenges of delivering on these targets by 2005 are significant, particularly as the majority of these homes are run as private enterprises and in the absence of any form of central funding. This article examines key issues associated with meeting national standards in the sector with specific reference to education and training provision. A strategic nationwide approach to education and training for healthcare assistants in care homes is recommended, coupled with robust evaluation of outcomes. Such initiatives will need to be supported by significant financial investment if the Government's targets are to be achieved.
Supporting care homes: the older people's specialist nurse
Authors: Hayes Nicky , Martin Finbarr
Published: May 2014

This article outlines the health needs of older nursing home residents and identifies the case for the role of an older people's specialist nurse within a multidisciplinary care homes support team (CHST). This model has been successfully introduced in the London boroughs of Lambeth, Southwark and Lewisham as a response to the profile of local health need among care home residents and changes in national policy such as the introduction of NHS-funded nursing care. The structure of the CHST is described, and the older people's specialist nurse is discussed in detail. The emergent role of the older people's specialist nurse as key to managing the interface between the nursing homes and primary care is highlighted as a key benefit of this unique role.
Ward managers' perceptions of the role of healthcare assistants
Authors: Jack, Barbara , Brown Jeremy , Chapman Tom
Published: May 2014

While unqualified nurses form an integral part of the UK's healthcare system, accounting for a large percentage of the workforce, there is limited evidence to identify the actual role of the healthcare assistant. This study explored hospital ward managers' views on the current and potential expansion of the healthcare assistant's role. A confidential survey was sent to all ward managers (n=35) in one large acute hospital trust. A response rate of 94% (n=33) was obtained. Data were analysed using descriptive statistics and open-ended questions were analysed for emerging themes. The results indicated that healthcare assistants are undertaking a wide diversity of procedures ranging from general tidying to carrying out complex clinical procedures. Additionally, 82% (n=27) of the managers reported that the healthcare assistant's role could be expanded, although concerns were raised regarding additional training and supervision.
A review of osteoporosis in men: implications for practice
Authors: Peate Ian
Published: May 2014

This article discusses the issue of osteoporosis from a male perspective. Osteoporosis is often seen as a woman's disease; however, there are a significant number of men who suffer with osteoporosis and the affects of the disease can have implications for the man's physical, social and psychological wellbeing. The reasons why osteoporosis may be increasing in the male population are discussed. The possible causes of osteoporosis as well as the risk factors that may put men at danger of contracting the illness are outlined. Bone density is an important factor related to the development of osteoporotic fractures — methods of measuring bone density using dual energy X-ray absorptiometry are provided, as are other important investigations that will be needed. The management and treatment of the male patient with osteoporosis and the role of the nurse are detailed.
Basic nursing principles need to be remembered
Authors: Castledine George
Published: May 2014

There have been some high-profile conferences recently, exploring the current developments in the nurse's role. It would seem that the profession is at last waking up to the fact that some of the new role developments in nursing may be a threat to the provision of essential nursing care.
Current management of neurogenic bladder in patients with MS
Authors: Woodward Sue
Published: May 2014

Multiple sclerosis (MS) is a common neurological problem and many sufferers are affected by urinary symptoms that negatively impact on their quality of life. Nurses are intimately involved in management of continence and other bladder problems with MS patients and need to be aware of appropriate assessment techniques and treatment options so that patients can be managed optimally. Nurses can have a significant role to play in reducing bladder symptoms and directly improving patients' quality of life. This article presents a review of current behavioural, pharmacological and surgical options for management of the neurogenic bladder in MS.