bluuebunny/crossref_metadata_2025 huggingface dataset:
Types of pressure-relieving equipment available: 2
Authors: Fletcher Jacqui
Published: August 2014

This is the second article in a two-part series. The first article reviewed the mode of action of the different types of equipment. This article examines some of the evidence behind the design and suggests selection criteria to assist when choosing individual Items of pressure-relieving equipment By presenting a broader view it is hoped to guide the reader through a logical approach considering all of the variables, thus enabfing the selection of the optimum piece of equipment.
Who holds the baby in the neonatal unit?
Authors: Rea Jackie
Published: August 2014

This article explores the role of non-nurses within the neonatal unit (NNU). Nursery nurses and health-care support workers (HCSW) or auxiliaries may be employed in the NNU and the term ‘non-nurse’ is used to describe them all. To satisfy professional curiosity a small survey of NNUs in England was undertaken to identify the role of non-nurses in caring for babies in the NNU. The results demonstrate that not all NNUs have delineated separate roles for nurses and non-nurses. The ENB and the UKCC have responsibilities in the shaping of the nursing profession and the creation of specialist and advanced nursing practitioners and HCSWs are fashioning the process. This article will address some of these issues within the NNU and the wider sphere of nursing and midwifery.
Cica-Care: adhesive gel sheet
Authors: Williams Clare
Published: August 2014

Keloid and hypertrophic scars can be a complication of burns, surgery and other traumas. Cica-Care (Smith & Nephew) has been developed for the prevention and treatment of such scars. This product focus presents the clinical features of both types of scars, highlighting the difference between them, and outlines the treatment options which include surgery, pressure treatment and pharmacological treatments. The mechanism of action of Cica-Care is still uncertain, but it appears to soften, flatten and blanch scars. The specific care of the gel sheet, including skin acclimatization, is also described.
Nuffield Research Award: Elderly patients’ participation in discharge decision making: 1
Authors: Jewell Sarah
Published: August 2014

This article is the first of a two part series describing a study that explored patient participation in discharge decision making. The study involved two phases and focused on the participatory relationship between older patients and nurses. In phase one, the author conducted a group interview with primary nurses at two elderly care units specializing in rehabilitation. The second phase involved a series of interviews with five elderly patients during their hospital admission. The data from both phases of the study were analysed using the Ethnograph software package. This first article discusses the views of the nurses while the views of patients are addressed in the second article. Phase one of the study showed that the nurses interviewed had an elaborate understanding of participation. They tended to stress practical examples of participation rather than stating the reasons why it should be encouraged. Informants recognized the need to involve patients in decisions about their discharge from hospital. However, they viewed elderly patients as being both passive and reluctant to participate in decision making. Several reasons were given for this which were seen as resulting from patient rather than nursing behaviour. Part two of this article will appear in Vol 5(17): 26 September.
Psychology 3: ‘Don’t give me that attitude!’
Authors: Wilkinson John A
Published: August 2014

The relationships between knowledge, emotions and behaviour are complex, and yet it is important to understand how these factors can affect a person's health. This is of particular relevance in relation to a person's lifestyle and his/her response to health promotion strategies. In this article there is a presentation of the psychological conceptualization of attitudes. Issues are raised which can be used to help nurses to understand some of the factors which underpin attitude formation and change. Use of this knowledge can be made to inform nursing assessment and to enhance compliance with professional advice. The main argument to emerge is that any standardized health advice is more effective if it is supplemented with an individualized focus which is directed towards empowerment of the person, and which is sensitive to his/her particular circumstances.
Marketing: a flawed concept when applied to health care?
Authors: Young Ann P
Published: August 2014

Since the introduction of a marketing orientation to the NHS in 1990, arguments continue to abound as to the extent and success of the internal market. This article identifies where and how the market is operating and explores the inherent difficulties of using this model, both ethically and economically. The dangers of increasing inequality, social manipulation, continuing cost pressures, loss of professional autonomy and restricted professional collaboration have to be balanced against the potential value of marketing on performance measures and a more responsive service. The article concludes that marketing needs to be tailored to the particular culture of the NHS rather than copied from the private sector and should emphasize client needs, integrated planning, good communication and the development of agreed quality indicators.
Prevention and management of pressure sores: role of education
Authors: Young Trudie
Published: August 2014

If and when the clinical practice guidelines on the prevention and management of pressure sores are launched by the Department of Health, nurse educationalists should be prepared for their implementation as they play a major role in educating nurses in this area and in ensuring that theory is translated into practice. This article discusses the issues surrounding educational requirements and addresses the problems of ensuring that education has a positive impact on clinical practice.
Irriclens: a sterile wound cleanser in an aerosol can
Authors: Williams Clare
Published: August 2014

Irriclens (ConvaTec) is the first wound cleanser to be presented in an aerosol can. Wound cleansing has become a ritualistic task; however, it should only be carried out if specifically required. Antiseptics have traditionally been used for wound cleansing, but in many areas are now being replaced by normal saline. Irriclens is a sterile, aqueous 0.9% sodium chloride solution, which can be used to cleanse a wound or for irrigation. Irriclens has the potential to be cost-effective as it prevents wastage and reduces the need for supplementary equipment.
Postoperative nausea and vomiting 1: physiology and aetiology
Authors: Tate Sylvina , Cook Hannah
Published: August 2014

There is a vast amount of research available relating to postoperative nausea and vomiting (PONV). This research has been analysed and summarized In a series of two articles which draw out the main factors Influencing the Incidence and affecting the treatment of the condition. This, the first article, will describe the physiological processes that result In PONV. An analysis will then follow of the many factors that contribute to the complex muHUactorlal aetiology of PONV. These factors Include personal, preoperative, Intraoperative and postoperative variables which affect differing neurotransmitter oentres in the chemoreceptor trigger zone (CTZ) which is situated in the brainstem. These variables will then be related to the appropriate neurotnmsmltter centre allowing a greater understanding of the most likely physiological pathways Involved In specific oases of PONV. The second article will explore the management and treatment of PONV.
Alternatives to seclusion in psychiatric care
Authors: Lehane Mike , Rees Colin
Published: August 2014

The use of seclusion In psychiatry is declining. Its punitive nature has been acknowledged and alternative, more therapeutic approaches are needed to deal with disturbed patients. What alternatives are available? This article reports a study that sought to examine the response to incidents that formerly would have led to seclusion in one psychiatric intensive care unit The sample consisted of 50 incidents. Information on the incident and subsequent action was recorded on standard incident forms and specially designed data collection sheets. The most frequent type of incident was damage to property, followed by direct or threatened physical assault on staff. The most common response was one-to-one nursing support, followed by the use of medication. In Just over half the incidents, both responses were used together. This therapeutic strategy demonstrates that aggressive incidents can be dealt with safely without recourse to seclusion.
Attitudes of practitioners to lesbian, gay and bisexual clients
Authors: Morrissey Matthew
Published: August 2014

Many health-care workers have a negative attitude towards their lesbian, gay and bisexual clients. Negative attitudes regarding same-sex attractions appear to be deeply ingrained in the majority of nurses' minds as a result of the socialization process. It is vital that nursing embraces Issues related to sexual orientation so that quality health care can be provided for all. Doctors also have a responsibility to address the issue of homophobia both within their profession and in relation to their clients. To facilitate this, a framework using a sexual health model should be employed as this would encourage the clinician to contemplate these sensitive issues. This article will explore the attitudes of nurses and will outline the Implications for care and education.
The Scope of Professional Practice in specialist practice
Authors: Autar Ricky
Published: August 2014

The Scope of Professional Practice (UKCC, 1994a) now offers nurses, midwives and health visitors new opportunities to develop their clinical role. Role expansion is at the centre of debate in the health service. In the spirit of Scope, trusts and regional health authorities have been experimenting with new roles that combine medical and nursing practice in order to promote a holistic approach to patient care. Education, experience and the appropriate clinical competency are the foundations for role expansion and the development of professional practice. However, some of the new roles and innovative practices have also been targeted at reducing junior doctors' hours (Read and Graves, 1994). New roles must be evaluated before they are allowed to develop and there is an urgent need for national evaluation of the initiatives underpinning Scope. This article examines the changing role of practitioners in specialist practice. The ethical, professional and legal issues surrounding these changes will also be considered.
Psychology 4: take my advice!
Authors: Wilkinson John A
Published: August 2014

This article considers the issue of compliance in the context of encouraging patients to follow advice given to them by nurses. Caution is expressed regarding the avoidance of coercion through the exertion of overt pressure or by more subtle means such as the socializing effects of becoming a patient. It is suggested that an effective and humanistic approach to the facilitation of compliance is through the empowerment of patients by nurses. This can be enhanced if strategies are based on comprehensive assessment. An eclectic level of analysis is used to show how compliance is mediated through personal, group and societal factors. A number of psychological research studies are reported to underpin recommendations as to how nurses might enhance the compliance of their patients in a range of care settings and applications.
Profore four-layer bandage system
Authors: Williams Clare
Published: August 2014

Profore four-layer bandage system (Smith & Nephew) Is a multi-layer compression system for the treatment of venous leg ulcers. Venous leg ulcers have long been an enormous drain on the NHS, particularly within the community sector. Compression therapy Is now known to be the mainstay of treatment for such ulcers. The Profore four-layer bandage system Is simple to use and provides the correct compression to effect faster healing.
Quasi-experimeiftal research designs
Authors: Behi Ruhi , Nolan Mike
Published: August 2014

In complex naturally occurring health-care situations, It Is often difficult, and sometimes Impossible, for ethical and/or practical reasons to meet the requirements of manipulation and control needed In true and Ideal group experiments. If researchers wish to Investigate causal relationships In such circumstances then quasi-experimental designs are recommended. These designs represent approximations of true experiments because they do not meet all the necessary requirements, such as random allocation of subjects to groups, control and manipulation. Consequently, quasi-experimental designs are not as powerful as true experimental designs In establishing causal relationships but nevertheless allow such relationships to be considered by a process of rejecting rival hypotheses. This article outlines the two main approaches to quasi-experimental designs and provides an example of each. Other methods related to the quasl-experiment are also highlighted.
Sudden infant death: who's to blame?
Authors: Powell Catherine
Published: August 2014

The sudden and unexpected death of an infant is probably the most catastrophic event that a family will encounter: In the aftermath of grief, parents will undoubtedly question aspects of the care that they provided. Health professionals who have been involved in the care and support of families before, during, or after a sudden or unexpected infant death may also question whether an alternative approach, or more timely advice, could have prevented the tragedy.
Homeostasis: restoring the internal wellbeing in patients/clients
Authors: Rinomhota A Sbupikai , Cooper Keith
Published: August 2014

This article gives a historical perspective of homeostasis and explores the concepts surrounding the term. The importance of the internal environment and the dynamic nature of homeostasis are discussed. Issues of homeostatic control and maintenance are highlighted and the role of feedback mechanisms is clarified. A rationale is presented to support the argum ent that the objective of holistic nursing care is to restore physical and emotional homeostasis, i.e. to facilitate the restoration o f the internal wellbeing in our clients/patients. Two aspects of a non-homeostatic model of health, namely the mind-body dualism and the reductionist approach, are considered.
Child prostitution: reaching out to children who sell sex to survive
Authors: Barrett David , Beckett Wilma
Published: August 2014

Childhood prostitution is an area that most health-care workers do not come into direct contact with other than through media coverage. It is difficult to obtain a national picture of the scale of the problems associated with childhood prostitution as research has been sparse, fragmented and mainly localized. Health and social care professionals need to be aware of the factors that influence routes into prostitution such as childhood abuse, poverty and breakdowns in family relationships if they are to provide relevant and appropriate health promotion interventions. This article explores the social, economical and political issues surrounding childhood prostitution, and highlights some interesting initiatives which have been implemented by health and social care professionals.
Neonatal intensive care nurse stressors: an American study
Authors: Heuer Loretta , Bengiamin Marlene , Downey Vicki Wessman , Imler Nyla Jubl
Published: August 2014

The purpose of this study was to determine the frequency of selected stressors and the level of associated stress experienced by neonatal intensive care unit (NICU) nurses in th e USA, and to identify their responses/coping mechanisms. The research instrument consisted of demographic data (education, location of practice, age, years in practice, gender) and a modification of the Stress Audit tool developed by Popoff and Funkhouser (1975). Participants were randomly chosen from health-care units located in the upper Midwest of the USA. Fifty-nine nurses (35%) responded to the postal survey. In terms of scale items, floating out of the unit (ability to staff other units when necessary) was the most stressful item and routine procedures the least stressful item. From a subscale perspective, knowledge was the least stressful and management the most. Subscale scores did not differ by marital status, number of years of practice as a registered nurse, or years of practice in NICU. Coping with stress was best facilitated by discussion with co-workers. Consistency of care, inservice education, mental health days (time off for stress relief, paid or unpaid) and staff support groups were reported as helpful in coping with job-related stress.
Steripaste: a new zinc bandage that is preservative free
Authors: Williams Clare
Published: August 2014

Chronic leg ulcers often present as a chronic open wound with surrounding eczematous skin. Paste bandages are widely used to treat such ulcers and their associated skin conditions, but can often lead to hypersensitivity reactions leading to contact dermatitis. This product focus features Steripaste (Seton Healthcare) which is a new preservative-free, medicated paste bandage that is available on the Drug Tariff for use in the community sector.
A study of postoperative wound management in nursing
Authors: Smith Lorraine N , Lait Margaret E
Published: August 2014

Wound management has changed considerably over the past decade. The change from dry to moist healing is the result of new scientific evidence. The number and variety of wound care products available on the market have increased, along with the importance of the acceptability of a particular type of product to individual patients' lifestyles. Annual worldwide expenditure on wound care is estimated to be in the region of $7 billion (US). The implications of efficient and effective wound healing for both the patient and the economy; therefore, are massive. This article presents the results of a study of postoperative wound management. The need for consistent and regular wound assessm ent is demonstrated and linked with length of hospital stay.
Psychology 6: What's your problem? A consideration of problem solving
Authors: Wilkinson John A
Published: August 2014

A substantial component of nursing is concerned with solving problems, or helping patients and clients to solve problems for themselves. This article considers problem solving in a range of nursing practice settings and outlines how psychology can help to explain and inform this process. The diverse nature of problems which nurses might encounter in their work are discussed and recommendations for the application of problem solving strategies are offered. No single approach to problem solving is sufficiently flexible to address the complex challenges met in nursing practice, and hence an eclectic approach to problem solving is proposed.
The psychosocial effects of skin diseases: need for support groups
Authors: Burr Sara , Gradwell Coleen
Published: August 2014

Patients with psoriasis may be psychologically vulnerable and suffer social isolation as a result of physical disfigurement It is important that nurses are able to assess the psychological needs of patients and, where necessary; facilitate the development of positive coping strategies. Staff and patients in the dermatology department at the Queen's Medical Centre, Nottingham, set up a support group to try to address these issues. One year on, an evaluation of the efficacy of the group has shown that such gatherings are essential to the psychological wellbeing of individuals with skin complaints.
Health of the Nation for people with learning disabilities
Authors: Holmes Anne , Parrish Alan
Published: August 2014

This article explores issues related to the health of people with learning disabilities, with particular reference to the Department of Health (1995a) document The Health of the Nation: A Strategy for People with Learning Disabilities. This publication has stimulated care staff across all agencies to take a fresh look at this client group and their health needs in the five key areas: coronary heart disease and stroke; cancers; HIV/AIDS and sexual health; accidents; and mental health.
Challenging behaviour in children with learning disabilities
Authors: Gates Bob , Wray Jane , Newell Rob
Published: August 2014

This article outlines the initial stages of an ongoing experiment to evaluate the comparative efficacy of two different therapeutic Interventions — behaviour modification and gentle teaching — In the management of challenging behaviour in children who have learning disabilities. Using a workshop approach, parents are taught the principles and practice of one of these two interventions to enable better management of their child's challenging behaviour. A range of Intervention outcomes are then compared with those of a control group. Preliminary analysis of data has been conducted on information gathered from those parents (n = 24 ) who attended the gentle teaching workshop only. The results indicate that brief Intervention training In gentle teaching can have a positive impact upon the challenging behaviour of the child.
Care Study: Care of a patient with post-traumatic stress disorder
Authors: Ashmore Russell
Published: August 2014

Amanda, a single 22-year-old woman, was involved in a road traffic accident One passenger died and another received a number of serious injuries. Amanda received injuries that required hospitalization and reconstructive surgery; from which she made a full recovery. Following discharge from hospital, Amanda developed a number of symptoms consistent with post-traumatic stress disorder. One month after the accident Amanda was referred to the community psychiatric nursing service by her district nurse. After treatment which comprised debriefing, relaxation and desensitization Amanda reported a significant improvement in her symptoms and was able to return to work. Amanda had no previous history of mental health problems.
Tegasorb hydrocolloid dressing: advanced formulation
Authors: Williams Clare
Published: August 2014

Tegasorb advanced formulation hydrocolloid dressing from 3M Healthcare can be used on a variety of wounds, e.g. leg ulcers and donor sites. It encourages a moist wound-healing environment and can be used in all stages of wound healing, from black necrotic tissue to the epithelializing wound. Tegasorb is a well-established hydrocolloid dressing that has recently been relaunched as an advanced formulation.
Nurses' role in peripheral venous cannulation
Authors: Castledine George
Published: August 2014

Recently I was invited to participate in a workshop on setting new standards for peripheral venous cannulation, which was organized by the Royal College of Physicians (RCP), London. I must admit to being concerned about the nature of the conference because of the recent emphasis on nurses taking on more medical tasks. However, by the end of the day I was convinced that specialist nurses should share the responsibility for peripheral venous cannulation.
Late psychosocial effects of conditioning for BMT
Authors: Molassiotis Alexander
Published: August 2014

This study was designed to assess psychosocial difficulties in long-term survivors of bone marrow transplantation (BMT) as a possible result of the type of pre-BMT conditioning. Eighty-three patients replied to questionnaires concerning several dimensions of quality of life. These subjects were assigned to one of three treatment groups: subjects who had received cyclophosphamide (CY) and total body irradiation (TBI) (n = 43); subjects who had received the BEAM protocol consisting of busulphan, etoposide, cytarabine, and melphalan (n = 31); and subjects who had received the University College Hospital (UCH) protocol consisting of cyclophosphamide, doxorubicin, carmustine and thioguanine (n = 9). The results indicated that, although overall psychosocial adjustment seemed to be similar in all three groups of patients, daily activities were more impaired and psychological/psychosomatic symptoms were more prevalent in the combination chemotherapy groups. Distressing physical and psychosocial symptoms usually affect quality of life and the incorporation of quality of life measures in clinical trials of cancer treatments is of great importance.
Aftercare under supervision: implications for CMHNs
Authors: Ford Jane , Rigby Paul
Published: August 2014

This article examines the implications for practice of the Mental Health (Patients in the Community) Act 1995, which came into force on 1 April 1996. The main purpose of this legislation is to introduce a system of ‘aftercare under supervision’ in the community for certain patients who have previously been detained under the Mental Health Act 1983, before discharge. The nominated ‘supervisor’ will have responsibility for ensuring that the aftercare plan requirements are fulfilled. As a result of their role as community keyworkers it is likely that community mental health nurses will undertake this role. Careful consideration needs to be paid to education and training in relation to these responsibilities, and practitioners need to become* aware of the challenges that such a role is likely to present.
Single-case experimental designs 1: using idiographic research
Authors: Behi Ruhi , Nolan Mike
Published: August 2014

The single-case experimental design is an example of idiographic research which involves establishing causality. The reasons for using idiographic research in nursing are discussed and important differences between nomothetic and idiographic designs are highlighted in this article. Single-case experimental designs are recommended in situations where both true experimental and quasi-experimental designs are difficult or impossible to use for practical or ethical reasons. Single-case experimental designs are ideal for nursing care situations because they study individual cases, making it possible to give individualized nursing care while simultaneously studying the outcomes of specific patients.
Faecal incontinence in adults 1: prevalence and causes
Authors: Norton Christine
Published: August 2014

Faecal incontinence is much more common in the general population than is often realized. Recent epidemiological work suggests that over 1% of all adults have some degree of faecal leakage. Although the problem increases with advancing age and disability, there are large numbers of otherwise healthy adults with this distressing symptom. Many, possibly the majority, do not seek professional help. The most common causes include childbirth by vaginal delivery; especially if assisted with forceps, any condition causing frequency or diarrhoea, and a variety of anorectal conditions. A detailed and empathic history taking, physical examination, and use of anorectal investigative techniques where indicated, enables an;accurate individual diagnosis in most cases. A subsequent article will explore the treatment and management options once a diagnosis has been reached.
Piloting an A&E and practice nurse educational exchange
Authors: Crouch Robert , Dale Jeremy , Haverty Sheila , Winsor Susan
Published: August 2014

The accident and emergency (A&E) department acts as an interface between primary and secondary care. Traditionally; general practice has been viewed negatively by A&E nurses. This article explores some of the issues surrounding these views. The need to challenge the traditional view of A&E as simply a department within a hospital and replace it by one that identifies A&E within the broader community context is identified. This change in ethos requires nurses who work in the A&E department to challenge their beliefs about the specialty. There is a need to look at the educational preparation of A&E nurses. A pilot educational exchange scheme> developed to explore ways of improving the relationship between A&E nurses and nurses working in general practice, is described.
Preoperative visiting: a role for theatre nurses
Authors: Carter Linda , Evans Tina
Published: August 2014

Over the past 20 years, giving preoperative information to patients has been recognized as benefiting them greatly (Hayward, 1975; Boore, 1978). Similarly, preoperative visits by theatre nurses have been widely advocated to allay patient anxiety. This article discusses preoperative visiting from the perspective of its value to theatre nurses, particularly in the planning of patients' nursing care and in the application of nursing models and a team approach to the delivery of care. In so doing, preoperative visiting may be a life-line for theatre nurses at a time when their unique contribution within the operating theatre is increasingly under scrutiny (Bevan, 1989).
The biology of Alzheimer's disease: 2
Authors: Delieu John , Keady John
Published: August 2014

In this article, the second of two parts, the authors continue their review of the biological processes of Alzheimer's disease and the implications for nursing practice. A glossary of terms can be found in the first article (Vol 5(3): 162–7). This article considers the function of the subcortical area of the brain and explores its effects on the world of the person with Alzheimer's disease. Nursing responses are also discussed.
Smoking with patients: policy vs therapy
Authors: Tarbuck Paul
Published: August 2014

While it is largely accepted that smoking is injurious to physical health, there is no general consensus on the value, or otherwise, of mental health nurses smoking in the company of their patients in the creation and maintenance of therapeutic relationships. This survey of key opinion-formers within medium and high-security mental hearth-care facilities was designed to ascertain whether a consensus exists.
Effects of cannabis abuse on people with serious mental health problems
Authors: Gray Richard , Thomas Ben
Published: August 2014

There is clear evidence of illicit drug abuse in psychiatric hospitals (Deahl, 1991), and illicit drug use has been associated with relapse in people with serious mental health problems. Cannabis abuse in the general population is common and has both desirable and undesirable effects on users. However, when cannabis is used by people with serious mental health problems, a more pronounced effect may be seen. There is little evidence to suggest that cannabis ‘causes’ schizophrenia, but its abuse may prove to be a trigger in vulnerable individuals. Studies have demonstrated that cannabis abuse can exacerbate the symptoms of schizophrenia and may reduce the effectiveness of antipsychotic drugs. Mental health nurses need to develop interventions in order to manage illicit drug abuse effectively in both the hospital and community settings.
Is it ever permissible to discharge an illicit drug user from hospital?
Authors: Aveyard Helen
Published: August 2014

Is it ever permissible to discharge a patient who uses illicit drugs on hospital premises? It is argued that there is nothing inherent in the use of illicit drugs by a patient which justifies his/her discharge. However, the implications of the drug use need to be examined. First, if a patient's activity presents a significant risk to others, the hospital may be in breach of safety regulations and may need to secure alternative provision of treatment. Second, if the continued use of drugs limits the benefits of treatment, this treatment may be considered an inappropriate use of resources.
Sexual dysfunction following radiotherapy for cervical cancer
Authors: Burke Linda M
Published: August 2014

The majority of patients with cervical cancer are treated with radiotherapy, which has many potential side-effects. This article reviews the literature, emanating primarily from the USA, which seeks to determine why sexual dysfunction is so often a problem for patients following such treatment and why nurses appear to be so reluctant to deal with this issue. The exact nature and severity of the difficulties experienced by women will be examined and also the reasons why nurses appear so reluctant to deal with this issue. Finally, possible solutions and strategies for action will be suggested.
Catheters: design, selection and management
Authors: Pomfret Ian J
Published: August 2014

Urinary catheterization is a common procedure that is performed on 12% of hospital patients (Crow et al, 1996) and 4% of community patients (Getliffe, 1990). When considering catheterization as a method of care, many decisions need to be made in order to select the optimum equipment and provide effective catheter care. This includes selecting the type of catheterization that needs to be performed, i.e. intermittent or indwelling, and choosing the right catheter material, size and balloon infill volume. The type and design features of the urinary drainage and suspensory system have a direct effect on individual patient comfort, dignity and lifestyle. Aspects of catheter care that need to be considered include: meatal hygiene, fluid intake, bladder washouts, constipation, clamping catheters, collecting specimens of urine, fixation of catheters and sexuality.
Causality and control: key to the experiment
Authors: Behi Ruhi , Nolan Mike
Published: August 2014

The main aim of the experimental approach in research is to discover causal relationships between variables. This article describes the concept of causality and discusses common and important aspects and factors related to causality, manipulation and control. The four principles which underpin the inference of causality in experiments are highlighted and the role of ‘control’ in achieving the aim of experimental studies is discussed. Some methods of control such as manipulation, randomization, matching subjects, and holding extraneous variables constant are considered. Experimental designs are underpinned by these concepts. Indication is given of the threats to internal validity, which will be discussed in detail in the next article in this series.
Treatment of venous leg ulcers: 2
Authors: Williams Clare
Published: August 2014

This article, the second in a two-part series, discusses the treatment options available for venous leg ulceration, and their implications for the nursing profession. Current views on the use of compression therapy, drug therapy, growth factors and surgery are examined. Successful management of patients with venous leg ulcers depends on thorough assessment, effective treatment and prevention of recurrence. Many health-care professionals lack the necessary knowledge, understanding and training to treat such patients effectively. Improvements in the care of venous leg ulcers will lead to significant reductions in treatment costs.
Advanced practice within learning disability nursing
Authors: Jukes Mark
Published: August 2014

This article describes the application of advanced nursing practice within the field of learning disabilities. It discusses the differences between advanced practice and specialist practice and proposes that managers' perceptions of the role of advanced nurse practitioners (ANPs) within the management of developing services will need to change if such practitioners are to be effective. Six defined areas are explored to show how advanced nursing practice within learning disabilities may be developed to allow ANPs to assert their rightful position and influence.
Role of the nurse teacher in advanced nursing practice
Authors: Autar Ricky
Published: August 2014

Education and experience are the foundations on which practitioners should base their clinical judgment and broaden the scope of their professional practice. PREP has secured a professional market for nurse education, the viability of which depends on closer collaboration between nursing education and nursing practice. Nurse teachers who are committed to practice are in a strong position to assist the development of practitioners, and work towards research-based practice. This article examines the role of the nurse teacher in the domain of advanced nursing practice.
Study of moving and handling practices on two medical wards
Authors: Green Christine
Published: August 2014

This small exploratory pilot study was undertaken to explore the moving and handling practices of nurses working on two medical wards and to determine nurses' perceptions of factors that might influence those practices. Data were collected by means of non-participant observation and semi-structured interviews. The results suggest that risk assessment of the task, load, environment and individual capabilities, carried out in the clinical area, was often incomplete. Factors influencing moving and handling practice included insufficient equipment, lack of space, unsuitable uniforms, and negative attitudes towards changing practice. In view of changing practices, nurses need to be aware of the factors that promote or hinder moving and handling practice if they are to address these issues.
Are nurse administrators losing touch with nursing?
Authors: Castledine George
Published: August 2014

In recent years much ado has been made over the new management changes in NHS trusts. Criticism has been directed at the way in which managers seem to be putting themselves before patients. For example, in 1994, Today ran a front page story on how patients were being shunted into hospital corridors while the managers were being treated to expensive new cars!
Continence following childbirth
Authors: Wells Mandy
Published: August 2014

Urinary and faecal incontinence are problems that can severely limit the social, emotional and sexual being of the woman. Childbirth is one of the major causes of incontinence in women, especially following long second stages of labour, traumatic deliveries, large babies and in multigravidae. This article highlights the issues surrounding childbirth and incontinence and the implications that they have for nursing care. Nurses, especially community nurses, midwives and practice nurses, need to take a proactive stance in the identification of incontinence in women. Once a problem has been identified, it is important that the woman has a thorough assessment and examination before deciding on a plan of care. The use of pelvic floor exercises is the main non-surgical treatment for women with mild to moderate stress incontinence and these can be taught by nursing staff.
Treatment of continence in people with learning disabilities: 1
Authors: Stanley Robert
Published: August 2014

This article is the first of a four-part series which examines the continence-based needs of people with a learning disability. It considers the difficulty in defining learning disability as it is not a unitary phenomenon but covers a spectrum where learning delay is present to varying degrees. At best, the term is used administratively and therefore people with learning disabilities are those who are known to agencies providing services for such people. However, less than half of the total UK learning disabled population will not be identified as suffering impaired intellectual ability. So, even as an administrative term, learning disability fails.
Autonomy and paternalism: partners or rivals?
Authors: Jones Hilary
Published: August 2014

This article is concerned with the ethical relationship between autonomy and paternalism. In the health-care setting both clients and professionals can be profoundly affected by the way in which this relationship is interpreted and this article sets out to explore this phenomenon. It begins by offering some well established definitions of autonomy and paternalism, and goes on to examine the two principles in detail as they relate to persons in good health and to those in ill health. Finally, an attempt is made to answer the question of whether the two concepts are in conflict or partnership.
Nurses must not become the mechanical hands of doctors
Authors: Castledine George
Published: August 2014

The question of which direction medicine is going is apertinent one, especially as we seem to be encouraging paramedics and nurses to take over work that was previously in the doctors' domain.
Choosing a commode for the ward environment
Authors: Ballinger Claire , Pain Helen , Pascoe Jennifer , Gore Sally
Published: August 2014

The choice of appropriate equipment to promote patient independence and enhance nursing care is of major concern to the nurse in the ward environment. This article reports on a recent evaluation of specialist commodes, (Ballinger et al, 1994), with reference to the programme funded by the Medical Devices Agency, Department of Health, under whose auspices the project was carried out. The results of user evaluations and technical tests of six mobile commodes are presented, the preferred model being the Mayfair commode supplied by Carters (J&A) Ltd. The article concludes by identifying a number of important considerations to bear in mind when selecting a commode.
Treatment of continence in people with learning disabilities: 2
Authors: Stanley Robert
Published: August 2014

Continence is a complex skill predicated on an array of voluntary and involuntary processes that must occur synchronistically. It is a skill that takes the non-disabled child years to perfect. Within the array of skills that combine to achieve continence, there are many opportunities for events to go awry. In clients with learning disability, overall brain function is impaired and more localized damage may coexist. The care and management of continence needs in the adult with learning disabilities can be construed as challenging to service providers. Continence needs, over and above neurological damage and/or societal damage, may also be based within a psychological need. This article, the second in a series examining issues associated with continence care in clients with learning disabilities, considers the differentiation between and understanding of impairment, disability and handicap, both globally and partially. The nurse is asked to place the continence needs of his/her client within this matrix.
NHS trusts and nurses' contracts of employment
Authors: Lunn Joanne
Published: August 2014

This article clarifies the legal position regarding employment rights following the transfer from NHS health authorities to NHS trusts. It explores the impact of the NHS and Community Care Act 1990 and examines the mechanism for transfer and the effect on contracts of employment. It also describes nurses’ rights if substantial changes are made to their detriment and the question of redundancy.
Infection control: human T-cell leukaemia virus infection
Authors: Kepple Joanne
Published: August 2014

Human T-cell leukaemia virus (HTLV) types I and II are blood-borne viruses which are transmissible by sexual contact, transfusion of infected blood, sharing equipment for intravenous drug use and breast-feeding. At present the estimated seroprevalence of these viruses in the UK is approximately 1 in 20000. HTLV I/ll infection carries a small and unpredictable risk of leukaemia or paralysis. In the absence of a treatment for HTLV infection, or effective therapy for associated diseases, the prevention of further transmission is of primary importance. Patients need sensitive and appropriate advice in order to understand the implications of their infection
Metastasis: the deadly part of cancer
Authors: Whyte Fiona
Published: August 2014

The most malignant characteristic of any cancer cell is the cell's ability to metastasize. The movement of the malignant cell from the primary neoplasm to a distant site, and the cell's subsequent growth there, is the most dangerous characteristic of any tumour cell. Metastatic development occurs via a series of complicated events. This article explores the stepwise process of metastatic spread, known as the ‘metastatic cascade’, highlights the organs commonly involved in metastatic spread, and debates the seed and soil hypothesis of metastasis. The nurse is introduced to the importance of recent medical research which highlights the genetic links identified in metastatic cell formation. Tumour suppresser genes and oncogenes, which are genes known to induce or promote cancer, and their implications for prognosis, are explained. Finally, the nurse's responsibility in maintaining his/her knowledge and understanding of metastasis in order that he/she may provide appropriate care and support for the patient and family is discussed.
Classification of pressure sores: 2
Authors: Healey Frances
Published: August 2014

Many different pressure sore classification scales are used in the UK. They all have differing strengths and weaknesses which may affect their use in research studies, prevalence and incidence surveys, and collaborative care planning. This article, the second of a two-part series, examines which scales fit the NHS Executive's (1995) recommendations of practice guidelines for the classification of pressure sores and discusses what evidence is available relating to the validity, reliability and utility of existing classification scales. None of the scales comply fully with the practice guidelines’ recommendation that they should be applicable to all skin types, and only two scales have demonstrated fair levels of inter-observer reliability.
Psychological profile of patients with neglected malignant wounds: a qualitative exploratory study
Authors: Dolbeault S. , Flahault C. , Baffie A. , Fromantin I.
Published: August 2014

Neglected malignant ulcerating tumours often result from failure to seek medical attention, even when the advancing tumour is visible to the patient and their friends and families. Although the appropriate wound treatment procedures are the same as for non-neglected malignant wounds, clinicians must take such neglect into account when planning the patient's care. Over a 2-year period, 25 patients at the National Cancer Centre Wound Care Unit in Paris were identified as presenting with a neglected tumour; 18 of these agreed to participate in a structured interview with a psycho-oncologist for an evaluation of their neglect behaviour. Initial results demonstrate a frequent, but not systematic, presence of a wide range of psychopathological disorders
Pilonidal sinus disease: a review. Part two
Authors: Bradley L.
Published: August 2014

Part two of this paper outlines a qualitative study, in which a Heideggarian hermeneutic phenomenological approach was used to answer the question, “What is it like to live with chronic pilonidal disease?” A review of the condition and the background to this study, including the rationale for the research approach, are presented in part one of this article.
Countdown to autumn
Authors: Croft Sue
Published: August 2014

As the autumn approaches, all sorts of good things begin to fall from the trees. Sue Croft introduces a range of themed rhymes and related maths activities, including subtraction.
From trash to treasure
Authors: Hewson Claire
Published: August 2014

It is essential that children learn about protecting the environment early on. The following ideas for crafts made out of rubbish will help children understand the importance of recycling and reusing.
A hippo helping hand
Authors: de Bruin Eleanor
Published: August 2014

This varied series of activities, based on Hazel Edward's book There's a Hippopotamus on Our Roof Eating Cake, includes developing school rules, discussing imaginary friends and creating a cookbook.
Life through a lens
Authors: Garner Lynne
Published: August 2014

This month, Lynne Garner provides ideas for activities introducing photography to children, its role and history, and to encourage children to have a go.