bluuebunny/crossref_metadata_2025 huggingface dataset:
Managing outbreaks of norovirus in an NHS hospital
Authors: Aziz Ann-Marie
Published: May 2014

Noroviruses are highly infectious and easily transmitted by contact with contaminated surfaces and objects, as airborne particles and by contact between individuals. While illness caused by norovirus is usually self-limiting, it can be serious in very young and elderly people, or in those who are debilitated or have a serious illness; they may require hospital treatment. Norovirus outbreaks in hospitals create significant disruption to patient care. They also have huge cost implications for NHS trusts through staff absence and ward closures, which are extremely disruptive and increase pressures on bed demand. The three most important actions during an outbreak of norovirus are effective hand hygiene, isolation of affected patients and enhanced cleaning of the environment. This article outlines how to identify norovirus infection and outbreaks, and describes how an acute trust managed outbreaks of norovirus and the procedures it adopted.
Flushing CVADs: heparin or sodium chloride 0.9%?
Authors: Bravery Karen
Published: May 2014

I have been trying to update the clinical practice guideline for my trust on flushing central venous access devices (CVAD). To complicate matters I was asked to ensure that our guideline was the same as our partner cancer unit. I work in a principle treatment centre for children’s cancer that is part of a virtual unit with an adolescent and young people’s cancer centre. We are in the process of preparing for peer review as a unified centre; hence the need for one guideline. The problem is that we flush our tunnelled central venous catheters (TCVC) with heparin and the other centre uses sodium chloride 0.9%. My dilemma is should we also stop using heparin?
The impact of workload on hygiene compliance in nursing
Authors: Knoll Martin , Lautenschlaeger Christine , Borneff-Lipp Marianne
Published: May 2014

The objective of this research was to clarify whether external factors (e.g. ward capacity, level of nursing intensity) had an influence on nursing staff compliance with hand hygiene guidelines. The study was conducted at a German hospital (450 beds). Quantitative data were collected prospectively in six trial phases (E1–E6) starting in June 2007 and ending in May 2008. Included in the study were ten hospital departments: four surgical wards, four internal medicine departments, and two interdisciplinary intensive care units. In six participant observation trials, nursing staff were monitored for the disinfection of hands. Narrative interviews were conducted immediately after the observation with those who did not disinfect their hands in accordance with national guidelines. Observations and interviews were unannounced, taking place at different times. The collected data was analysed on subsequent categorization after summarizing the core statements (content analysis). The statistical relevance of staff compliance to the rate of used ward capacity could be proved using a multifactorial regression model (P=0.011). Workload factors (e.g. maximum ward capacity, severity of patient cases) have an impact on staff compliance with hand hygiene guidelines, even where non-compliance contradicts the personal level of professional training.
Infection control in IV therapy: a review of the chain of infection
Authors: Lavery Irene
Published: May 2014

The aim of this article is to review the principles of infection control relating to intravenous (IV) therapy. IV therapy and peripheral IV cannulation are common procedures. Zingg and Pittet (2009) noted that as many as 80% of hospitalized patients will have a cannula in situ, and Hart (2008) suggested that patients who require IV therapy are often seriously ill and immunocompromised, thus are more susceptible to infection. The Department of Health (DH) (2007a) estimated that 6000 patients acquire a catheter-related bloodstream infection every year in the UK. Robust standards of practice are therefore paramount to ensure safe and competent practice, both in peripheral IV cannulation and IV care. Using the chain of infection as a framework to review practice will enable practitioners to ensure thorough standards of practice, and the Royal College of Nursing (RCN) (2005) stated that only trained and competent staff using strict aseptic techniques should be involved in IV or cannulae care. Furthermore, the Code (Nursing and Midwifery Council (NMC), (2008) stipulates all practitioners must deliver care based on the best available evidence and/or best practice, and that knowledge and skills for safe and effective practice must be kept up-to-date throughout each health professional’s working life.
The management of breakthrough cancer pain
Authors: Davies Andrew N
Published: May 2014

Breakthrough cancer pain is a heterogeneous condition, and management should involve a thorough assessment, an individualized treatment plan, and a thorough re-assessment. This article will highlight the recommendations for the management of breakthrough cancer pain from a task group of the Science Committee of the Association for Palliative Medicine of Great Britain and Ireland, and briefly review the new opioid preparations that have been developed for breakthrough pain.
Travel health: sun protection and skin cancer prevention for travellers
Authors: Wood Cate
Published: May 2014

The UK population likes to travel to sunny parts of the world, where the risk of sunburn is greater than it is at home. Sunburn and the cultural desire for a tan is one of the risk factors for the increase in skin cancer. The rise in foreign travel has resulted in an increased demand for pre-travel health services, with nurses in primary care acting as the main providers. Within these consultations, the traveller and their travel plans are risk assessed.Travel health consultations give an ideal opportunity to discuss and advise the public regarding sun burn and skin cancer protection. However, there are also other ways to impart safety in the sun message to travellers. Skin protection is a health promoting activity provided as a part of public health provision and all nurses can play a role in prevention.
Physiological measures of assessing infant pain: a literature review
Authors: Raeside Lavinia
Published: May 2014

Neonatal pain assessment is not standardized. Clinicians may use various parameters in the measurement of pain which can lead to different interpretations. Currently, there is no validated biological marker for assessing infant pain in any age group. However, in the non-verbal patient, the most feasible way to assess pain may be by evaluation of physiological parameters. The author conducted a systematic review of the literature using qualitative methods and seven research papers were selected for review, in which physiological measures were used in the assessment of neonatal pain. Heart rate was the most frequently used physiological pain measure in these studies. Oxygen saturation, blood pressure and respiratory rate lacked sensitivity and specificity and cannot be used independently. These measures may detect pain but cannot quantify it and are, therefore, not useful assessments of chronic pain. The multidimensional approach to pain assessment may be the most appropriate owing to the correlation between behavioural and physiological indicators of pain in the neonate.
Intravenous therapy: preparation and administration of IV medicines
Authors: Lavery Irene
Published: May 2014

The aim of this article is to review the preparation and administration of intravenous (IV) therapy and to outline safe standards of practice. This article reviews the preparation for the procedure and then outlines actions for preparing—the patient, the practitioner, the environment and equipment, and then the medication—before describing the administration of any IV medication, whether via a bolus, intermittent or continuous route. A review of errors in IV therapy indicated calculation skill and a wide knowledge is required, while the National Patient Safety Agency (NPSA) (2010) highlighted omitted and delayed medications as the second largest cause of medication incidents. Therefore, the Royal College of Nursing (RCN) (2010) suggested each practitioner must have knowledge of the principles of reconstituting, including aseptic technique, compatibility (physical, chemical and therapeutic), stability, storage, labelling, interactions, dosage, calculations and the use of appropriate equipment. Furthermore, Finlay (2004) advocated that training must also include the management of anaphylaxis. The necessity for safe and consistent IV practice is endorsed and explored through Crimlisk et al's (2009) nine rights of IV medications, and Billings and Kowalski's (2005) mnemonic (CATS:PRRR).
Homeostasis 6: nurses as external control agents in rheumatoid arthritis
Authors: Clancy John , McVicar Andrew , Mooney Janice
Published: May 2014

All disorders involve a disturbance of cellular and hence chemical function in the body. Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory disease that usually attacks synovial joints and surrounding ligaments, muscles and their tendons and blood vessels. This article applies the concept of health professionals operating as external agents of homeostatic control ( Clancy and McVicar, 20011a ; 2011b ) to RA and to the care of affected patients, using a case scenario to illustrate attempts to minimize homeostatic imbalances. After reading the article, nurses should be able to understand: how the principles of homeostatic theory apply to skeletomuscular function, in particular to synovial joint function; the skeletomuscular homeostatic role in movement; and that homeostatic failure of reduced mobility, as in RA, is a result of nature-nurture interaction; that illness arises from a cellular, hence chemical, homeostatic imbalance(s) ( Clancy and McVicar, 2011a ; 2011b ; 2011c ; 2011d ; 2011e ). RA is considered a cellular (B-lymphocyte) hence chemical (autoantibody) imbalance that causes the homeostatic imbalances (inflammatory pain, reduced mobility, reduced activities of daily living) associated with the condition. Health professionals are able at act as external agents of homeostatic control to only a limited extent when caring for people with RA because, as with any progressive disorder, they will only be managing signs and symptoms to improve patients' quality of life.
Clinical nurse specialists: essential resource for an effective NHS
Authors: Vidall Cheryl , Barlow Helen , Crowe Maggie , Harrison Isabel , Young Annie
Published: May 2014

Despite emerging evidence for the clinical and financial efficacy of the clinical nurse specialist (CNS), the provision of this role is patchy across the country. There is also a risk that incumbent CNS' may be redirected to less specialist work in trusts that do not appreciate the full value of the service that these nurses provide. Optimal and equitable patient access to CNS care will require the development of a strong evidence base showing that specialist nurses not only deliver patient-focused care, but that they can also help to meet healthcare managers' objectives of streamlined, cost-effective clinical services.
Child to adult: transitional care for young adults with cystic fibrosis
Authors: Al-Yateem Nabeel
Published: May 2014

Managing the transitional care needs of young adults with a complex chronic illness such as cystic fibrosis (CF) as they move from a child-orientated to adult setting has been reported in the literature as challenging and stressful, and may impart additional risks to the young person's health. However, in the Republic of Ireland, which has the highest incidence of CF in the world, the current services provided for children during this transitional period are still reported as underdeveloped. The aim of the author's research was to explore and understand the experience of young people before and after their transitional care, and the factors that both contribute to and hinder that experience. A qualitative approach guided by phenomenological tradition, and using in-depth interviews. The findings suggest that there are a range of needs required for patients during this transitional period, including the need for information, interventions that decrease the negative feelings associated with transition (e.g. distress, anxiety, uncertainty), structured service, and an approach to care that focuses on young adults. The author concludes that health professionals in the clinical setting who have responsibility for young adults in transitional care should focus on these needs to provide a more relevant and effective transition service.
Fertility services for same-sex couples: policy and practice
Authors: Wykes Kerry Anne
Published: May 2014

Access to safe and high-quality fertility services is essential for the health of both the woman requiring services and any resulting child. While having children is a human right and legislation and society have become more liberal, same-sex couples may have problems accessing fertility services for several reasons. There is still significant opposition to same-sex couples accessing fertility treatment services, which are already stretched and vary across the country. Some lesbian couples access private clinics, which involve a number of costs because they believe these are more willing to treat same-sex couples. Women may make informal self-fertilisation arrangements; this poses health risks in terms of sexually transmitted infections and a lack of prenatal and holistic advice and care. As patient advocates, nurses and nurse managers can identify areas where services could be more inclusive. Nurses could push for accessible, high-quality fertility services, using policy and evidence to support their development. One way forward may be to encourage more self-insemination at home in a safe way. This has the potential to increase patient empowerment and reduce costs to the NHS. However, any such innovation should always have the safety and equality of patients at its core.
Does nurses' vulnerability affect their ability to care?
Authors: Heaslip Vanessa , Board Michele
Published: May 2014

Recent reports from the Department of Health (2008) , the Parliamentary and Health Service Ombudsman (2011) and the Commission on Dignity in Care for Older People (2012) have been highly critical regarding the care that some patients have experienced. They have highlighted that fundamental aspects of care are missing resulting in a lack of high quality individualised nursing care, which is in contrast with holistic nursing philosophy. We have to ask ourselves what is happening within nursing, as many enter the profession owing to a desire to ‘make a difference’. Drawing on focus group data exploring perceptions of caring for residents with dementia in a care home setting, the authors found that nurses and healthcare assistants experience a mutual vulnerability with patients. This paper explores whether this mutual vulnerability could lead to nurses focusing on the clinical aspects of their role to the detriment of the compassionate, caring components of nursing.
Infection control in enteral feed and feeding systems in the community
Authors: Ojo Omorogieva , Bowden Julie
Published: May 2014

This article examines the infection risk to adult patients receiving home enteral nutrition (HEN) and strategies for its prevention and management. Enteral nutrition was historically associated with acute care settings owing to its invasive nature. The changing landscape of community care means that it is now likely to be administered in the patient's home or in other community settings such as nursing homes. HEN is associated with two main routes of infection risks: the risk of gastrointestinal infection from contamination of the feed and feeding accessories, and local wound infection at the stoma site. Guidelines for the prevention and control of HEN-associated infection are provided and explained. These guidelines emphasise patient and carer education, effective hand hygiene, correct storage and administration of the feed, early detection and management of potential infections.
Annual review for housebound patients with coronary heart disease
Authors: Barrett Julie Ellen Marie
Published: May 2014

The care of people with long-term conditions is a priority for the NHS. While there are many strategies in place in primary care to support the management of patients with long-term conditions, there is a paucity of services for people who are housebound. Coronary heart disease (CHD) is the most common cause of death in the UK and costs more than £9 billion every year ( British Heart Foundation, 2012 ). This article describes a pilot project set up by a nurse, working under an honourary contract within a general practice. The project’s aim was to deliver a service, to housebound patients with CHD, which would provide an annual review of their condition in the home. This pilot provided some justification for the expansion of the service to all housebound patients who have a long-term condition, ensuring that they receive the same equitable assessment, treatment and health promotion advice afforded to those able to come into the practice. Some of the findings from the patient visits are discussed and a case is made for the expansion of the project beyond the pilot.
Strategies to reduce treatment costs of peristomal skin complications
Authors: Martins Lina , Tavernelli Kathy , Sansom Wendy , Dahl Kirsten , Claessens Ineke , Porrett Terri , Andersen Birgitte Dissing
Published: May 2014

Peristomal skin complications (PSCs) are common and troublesome and the consequences are substantial both for the patient and from a health-economic viewpoint. The purpose of this article is to demonstrate that early detection and treatment of PSCs, combined with the use of a correctly fitted and appropriate pouching system, can reduce treatment costs—in the UK, it is estimated to save £28.1m annually. A model for cost estimation of PSCs and a real-life global data set of people with stomas are used for the calculations. A high priority should be given to ensuring resources are available to provide education, guidance and assistance to people with a stoma. This would support increased awareness of the first signs of PSCs and enable self-management at an early stage.
Key considerations of intermittent catheterisation
Authors: Mangnall Joanne
Published: May 2014

Intermittent catheterisation provides a safe and effective alternative to indwelling catheterisation for patients who require bladder drainage. It can be undertaken by health professionals in a variety of clinical settings for a range of clinical indications, and increasingly by patients themselves who use it as a long-term bladder management technique. The relative simplicity of the technique comes with the potential for health professionals to underestimate the skills required when considering a regimen of intermittent catheterisation and, perhaps more importantly, to underestimate the impact it may have on individual patients. The aim of this article is to consider intermittent catheterisation, its indications as a bladder management technique, and the potential psychological impact it may have on the patient, as well as how this may influence concordance.
Moisture-associated skin damage: aetiology, prevention and treatment
Authors: Voegeli David
Published: May 2014

The concept of excessive moisture causing damage to the skin is not a new one, and provides a rationale for many fundamental nursing interventions. Although traditionally thought of as a specific problem of continence care, it is a common problem encountered in many different patient groups. As a consequence the umbrella term moisture-associated skin damage (MASD) has been introduced to describe the spectrum of damage that occurs in response to the prolonged exposure of a patient's skin to perspiration, urine, faeces or wound exudate. It is generally accepted that MASD consists of four main separate conditions, each having slightly different aetiologies, all of which will be explored in this paper. Careful assessment can help distinguish between the four and enable appropriate prevention and treatment interventions to be implemented. Whatever causes the excessive moisture, effective interventions should consist of the adoption of a structured skin care regime to cleanseand protect, methods to keep the skin dry, controlling the source of the excessive moisture and treating any secondary infection.
Current assessment of patient safety education
Authors: Mansour Mansour
Published: May 2014

The purpose of this literature review was to examine current evidence on how student nurses and nursing faculty members perceived the integration of patient safety education in preregistration/undergraduate nursing training. Databases searched from January 2000 to April 2011 included CINAHL, PsycINFO, British Nursing Index, PubMed, AMED, Academic Science, Midline, Cochrane Library Database, Web of Knowledge, Ovid Nursing Database, Wiley Online Library and Science Direct. In total, 77 articles were initially found, although only 15 were included in the author's review. Of these, 5 papers were research- based articles that examined aspects of patient safety education in undergraduate/pre-registration nursing training, and 9 papers were literature review and discussion based, which provided insight into the experience, assessment, evaluation or implementation of patient safety education curriculum in nursing education. The author's literature review highlights the continuing lack of research on patient safety education in undergraduate/preregistration nursing training and, in particular, outlines areas in nursing education which need to be addressed to develop patient-safety-friendly nursing curricula.
Managing passive incontinence and incomplete evacuation
Authors: Collins Brigitte , Norton Christine
Published: May 2014

Both passive faecal incontinence and evacuation difficulty are distressing and demoralising conditions, resulting in physical and psychological problems including social restrictions, loss of self-esteem, altered body image and loss of skin integrity. Conservative management and biofeedback therapy has been shown to help most patients with faecal incontinence and evacuation difficulty by creating a manageable situation that can significantly improve quality of life. However, some patients may not improve their symptoms and require alternative measures. This article reports an audit of the use of the Qufora mini irrigation system in 50 patients (48 female, 2 male) with passive faecal incontinence and/or evacuation difficulty who had failed to respond to conventional biofeedback. Seventy percent found the irrigation comfortable and 74% rated the system as good or acceptable. Two-thirds believed symptoms were improved and would wish to continue using the system. Prospective studies are needed to confirm which patients are most suitable and respond well to the irrigation.
The Keogh review on hospital deaths
Authors: Tingle John
Published: May 2014

John Tingle discusses the Keogh review into the quality of care and treatment provided by 14 hospital trusts in England.
Factors influencing participation in breast cancer screening
Authors: Edgar Lynne , Glackin Marie , Hughes Caroline , Ann Rogers Katherine Mary
Published: May 2014

Despite the efficacy of mammography and the widespread promotion of screening programmes, a significant number of eligible women still do not attend for regular breast screening. An integrative review methodology was considered the most appropriate means to critically analyse the available literature pertaining to factors which influence participation in breast cancer screening. From the extensive literature search, 12 selected core research papers met the inclusion criteria and were incorporated in the literature review. Four themes emerged from the literature which impact on participation in mammography screening: psychological and practical issues, ethnicity issues, influence of socioeconomic status and issues related to screening programmes. The recent Independent Review Panel on Breast Cancer Screening endorsed the importance of access to information which clearly communicates the harms and benefits of breast screening to enable women to make informed decisions about their health. The recommendations from the panel and others have been included in this review.
Instilling a patient safety culture in the NHS
Authors: Tingle John
Published: May 2014

John Tingle, welcomes much of Professor Don Berwick's review in the aftermath of the Mid Staffordshire Hospital scandal as thoughtful and reflective, but says one key recommendation—to create criminal sanctions against health staff—will not make the NHS safer for patients.
Thrombolytic dosing in acute ischaemic stroke
Authors: Catangui Elmer J
Published: May 2014

Thrombolysis treatment for acute ischaemic stroke is effective if it is administered within 4.5 hours of stroke onset. Alteplase is a licensed thrombolytic treatment for ischaemic stroke. The dose of alteplase is dependent on a patient's weight. The stroke team involved in the administration of the treatment usually estimate a patient's weight prior to the treatment in order to ensure the correct dosage. This paper highlights the reliability of body weight estimates in determining the accuracy of thrombolysis dosing and the implication of dosing errors to post-thrombolysed patients.
The quality of care provided in NHS trusts reviewed
Authors: Glasper Alan
Published: May 2014

Professor Alan Glasper discusses the ramifications of Sir Bruce Keogh's review into the quality of care and treatment provided by English NHS trusts
Perioperative simulation learning and post-registration development
Authors: Inch Jessica
Published: May 2014

Competence to practise in the perioperative environment requires specialist knowledge ( Gillespie and Hamlin, 2009 ). Newly qualified staff in this environment can experience difficulty in making the transition into practice ( Stratton, 2011 ) and often feel overwhelmed by the skills required ( Callaghan, 2010 ). Simulation-based learning techniques are increasingly used by practice educators specifically within these environments ( Cato and Murray, 2010 ) to aid with acquisition of skills, emergency care delivery, general post-registration development and also as a standardised indicator of ‘competence’ ( Bullock et al, 2008 ; Cato and Murray, 2010 ). This article will consider the impact of this educational strategy on the learner's lifelong development following registration, and its position in relation to the widely accepted learning paradigms of Benner's ‘Novice to Expert’ and Maslow's ‘Hierarchy of Needs’. Through discussion of the nature of education in the practice setting, the reader will be prompted to reconsider the actual value of simulation-based learning in the post-registration arena and how this may be used to redefine simulation in the clinical setting.
Making the most of being a student nurse
Authors: Botten Emma Louise
Published: May 2014

With a new academic year commencing, Emma Botten, a newly qualified mental health nurse, gives an insight into her experience as a student nurse. She offers her top tips on how to make the most of these three years and prepare for a successful future career in nursing.
Acute decompensated heart failure: diagnosis and management
Authors: Riley Jillian
Published: May 2014

Chronic heart failure is common in the UK, with a prevalence estimated at 3% of people aged between 65 and 74 years. This prevalence increases with age and affects approximately 15% of the older population ( British Heart Foundation, 2011 ). A significant number of such people are diagnosed after presenting to their local emergency department with severe breathlessness. Advances in patient management have improved outcomes, but the prognosis remains poor. A recent epidemiological study of patients with heart failure in north west London reported that around 14% of patients die within 6 months of diagnosis ( Mehta et al, 2009 ). The UK national audit data of 2011–2012 reported that approximately 11% of patients admitted to hospital with acute heart failure die during their in-hospital stay. For those discharged, there is a greater-than-25% risk of death within 12 months. This risk of in-hospital and 12-month mortality varies widely, but appears to largely relate to the inpatient management and organisation of follow-up ( National Institute for Cardiovascular Outcomes Research, 2012 ).
Psychological issues in voluntary hospice care
Authors: Elliott Gill , Umeh Kanayo
Published: May 2014

Background: Hospices require a multidisciplinary team of health workers to ensure that patients receive appropriate palliative care. One way to tackle this challenge has been to rely increasingly on volunteer carers. Recruiting and retaining volunteers requires some understanding of the psychological challenges (thoughts, emotions and actions) associated with voluntary care. Aim: This study examined the psychological experiences of volunteer carers in a UK hospice. Methods: The study employed a qualitative design. Nine voluntary careers in one UK hospice were interviewed about their experiences using a largely unstructured interview format. Data were analysed using a grounded theory protocol. Findings: Five major themes emerged: motivation to volunteer, volunteering skills, psychological support and holistic care, positive perceptions of the hospice, and performance hindrances. The skills theme (reflecting abilities acquired from previous experience) was especially prominent. Overall, a model emerged suggesting that volunteers experience cognitive–affective– behavioural challenges involving themselves, patients and the work environment. Self-related challenges seem especially prominent. Implications for nursing care are considered.
Spiritual coping in rehabilitation–a comparative study: part 2
Authors: Baldacchino Donia , Torskenaes Kristina , Kalfoss Mary , Borg Josette , Tonna Aaron , Debattista Clifford , Decelis Neville , Mifsud Rodianne
Published: May 2014

Spiritual coping, which may or may not contain religiosity, may enhance adaptation of clients with chronic illness. Part 1 of this article ( Baldacchino et al. 2013 ) presented the research methodology of this cross-sectional comparative study, which explored the spiritual coping of clients with chronic illness receiving rehabilitation services in Malta (n=44) (lower limb amputation: n=10, chronic heart disease: n=9, osteoarthritis in an institution: n=10 and in the community: n=15) and Norway (n=16) (post-hip/shoulder surgery: n=5; chronic heart disease: n=5; chronic pain: n=6). Data were collected from seven purposive samples by focus groups. Roy’s adaptation model (1984) and Neuman’s Systems Model (2010) guided the study. Part 2 discusses the findings, which consist of one main spiritual coping theme and three sub-themes: ‘adopting religious coping strategies, relationship with God, and time for reflection and counting one’s blessings’. Commonalities were found in the findings except in one dimension, which was found only in the Malta group, that is, being supported by others with a similar condition. This difference may be a result of the environment in the rehabilitation centres, cultural, and geographical differences between the two countries. While considering the limitations of this study, recommendations are proposed to the rehabilitation and education sectors and further trans-cultural comparative longitudinal research with mixed method approach on various clients with acute, chronic and life-threatening illness.
Pressure ulcer prevention: making a difference across a health authority?
Authors: Guy Heidi , Downie Fiona , McIntyre Lyn , Peters Jeremy
Published: May 2014

Pressure ulcers (PUs), their cause and prevention have been discussed in the literature for many decades. Their prevention and management has been the core of a tissue viability nurse's daily clinical and strategic workload. The important point to acknowledge is that not all PUs can be prevented but it is believed most of them can and all preventative measures must be implemented and evaluated. Initial efforts focused on establishing a baseline of incidence and prevalence. More recently, the Department of Health has proposed that PUs could be eliminated in 95% of all NHS patients and incentivised the measurement of PUs and other harms by use of the NHS Safety Thermometer through the introduction of a new initiative. A research company was commissioned to explore which communications interventions would be effective in helping health professionals to prevent and treat PUs. A campaign was subsequently set in motion to educate and inform clinical staff on the cause and prevention of PUs.
Periphally inserted central catheters—a ‘serous’ complication
Authors: Hughes Meinir Elen
Published: May 2014

Peripherally inserted central catheter (PICC) placement in the upper arm appears to have led to an increased incidence of the inadvertent puncture of lymph vessels, which transport lymph fluid around the body. The fluid flows from the lymph vessel in the arm, through the subcutaneous tract created by the PICC, accumulating in discharge of serous fluid at the exit site. The symptoms may be minimal or excessive and currently there are no published data or guidance as to how to manage this complication. Possible management strategies are proposed in this article. They involve the assessment of the amount and persistence of the discharge, with removal indicated when symptoms persist or when the volume is excessive.
Bone metastases: assessment, management and treatment options
Authors: Farrell Carole
Published: May 2014

Cancer cells from a primary tumour can spread to other parts of the body through the bloodstream or the lymphatic system. Bone metastases are common in multiple myeloma, where 70–80% of patients have bone metastases at diagnosis. They are also a common feature in solid tumours such as breast, lung, prostate, thyroid and renal carcinomas. The median survival in patients with bone metastases from breast cancer is 24 months; 20% of patients survive for 5 years or more. Pain is the most common symptom of bone metastases, which can often be severe and difficult to control. This article will discuss normal bone physiology and explain the changes that occur when cancer cells spread to bone. It will outline the signs and symptoms of bone metastases and discuss patient assessment, symptom management and treatment options, including different bisphosphonates. The physical and psychological impact of bone metastases should not be underestimated and nurses are well placed to improve the quality of life of patients.
Patients' experiences of the PICC insertion procedure
Authors: Nicholson Jackie , Davies Louise
Published: May 2014

Peripherally inserted central catheters (PICCs) are a type of central venous access device used to deliver a variety of intravenous therapies, including chemotherapy. PICCs may be placed by interventional radiologists, anaesthetists or, as is increasingly common, by specialist nurses in the hospital setting. However, little is known about how patients feel regarding the PICC insertion procedure. The aim of this study was to interview patients who had undergone a recent PICC insertion in the chemotherapy day unit to identify their experiences. On analysis of the qualitative data obtained from the semi-structured interview, five themes emerged: the context of cancer; expectations; levels of pain and anxiety; coping strategies; and explanation. The findings of this study support some previously described elements of procedural experiences; however, new understanding has provided implications for practice in the areas of expectations, allaying anxiety levels, supporting individual coping strategies and providing explanation. The major limitation of the study was the homogenous sample of oncology patients with a clear link between the patient experience of the PICC insertion and the context of cancer. The main recommendation for further research would be to repeat this study with a broader patient population.
Developments in neonatal care and nursing responses
Authors: Healy Patricia , Fallon Anne
Published: May 2014

This article reviews the origins and evolution of neonatology and considers the role of the neonatal nurse within this specialty. Neonatal nurses are a vital part of the neonatal team that provides care for sick babies. The nursing care required by sick babies and their families on a neonatal unit can be variable and complex. The past century has seen significant changes in the role of the neonatal nurse. This has come about through dramatic technological developments on neonatal units, an increased understanding of neonatal physiology and pathology, changes in the education of neonatal nurses, and active and ongoing clinical research within the specialty. The resulting significant advances in neonatal care, including that provided by neonatal nurses, have made a crucial and steadfast contribution to marked improvements in neonatal outcomes.
Understanding the debate around regulation of support workers
Authors: Vaughan Suzanne , Melling Karen , O'Reilly Lynn , Cooper Denise
Published: May 2014

While much is written about the regulation of healthcare support workers (HCSWs), many authors and policy makers do not distinguish between assumption and evidence. As calls for compulsory regulation of HCSWs grow louder, it is crucial that the evidence underpinning the debate on both sides is considered carefully and critically. The authors reviewed journal articles and policy documents with the specific aim of clarifying the arguments for and against further regulation from an evidence-based perspective. The majority of material recommended HCSW regulation, however, the mechanisms by which regulation would deliver better patient care were often missing and were rarely evidence-based. This article provides clear definitions of the key terms and processes needed to engage in the debate, followed by a summary of the arguments for and against the regulation of support workers.
Assessment matters—mentors need support in their role
Authors: Bennett Maggie , McGowan Brian
Published: May 2014

Background

In the UK the Nursing and Midwifery Council (NMC) standards to support learning and assessment in practice state that mentors are responsible and accountable for the assessment of pre-registration nursing students in practice. This study was undertaken to explore mentors' experience of assessing nursing students in practice post implementation of the NMC standards.

Method

Five focus groups were conducted with mentors (N=35) who had assessed adult pre-registration nursing students in the previous 12 months. The focus groups were recorded, transcribed and analysed to generate categories.

Results

Five categories were identified from the data: Changing roles and responsibilities; Exploring the past to understand the present; Just knowing; The odds; Time to mentor. The findings highlighted that mentors were aware of their role and responsibility for the assessment of students in practice. However, many felt this was a new responsibility and role in which they lacked experience. Some existing mentors felt that they may not have had the necessary preparation to effectively assess students in practice and identified their need for support.

Conclusion

Given that mentors are expected to be competent assessors of students in practice and protect the public through gate-keeping professional registration, this study suggests that serious consideration should be given to how mentors are prepared and the ongoing support and education they receive in assessment.
Venous disease and chronic oedema: treatment and patient concordance
Authors: Todd Marie
Published: May 2014

Compression therapy is the mainstay in the management of chronic venous disease, venous leg ulceration (VLU) and chronic oedema. The management of VLU alone is thought to cost a staggering £400 million per year and accounts for 13% of all district nursing visits. The predicted increase in elderly, obese and chronically ill patients will pose a further strain on already stretched resources. The impact of chronic venous and lymphovenous disease is also costly in terms of physical and psychological terms for patients. Adopting a preventive approach would reduce the financial, workload and symptomatic aspects of this condition.
Breast cancer in younger women from diverse cultural backgrounds
Authors: Reidy Mary , Denieffe Suzanne
Published: May 2014

Research identifies unique challenges for younger women diagnosed with breast cancer at or before 45 years of age. This paper explores the experiences of younger women from diverse cultural backgrounds with breast cancer to see if there are differing healthcare provision needs across cultures. Sandelowski and Barroso's framework for undertaking a meta-synthesis is used in this paper. Initial searches in academic databases returned 42 papers of interest. Re-reading the papers in the context of the research question identified 12 studies which met the inclusion criteria. Five key themes were identified in these 12 studies. The overarching finding is that, irrespective of cultural background, the confrontation with breast cancer transforms the younger woman's life. It seems that healthcare provision needs do not differ substantially across cultures. Health professionals should address the unique psychosocial effects of cancer in the context of the lifestage of the woman.
Should patient experience be measured locally or nationally?
Authors: Sharma Vibha , Davis Arwenna
Published: May 2014

In the last BJN Oncology Supplement, Consultant Editor Helen Roe's Editorial discussed surveys for measuring the experience of cancer patients. In response, we received this letter from Macmillan Cancer Support with their thoughts about how best to gather insight to drive improvements in patient experience.
Blood transfusion sampling and a greater role for error recovery
Authors: Oldham Jane
Published: May 2014

Introduction: Patient identification errors in pre-transfusion blood sampling (‘wrong blood in tube’) are a persistent area of risk. These errors can potentially result in life-threatening complications. Current measures to address root causes of incidents and near misses have not resolved this problem and there is a need to look afresh at this issue. Project purpose: This narrative review of the literature is part of a wider system-improvement project designed to explore and seek a better understanding of the factors that contribute to transfusion sampling error as a prerequisite to examining current and potential approaches to error reduction. Search strategy: A broad search of the literature was undertaken to identify themes relating to this phenomenon. Key discoveries: Two key themes emerged from the literature. Firstly, despite multi-faceted causes of error, the consistent element is the ever-present potential for human error. Secondly, current focus on error prevention could potentially be augmented with greater attention to error recovery. Conclusions: Exploring ways in which clinical staff taking samples might learn how to better identify their own errors is proposed to add to current safety initiatives.
Putting values at the heart of nursing
Authors: Barron Kim
Published: May 2014

Kim Barron argues that pre-registration education for mental health nurses should prepare students in the use of emotional intelligence to understand and support service users.
Stepping into the wilderness
Authors: Lefever Paul
Published: May 2014

Walking in the Scottish Highlands is bound to make you physically fitter. But for members of the Norfolk-based Discovery Quest project, many of whom have diagnoses of serious mental health problems, the benefits go far wider than that. Project manager Paul Lefever explains.
Continuing Professional Development: Early intervention in psychosis
Authors: Gillam Tony
Published: May 2014

This unit focuses on early intervention in psychosis. The unit includes illustrative examples, an overview of the development of early intervention and its key concepts and some self assessments to test the reader’s knowledge. Although some further reading is recommended, the unit can be taken as a stand-alone introduction to the topic.
Maintaining the momentum: better services for children and young people
Authors: McDougall Tim
Published: May 2014

The National Advisory Council for Children’s Mental Health and Psychological Wellbeing was created to review the continuing development of children’s mental health services in England. One year on, Tim McDougall reviews progress and sets out the future challenges facing us all
Lie back and hear the birdsong
Authors: Gillam Tony
Published: May 2014

Being confronted by a health scare made Tony Gillam take stock of his sedentary lifestyle and sign up for yoga classes. Even as a self-proclaimed ‘bad student’, he can now see the benefits of taking regular exercise and learning how to relax
News
Authors: Swanson Andy
Published: May 2014

A new guide has been launched to ease the plight of thousands of people with mental health problems who are ‘yo-yoed’ back and forth from prison to the community without support.
Making an impact on how mental health problems are managed at work
Authors: Lockett Helen
Published: May 2014

Sainsbury Centre for Mental Health has just launched ‘Impact on Depression: the workplace mental health programme’. As Helen Lockett explains, this offers employers across the UK access to effective training on mental health conditions
A practical application of bibliotherapy
Authors: Davies Janet
Published: May 2014

Janet Davies outlines the importance of reducing social exclusion through the work of a local community resource
Examining the impact of food on mood
Authors: Anderson Diana , Philpot Ursula
Published: May 2014

Diana Anderson and Ursula Philpot highlight the importance of nutritional balance in mental and physical health and the role of the dietitian
Low-grade psychotic symptoms in a non-clinical population: a study
Authors: Fleming Mick , Martin Colin R
Published: May 2014

Low-grade psychotic symptoms have consistently been found to be experienced by members of the general population. Evidence suggests that they are less frequent, intrusive and severe than those experienced by people with a diagnosis of schizophrenia. Anxiety and depression are two psychosocial factors that have been implicated in the development of these less severe psychotic symptoms. There are many similarities between low-grade psychotic symptoms and the more severe symptoms of people with a diagnosis of schizophrenia. This study explored the pattern of two low-grade psychotic symptoms in a sample of 121 people from a non-clinical population. The analysis of results from measures of anxiety and depression and the dimensions of voice hearing and delusions found a significant relationship between reported levels of anxiety and the presence of voice hearing and delusions. A dimensional approach provides the clearest opportunity to explore the nature of low-grade psychotic symptoms. Implications for clinical practice are discussed.
Obsessive compulsive disorder: nature and treatment
Authors: Gournay Kevin , Rogers Paul
Published: May 2014

This article discusses obsessive compulsive disorder (OCD), and common approaches to treatment of the condition. The mental health professional’s role in recognising the clinical features of OCD will be explored and a case study is included to illustrate how OCD can present. The article includes some self-assessment to test the reader’s knowledge
Keep your waist down
Authors: Beary Michael
Published: May 2014

Michael Beary reviews our understanding of the roles of different types of fat found in the human body and highlights the importance of waist measurement
Acknowledging hidden emotions on Triangle Island
Authors: Bates Peter
Published: May 2014

This article extends the metaphor begun in Living on Triangle Island ( Bates, 2010 ), which explored possible relationships between person-centred approaches, social inclusion and community engagement in the context of mental health. Here we examine some literature from the academic disciplines of disability studies and psychoanalytic therapy from the perspective of social inclusion.