bluuebunny/crossref_metadata_2025 huggingface dataset:
Medical investigations 5: Colonoscopy
Authors: McConnon Alistair
Published: December 2014

Flexible fibreoptic colonoscopy allows direct visualization of the entire colonic mucosa (Figure 1). By passing instruments through the colonoscope it is also possible to collect biopsies for cytological and histological examination, to remove colonic polyps and to control active bleeding points. Colonoscopy is indicated in the investigation and diagnosis of: rectal bleeding; altered bowel habit; unexplained iron deficiency anaemia; inflammatory bowel disease; colorectal neoplasia; and diverticular disease.
Evaluation of a paediatric diabetes specialist nurse post
Authors: Lowes Lesley
Published: December 2014

The specialist nurse caring for children with diabetes is widely recognized as a valued member of the paediatric diabetes team. However, there has been minimal exploration or examination of the clinical role of the paediatric diabetes specialist nurse (PDSN). This in-depth evaluation critically examines the impact of a PDSN post, comparing data from the first 2 years of the post against corresponding data from the previous 2 years. Results are encouraging, showing that much has been achieved. Home management was successfully introduced, length of stay was halved for newly diagnosed children initially hospitalized, suggested guidelines for length of stay for readmissions were met, age-banded education sessions were implemented and clinic non-attendance was substantially reduced. The readmission rate for children with established diabetes was increased, and reasons for this are discussed outlining intervention being introduced to proactively address this problem. The findings from this evaluation support the belief that PDSNs, as members of a multidisciplinary team, make a substantial and valuable contribution to paediatric diabetes care.
Flexible roles: a new model in nursing practice
Authors: Langstaff Deborah , Gray Bridget
Published: December 2014

The problem of how to retain experienced nurses within a given specialist field impacts on both nurses and managers. This article explores the development of a new clinical role which gives experienced E and F grade nurses the opportunity for personal and professional growth. Within the new role, 50% of the nurse's time is devoted to ward-based clinical work and the other 50% to developing an area of clinical practice or research, as is the case with some clinical nurse specialists. There is flexibility over the area of specialist interest to reflect the needs of the service and the expertise and interests of the individual, and there is also flexibility in relation to the clinical commitment which increases opportunities for job shares. This development has arisen from an organizational culture which recognizes the need for more flexible job classifications and work rules. This new model for practice also represents a new model for management. In fostering self-reliance within the workforce it enables all parties to work towards a shared vision which Is mutually beneficial for nurses, managers, the organization and, most importantly, the patient.
A review of nurse occupational stress research: 1
Authors: Wheeler Herman H
Published: December 2014

This is the first in a series of articles that review the field of nurse occupational stress research. The review in its entirety provides a focus for further research on nurse stress; further research is crucial, especially at a time when major changes in nursing and the NHS in general provide major challenges which some people would argue are critical prerequisites for increased work-related stress. The review highlights the many weaknesses and gaps in nurse stress research and invites future researchers to take up the challenge.
The ethical dilemma of the do not resuscitate order
Authors: Mason Sue
Published: December 2014

Tingle (1988) stated that doctors and nurses frequently find themselves in the position of making decisions which are not solely medical or nursing but of a moral or ethical nature. To illustrate this concept the author describes and analyses how the ethical arena has impinged upon her practice. Professional accountability and patient involvement are critical issues which need to be addressed. Do not resuscitate decisions should be based on a collaborative approach centred around the patient.
Compulsory removal of competent adults from their homes
Authors: Griffiths Pauline
Published: December 2014

The National Assistance Act 1948 was enacted in order to provide the legal framework for the care and support of society's ill and socially deprived. In certain limited circumstances, Section 47 of this Act permits the compulsory admission of competent adults to hospital or to other types of residential care. The fine balance between protection from harm and respect for personal freedom is not served well by this Act which has its origins in Poor Law legislation. It is no longer in accordance with current practice and therefore needs to be reviewed. This could be achieved by setting up regulatory systems to protect the rights of individuals considered to be in need of compulsory admission. However, it seems likely that the only way to protect the individual's civil liberties effectively Is by changing the existing law.
Whistleblowing guidelines for nursing colleagues
Authors: Castledine George
Published: December 2014

Following the inquiry into the case of Amanda Jenkinson, the nurse jailed for harming an elderly patient on an intensive care unit, there has been a media outcry for doctors and nurses to be more diligent in reporting colleagues whom they suspect may be a danger to the public. Such an act is not as easy as it may seem. For example, it is sometimes difficult to pinpoint exactly what is ‘strange’ about someone's behaviour.
Developing the role of clinical child health nurses
Authors: Coad Jane , Cooper Christine
Published: December 2014

The publication Developing Roles of Nurses in Clinical Child Health (Royal College of Paediatrics and Child Health and the Joint Advisory Committee on Children's Nursing, 1996) has acted as a catalyst for debate in relation to the role of paediatric nurses. Historically, paediatric nurses have always had to battle to develop their specialty but have also been at the forefront of promoting quality care for children. Recent developments in the NHS and the move towards community care has changed the sickness perspective to one of health (DoH, 1991) which has influenced how children's nursing is perceived. This is exemplified by the change of the term paediatric nursing to child health nursing.
Olive Oil and the Mediterranean Diet: Implications for Health in Europe
Authors: Assmann Gerd , de Backer Guy , Bagnara Sebastiano , Betteridge John , Crepaldi Gaetano , Fernandez-Cruz Arturo , Godtfredsen John , Jacotot Bernard , Paoletti Rodolfo , Renaud Serge , Ricci Glorgio , Rocha Evangelista , Trautwein Elke , Urbinati Gian Carlo , Vareia Gregorio , Williams Christine
Published: December 2014

At a meeting convened by the European Commission at the Italian National Research Council in Rome, 11 April 1997, European nutrition, cardiology, lipidology and public health specialists gathered to reach a health consensus on olive oil and the Mediterranean diet.
Nurses' documentation of infection control precautions: 2
Authors: Finn Lesly
Published: December 2014

A small action research study was undertaken, using a quasi-experimental approach, to establish to what extent infection control advice was documented and to assess the effectiveness of the provision of an example care plan for control of infection. The study population comprised two groups of patients colonized or infected with ALERT organisms and involved 28 wards in six hospitals. Baseline data confirmed that infection control precautions were documented for less than 25% of patients overall. Provision of an ‘example’ care plan, together with guidance in its use, was followed by an increase in documentation for all items audited, while identification of the infection in the care plan showed a statistically significant increase (P <0.05). However, in spite of this apparent improvement the documentation of appropriate care for control of infection remained inadequate. It is concluded that, while various strategies to effect change are at the infection control nurse's disposal, the need to integrate infection control with practice must be addressed at every level to include managers, educators and practitioners.
Development of an introductory course in child protection
Authors: Ireland Lorraine M , Powell Catherine
Published: December 2014

The maltreatment of children is a significant public health and social problem. Healthcare professionals have a crucial role to play working with other agencies to protect children from abuse and neglect. The need for training, support and clinical supervision in this work has been identified. This article discusses the collaborative work that led to the establishment of an introductory course in child protection (English National Board 970) at one school of nursing and midwifery and outlines the benefits of undertaking such a course. The course has attracted participants from a range of healthcare settings and has proved to be well evaluated and oversubscribed. Practitioners have returned to their work setting with increased awareness of child maltreatment and an understanding of the need for a proactive approach to child protection.
Children's nursing in Russia: the future generation of professionals
Authors: Jones Karthryn
Published: December 2014

Nurses in Russia are trained by doctors who continue to define nurses' role after qualification. A children's hospital in Moscow, assisted by workers from a British charity, the Tushinskaya Children's Hospital Trust, Is currently attempting to give nurses more autonomy and control. The project focuses on the examination and delivery of nursing care within the context of the Russian healthcare system. The aim of the project is to improve the holistic care of the hospitalized child and his/her family. Healthcare workers receive training in family-centred care, the emotional care of the child, interpersonal skills and infection control. Teachers, in conjunction with a Moscow medical school, run a course in paediatric nursing. A formal evaluation of the project is difficult because of the cultural differences in the measurement of quality. However, there are plans to use a model ward which was set up by Russian and British colleagues at the Tushinskaya Children's Hospital as an example of good practice to other hospitals in Moscow.
Efficacy of cardiac rehabilitation 1: a critique of the research
Authors: Brennan Arthur
Published: December 2014

This article, the first of two parts, suggests that cardiac rehabilitation has two primary foci: the reduction of morbidity and mortality, and the amelioration of distress associated with cardiac pathology. While exercise programmes figure prominently in cardiac rehabilitation, empirical studies attest to their relatively modest impact on the recurrence of myocardial infarction. Other interventions such as stress management programmes reduce psychological distress and increase effective coping mechanisms, but only for a limited period. Traditional educational programmes compare unfavourably with cognitive-behavioural interventions. Empirical research appraising the efficacy of many cardiac rehabilitation interventions are tainted by numerous design problems. The second part of this article considers research into the efficacy of smoking cessation and type A behaviour modification programmes.
Developing a concept analysis of autonomy in nursing practice
Authors: Wilkinson John
Published: December 2014

This article presents a concept analysis of autonomy and offers some insights into the quest for and operationalization of autonomous nursing practice. Recommendations are made regarding automony and nursing practice at the level of the individual practitioner. This concept is also examined in relation to the context in which nursing care is delivered. The conclusions drawn as a result of this analysis serve as a focus for debate on the challenges that nurses and those involved in their education face.
Medical investigations 6: Bone marrow aspiration
Authors: Jenkinson Tim
Published: December 2014

When performed under local anaesthetic, bone marrow aspiration (BMA) is a safe, quick and relatively simple method of obtaining a sample of red bone marrow for cytological, histological and microbiological examination. The additional technique of bone marrow biopsy (BMB) provides a representative core of bone marrow for examination of the architecture and cellularity of the bone marrow. BMA and BMB, therefore, provide a reliable method of ascertaining the numbers, nature and development of erythrocyte, leucocyte and platelet precursors.
Nurse occupational stress research 2: definition and conceptualization
Authors: Wheeler Herman H
Published: December 2014

This article commences with the view that appropriate and clear definitions and conceptualizations of nurse stress are central to meaningful nurse stress research and management. Stress definitions are examined using psychology and nursing literature. The conclusions drawn suggest that, sadly, too many reports on nurse stress fall to make clear the theoretical underpinning, working definitions and conceptualizations of the studies reported. Many studies, in defining stress, causation and stress management fall to acknowledge the inextricable links between nurses' (public) work and their private lives. The question of what nurse stress research rating scales test is also considered.
Simon Weston: lessons for rehabilitative care
Authors: Castledine George
Published: December 2014

Recently, I had the pleasure of meeting Simon Weston, the Welsh Guard who sustained nearly 50% burns at Bluff Cove in the Falklands when his ship was hit by an Argentine bomb. A fireball swept through the ship killing 46 soldiers and injuring 97 others. After 15 years and 60 operations, Simon still has disfigurement to his face and hands but feels that he is lucky to be a live. Seeing what he has achieved since that day makes one realize that he is no ordinary person.
Evaluating the success of clinical supervision
Authors: Cutcliffe John R
Published: December 2014

Clinical supervision continues to be a topical issue within nursing and current debate centres around how it can be systematically evaluated. Therefore, Butterworth et al's (1997) multi-site study exploring several questions of clinical supervision and outcome/evaluation has been eagerly anticipated.
Efficacy of cardiac rehabilitation 2: smoking and behaviour modification
Authors: Brennan Arthur
Published: December 2014

The first part of this article (Vol 6(:12): 697–702) critically reviewed the research on the acclaimed beneficial effects of a number of cardiac rehabilitation programmes including exercise, stress management and educational interventions. This article will examine empirical studies on the efficacy of smoking cessation and type A behavioural modification programmes. Lamentably, few studies have been conducted on the efficacy of smoking cessation. Caution is indicated when establishing conclusions from studies on type A behaviour given the conceptual problems of this construct, i.e. its inability to consistently predict coronary heart disease, evidence of confusion surrounding the improper use of the psychometric measures and the neglect of salient psychosocial baseline variables. A number of clinical implications and future directions for research are indicated.
Drug administration in day centres for people with learning disabilities
Authors: Branford D , Knifton C , Jackson S
Published: December 2014

A study was made of the problems associated with the need to administer medicines at day centres for people with learning disabilities. In Leicestershire, 167 (13%) of 1317 people with learning disabilities who attended day centres required the administration of medicines. The percentage of attenders requiring drug administration varied from day centre to day centre (minimum 4%, maximum 23%). Antiepileptics were the most commonly administered drugs, followed by antipsychotics. The administration of medicines took up a significant amount of time for senior members of the day centre staff and had a great potential for errors. In only 32 cases was it deemed essential that the drug administration occurred at the day centre.
‘Getting in touch’ with people with severe learning disabilities
Authors: Caldwell Phoebe
Published: December 2014

This article explores innovative and interactive ways of working with people who have severe learning disabilities, special needs and/or challenging behaviour who, despite the efforts of those who support them, are not able to respond to attempts to interact with them. It examines the possibilities of communicating by using people's own behaviours and outlines how these methods of interaction can be developed into a ‘language’ which people with these disabilities recognize and find motivating. Entering into a person's world in a way that is not confusing or threatening may allow him/her to move from solitary self. stimulation to shared activity. People with these disabilities will then become aware of a world outside their own (sometimes they are aware of this but are unable to make a connection between what they perceive and themselves), and begin to understand their relationship to It. Surprise is an important element as it shifts attention from the inner space to the source of the intervention. A number of examples illustrate a range of person-centred approaches and the variety of disabilities that may be assisted.
Pressure sores: counting the legal cost of nursing neglect
Authors: Tingle John
Published: December 2014

In Vol 4(22): 1298–9, the author discussed the Audit Commission's (1995) report on coordinating care for elderly patients which found serious lapses in the way pressure sore prevention is carried out. This article discusses recent legal cases and complaints made to the Health Service Commissioner or Ombudsman regarding pressure sores. It focuses on case reports and complaints. These are useful educational tools which illustrate the problems in this area and the steps needed to improve the quality of care. The conclusion reached is that most pressure area complaints and cases could have been easily avoided at minimum or no expense.
Can data collection during the grieving process be justifiable?
Authors: Rohertson Janet , Jay Jennifer , Welch Sarah
Published: December 2014

Research has shown that there are a number of competing theories regarding the use of bereaved people for research purposes. One view emphasizes their vulnerability, weakness and inability to take part in decision-making. Another is that there is an infringement of rights if people are denied the freedom of choice to take part in research. This article considers issues concerned with data collection from recently bereaved relatives who were at some stage of the grieving process. The participants were interviewed as part of the OXMIS study which aimed to identify the incidence of myocardial infarction in Oxfordshire. A total of 142 interviews took place (59 home visits and 83 telephone interviews). Of the cases not interviewed, sufficient information was gained in 94% from other sources to fulfil the required criteria. The perceived benefit or apparent risk of vulnerable groups participating in research is discussed in light of the study results.
The ABC of committee work 1: officers, members and their duties
Authors: Jones Wendy
Published: December 2014

Many nurses will be asked during their career to serve on a committee but will have little concept of the work and procedures involved. This article, the first of two parts, describes the work of the officers and members of a committee. The chairperson controls meetings according to rules which make for the smooth and equitable running of the committee. The secretary, who has to work closely with the chairperson, is often more experienced regarding the rules and can do valuable work in guiding the chairperson. Normally, the secretary's job includes duties before, during and after meetings. A treasurer looks after the financial affairs of any committee which holds a budget. The vice-chairperson is the natural successor of the chairperson and should be groomed to take the chair.
Medical investigations 7: Colposcopy
Authors: Dawson Sarah
Published: December 2014

The colposcope is a binocular, low-powered, magnifying microscope which facilitates direct visualization, examination and biopsy of the epithelial cells that line the vaginal aspect of the cervix. Colposcopy is indicated in all women who have had an abnormal cervical smear result (Pap smear) as it allows the accurate diagnosis, localization and staging of cervica lintraepithelial neoplasia (CIN) (Table 1). The area of the cervix where columnar epithelium (endocervix) meets squamous epithelium (exocervix) is known as the transformation zone and it is in this region th at precancerous cell changes are first seen (Figure 1). Colposcopic examination may also reveal inflammatory changes, pa pilloma and invasive carcinoma. For practical purposes colposcopy is usually performed in all cases where there is a suspicion of CIN2 or CIN3. Colposcopy also allows the gynaecologist to treat CIN conservatively by cryotherapy, electrocoagulation diathermy, cold coagulation and laser vaporization. Where the cells of the tranformation zone cannot be clearly visualized or treated using a colposcope, the more radical procedure of cone biopsy will need to be performed. This entails surgical excision of a cone or cylinder of tissue which will contain the entire transformation zone. This procedure requires a general anaesthetic and hospital admission.
What has happened to morale in nursing?
Authors: Castledine George
Published: December 2014

Recent difficulties in recruitment and negative attitudes from nurses towards nursing have made me worry about the present climate within our profession and consequently nursing's future. Change has an effect on all professions but nursing is suffering badly at the moment.
Creating a new brand of mental health nurse
Authors: Sweeney John , Farrington Andy
Published: December 2014

Mental health nurse training provision has been criticized for failing to develop practitioners with the appropriate skills to care for clients with severe mental illness (Owen and Sweeney, 1995), However, a tide of change is about to wash over the initial and ongoing education of mental health nurses.
Complications of allergies to latex urinary catheters
Authors: Woodward Sue
Published: December 2014

Latex products are widely used both in our homes and in hospitals. Latex allergy is an increasingly worrying problem for health professionals, not least urinary catheters. The pathophysiology of latex allergy is discussed with reference to catheter allergy. Other known problems of latex catheters are also highlighted, including toxicity leading to urethritis and stricture formation and encrustation. Nurses need to be aware of the increasing incidence of latex allergy and the importance of screening patients specifically for this risk factor.
The biology of dementia due to Parkinson's disease
Authors: Delieu John , Keady John
Published: December 2014

This article is one of a series focusing on dementias due to an underlying biological factor. The reader should refer to the previous articles in the series (Delieu and Keady, 1996a, b). This article focuses on the normal structures within the brain which are involved in motor control and describes what occurs when this system is disrupted by an inappropriate reduction in the neurotransmitter dopamine. In time, this reduction in dopamine may have deleterious effects on other neuronal systems within the central nervous system, namely the diminished acetylcholine neurones which may lead to a dementional state. Possible causes of Parkinson's disease are discussed and some treatments briefly outlined.
Managing patients suffering from acute and chronic fatigue
Authors: Cook Neal F , Boore Jennifer RP
Published: December 2014

The subjective experience of fatigue is common and debilitating, and affects many individuals in various healthcare settings. The condition requires adequate assessment, innovative planning and interventions, and patient-centred evaluations by the nursing profession. Fatigue, whether acute or chronic, needs to be recognized as a true and valid condition in order for treatment to be successful. There are many considerations to be taken into account when working with the fatigued, and this article suggests how the areas needing most attention may be tackled. Chronic fatigue and acute fatigue can be quite different conditions, requiring different approaches, of which nurses need to be aware. In order to reduce the effects of fatigue on the client, nurses need to fully understand the factors surrounding the phenomenon of fatigue to provide expert care, to help educate the patient, and improve the quality of life.
Putting Working Paper 10 into practice: education and training
Authors: Burke Linda
Published: December 2014

Education and Training: Working Paper 10 (WP10) (Department of Health (DoH), 1989a) may prove to be another example of policy implementation whereby the needs of nurse education will be dominated yet again by service demands for greater resources. Alternatively, there are indications that it could result in the most significant change in nurse education since the 1949 Nurse Registration Act. Over the last 7 years, there has been relatively little discussion about WP10 In the nursing press. The aim of this article, therefore, is to evaluate the impact of WP10 on nurse education, highlighting the reasons for its inception and discussing its main proposals. The author examines the Issues that have arisen from its implementation so far, and those which may emerge in the future.
The ABC of committee work 2: how meetings are conducted
Authors: Jones Wendy
Published: December 2014

The first part of this article looked at the roles of the officers in a committee. This second part illustrates for nurses how committee meetings should be conducted. Rules govern the way meetings are announced and who may be present. The opening and closing of meetings need to be properly defined and conducted. Most committee meetings adopt the same agenda format. General conduct and the order of business are equally universal but latitude is exercised in less formal committees. Awareness of proper committee procedures makes it much more comfortable and satisfying to participate in meetings.
The importance of voting in the UKCC elections
Authors: Castledine George
Published: December 2014

The forthcoming UKCC elections provide nurses with an opportunity to exercise their democratic right. In this country we are fortunate to be able to vote for those members of the profession whom we would like to represent us in setting practice and educational standards and protecting the public. Governance or self-regulation is a privilege given to professions so that they can earn public trust by demonstrating accountability for their sphere of practice.
Clinical effectiveness and the pace of change
Authors: Baker Julie , Gilbert David
Published: December 2014

The history of changing clinical practice is littered with good intentions which have had minimal impact on practice. For example, despite the NHS-wide interest in evidence-based practice few initiatives exist which help organizations learn how to act on evidence. The King's Fund Promoting Action on Clinical Effectiveness (PACE) programme seeks to bridge this gap by demonstrating how evidence-based practice can be implemented, PACE, which is funded by the NHS Executive, has two main elements: Sixteen loca l pro jects working on clinical to pics which range from press ure sore management at Chase Farm Hospital, Enfield, to the employment of a family support worker for people with schizophrenia in the Wirral. N ursing is a main component of many of these projects. A PACE network which supports individuals involved in work on clinical effectiveness. So far, a bout 400 people have jo in ed the network and over 150 have a ttended the informal discussion days which provide opportunities for members to share experiences and learn from one another; to pics include wound care, asthma and learning disabilities.
Infection control and related issues in intravascular therapy
Authors: Vost Joyce , Longstaff Victoria
Published: December 2014

The use of intravascular (IV) catheters has become an increasingly common practice in today's healthcare setting. This increase, however, brings associated problems. An overview of the current literature surrounding IV devices and infection control issues was undertaken. This included: the pathogenesis of infection with reference to local and systemic complications; the importance of handwashing; the influence of catheter material and type on infection rates; the controversy over skin preparation and whether it is best to use povidone-iodine, chiorhexidine or an antibiotic ointment; insertion techniques; the duration of line placement; the dilemma over the choice of dressing, i.e. gauze vs transparent; nurses' responsibilities in relation to the UKCC standards and professional accountability; safety issues; and the main principles surrounding the safe disposal of sharps. To conclude, this overview finds that all healthcare professionals must be held accountable for every aspect of IV therapy, including the control of infection.
The use of restraint on patients in Israeli psychiatric hospitals
Authors: Porat Sara , Bornstein Judith , Shemesh Annarosa Anat
Published: December 2014

This first-ever study of the use of restraint on psychiatric patients in Israel sought to determine the dominant motivations in the decision to use restraint, which patients were most likely to be restrained, and whether there was a consistent policy on the matter. A survey of the official records of every instance of restraint during one month in the closed wards of all government psychiatric hospitals, supplemented with interviews, revealed that 14.2% of the study population had undergone restraint. The declared reasons were conventional, i.e. violence, disturbed behaviour, etc. Undeclared was an interaction between patients and staff, both the most professional and the less skilled, which surprised the authors and requires more investigation. Some subgroups, e.g. women and certain immigrant groups, were restrained markedly more frequently than other groups. No consistency of policy was found. Overall, much of the restraint applied is deemed unnecessary and recommendations are made for its reduction.
Towards anti-oppressive practice in mental health nursing
Authors: Hopton John
Published: December 2014

Working in Partnership, the Department of Health's report on the 1994 review of mental health nursing, implies that mental health nurses should develop anti-oppressive approaches to nursing practice. There is a notable absence of articles within the nursing literature which specifically address this Issue. This is possibly because the historical and ideological issues which have informed the development of mental health nursing are complex and difficult to unravel. However, an integration of the theories of David Cooper and Frantz Fanon may provide an appropriate starting point for the development of a theory of anti-oppressive practice Which addresses some of the issues specific to mental health nursing.
Understanding motivation to enhance patient compliance
Authors: Wilkinson John
Published: December 2014

Motivation as a psychological concept is important in health care because frequently good care is dependent on the motivation of the patient, his/her family and the practitioners within the healthcare team. In addition, nurses need to be motivated to keep up to date with professional developments. This article describes George Kelly's framework of motivation and suggests recommendations to enhance practice in this area. The main conclusion is that although external determinants can encourage a person to engage in a particular activity the most effective kind of motivation is that which is internally mediated.
Legal problems in the operating theatre: learning from mistakes
Authors: Tingle John H
Published: December 2014

Nurses and other professionals have a legal as well as a professional duty to keep up to date with developments and changes in their clinical field of practice. Healthcare professionals should also be aware of major studies and the complaint and litigation trends in their specialties. This information can inform practice and lead to improvements in the quality of patient care. The information can often be found in the healthcare literature and the general press. This article looks at examples of the reported cases and research on negligence in theatres and discusses the legal and professional duty to keep up to date.
Is euthanasia a ‘quick-fix’ to the dying process?
Authors: Castledine George
Published: December 2014

Most nurses are reluctant to commit themselves to a specific philosophy of nursing as they feel that boundaries keep changing according to individual patients' needs. The same can be said about nurses' attitudes to euthanasia as these are also dependent on the degree and nature of each patient's suffering.
Should we reshape nurse education yet again?
Authors: Murray Cyril , Wild Jill
Published: December 2014

The RCN Education and Training Policy Committee has circulated a leaflet Shaping the Future of Nursing Education (RCN, 1997) which proposes a new structure to the ways in which nurses become qualified, The Committee is boldly opening up the debate at a time when some individuals in the profession are questioning whether the current system of preparing nurses is meeting the future health care needs of the country.
Notes on the pathogenesis of serious pressure sores
Authors: Lowthian Peter
Published: December 2014

It is often assumed that pressure sores are caused by the flattening of blood capillaries, resulting in tissue ischaemia. However, the available evidence, especially that from animal experiments, indicates that microvascular trauma has a significant part to play. Published curves showing the relationship between level of pressure and duration of application also show that simple ischaemia is an inadequate explanation of pressure sore pathogenesis. The crucial pressure (tissue pressure) is normally estimated from interface pressure measurements. However, the relationship between tissue pressure and interface pressure is more complex than is generally realized. Other factors, such as shearing and static friction, are discussed briefly, and recommendations are made for clinical practice and further research.
Perceptions of environmental stressors in the neonatal unit
Authors: Raeside Lavinia
Published: December 2014

The purpose of this study was to explore maternal and infant stress within the neonatal intensive care unit (NICU) environment and to assess the perceptions of neonatal nurses in relation to these stressors. Using both qualitative and quantitative methods, 12 mothers and 12 nurses were interviewed. Within the framework of the Roy Adaptation Model, the interview schedules were structured to include an 18-item stress scale. Results reflected a lower maternal stress level than was perceived by nurses, with mothers of very low birth weight babies reporting higher stress levels than mothers of low birthweight babies. Nurses' perceptions of the elements of the environment that caused most maternal stress differed from those reported by mothers. The highest reported stressor in the maternal group was the heat intensity; however, the nursing sample perceived the highest maternal stressor to be the monitors attached to the baby. This study highlights the need for increased awareness of stress in both the technological and psychosocial environment of the NICU. The promotion of individualized developmental care is also emphasized, with the aim of modifying and controlling environmental stress for both the mother and the neonate.
Advanced nursing practice in the USA: new directions for NPs
Authors: Sharu Debra
Published: December 2014

The demand for nurse practitioners (HPs) continues to increase in the USA and, as a result, the HP role is expanding. Originally, HPs were primarily based in the primary care arena; however, they are now filtering into secondary and tertiary healthcare settings, bringing with them advanced clinical skills. This has led to many clinical nurse specialists undertaking HP programmes. American nurses are now calling for a merger of these two roles and for changes in HP training programmes that will prepare practitioners for work in secondary and tertiary care environments as well as primary care settings. British nurses continue to examine the perimeters of advanced nursing practice; however, the realms of secondary and tertiary care should not be neglected, but rather incorporated into these developing roles and educational preparations.
Nurse occupational stress research 3: a model of stress for research
Authors: Wheeler Herman H
Published: December 2014

The second article in this series (Vol 6(12): 710–13) explored definitions of stress and emphasized the need for suitable models of nurse stress for research purposes. This article, the third in the series, examines models of stress, and identifies those which may be suitable for future nurse stress research. The author's model of nurse stress for use in carrying out research and stress management is outlined and discussed.
The Vicair Academy and Liberty range of pressure-reducing seating
Authors: Williams Clare
Published: December 2014

Many patients can be sitting in a chair for between 3 and 14 hours each day, consequently the type of cushion they are sitting on is of the utmost importance. These patients are often at high risk of developing pressure sores — possibly more so than bed-bound patients. Vicair, whose UK distributor is Gerald Simonds Healthcare, has developed two types of pressure-reducing cushions: the Vicair Academy and Liberty Fluid-Air. These cushions offer pressure reduction in a system that is user-friendly and particularly lightweight. This product focus highlights the problems associated with seating and explains how the Vicair range of cushions attempts to address them.
Lessons to be learned from a nation in mourning
Authors: Castledine George
Published: December 2014

Bereavement is a subject which is seldom talked about unless we are directly affected by it. The death of Princess Diana was one of those unique occasions when we were suddenly made aware of our own mortality. It also made us think about the ways in which we deal with our feelings of loss.
Interdisciplinary teamwork: consideration of the challenges
Authors: Barr Owen
Published: December 2014

Most services currently provided by the NHS involve a considerable amount of interdisciplinary team working. The effectiveness of team structures and team functioning is variable, ranging from effective to fragmented service coordination. Despite major developments in establishing productive multidisciplinary team working over the past decade, several key challenges still need to be overcome. This article outlines a definition of and the rationale for successful interdisciplinary teamwork. It considers key organizational, professional and interpersonal challenges that need to be addressed if the present level of teamwork is to be enhanced.
Expanded role of the nurse: accountability confusion
Authors: Tingle John
Published: December 2014

Nurses are increasingly taking over the clinical activities once carried out by doctors. In some areas it has now become difficult to distinguish the boundaries between nursing and medical health care. These changes raise important legal issues which will need to be considered by a court when dealing with clinical negligence cases involving the expanded role of the nurse.
Correspondence
Authors: Narayanasammy Aru , Fox Jane , Dimond Bridgit , Barr Owen , Farmer ES
Published: December 2014

There are compelling reasons to suggest that nursing should be an all-graduate profession (RCN, 1997). Technological advancement, research-based education, clinical effectiveness, and evidence-based practice all provide the impetus for such change to take place. Nursing education has at last earned long overdue recognition. Infrastructures which can accommodate the implementation of an all-graduate nurse education programme in the UK are already in existence. These infrastructures developed as a result of Project 2000 and the recent integration of nurse education into the higher education sector.
Impact of Dearing on the future of nurse education
Authors: Castledine George
Published: December 2014

Early reactions to the Dearing Committee's (1997) review of higher education have focused primarily on the issue of students having to pay their own tuition fees and maintenance grants. There has been much concern that this will deter some students from entering higher education. Nursing courses throughout the country are already experiencing problems recruiting enough students to meet demands. However, students entering the traditional diploma-based Project 2000 courses will still be guaranteed their NHS bursary.
Qualitative research in nursing: a quest for quality
Authors: Cutcliffe John
Published: December 2014

As nursing is still in the process of establishing its own unique knowledge base many nurses are starting to undertake research projects. While such attempts should be encouraged it is reasonable to state that a proportion of this research is poor which has led to justifiable criticism from other professions.
Taking a sexual health history: the role of the practice nurse
Authors: Peate Ian
Published: December 2014

Nurses working in general practice (GP) settings are generally multi-skilled and competent practitioners who come into contact with a huge cross-section of patients. These patients frequently present with a combination of health problems/needs. The practice nurse is often the first person with whom the patient comes into contact and/or consults. Practice nurses therefore have an important role to play in promoting health, including sexual health. This article examines the conclusions of Jewitt's (1995) work which explored the development of sexual history taking in GP settings. The pivotal role of the practice nurse is highlighted and the importance of taking a sexual health history is discussed. The obstacles and barriers faced by practice nurses when taking a sexual health history are outlined. Recommendations for practice are discussed, and a check list is presented that will enable practice nurses to consider their invaluable input into the holistic care of patients in more detail.
Venous leg ulcers: short-stretch bandage compression therapy
Authors: Hampton Sylvia
Published: December 2014

Graduated compression therapy is rapidly becoming the treatment of choice for venous leg ulcers; it is cost-effective and offers faster healing rates than without compression. Holistic assessment of the patient along with education of the practitioner leads to the safe application of compression bandages. This article looks at the assessment of venous ulcers and how application of short-stretch bandages can achieve graduated compression, leading to rapid healing. As with any new skill, compression bandaging requires the practitioner to have received research-based education and practice and to have a clear understanding of how the technique achieves the objective.
Dressing selection: use of combinations of wound dressings
Authors: Young Trudie
Published: December 2014

There are many wound dressing products available. In certain circumstances they are used in combination. In order to protect the patient, the use of dressing combinations should have a clear purpose and the support of the manufacturers. Inappropriate combinations are costly and ineffective and serve only to perpetuate practice that does not have a sound research base. This article highlights the issues surrounding dressing selection and offers guidance on appropriate dressing combinations.
Controlling the direct supply of genetic tests
Authors: Dimond Bridgit
Published: December 2014

The day may come when people could, by means of a simple test, obtain a print out of their genetic profile indicating their future health possibilities or probabilities. The implications of this are frightening as a potential is not a certainty.
Nutrition and diabetes: putting guidelines into practice
Authors: Aitken Gillian
Published: December 2014

Dietary recommendations for the management of diabete, have changed over the past 10 years. There is now a reduced emphasis on the importance of carbohydrate in the diabetic diet. The first move away from carbohydrate restriction came in 1982 when the British Diabetic Association published its ‘Dietary recommendations for diabetics for the 1980s’. This document suggested that the diet for people with diabetes should be based on a high intake of complex carbohydrate and fibre, with a restriction of fat intake. This article discusses the impact of these recommendations on different nutrients, and demonstrates, through the use of a case study, how these can be put into practice.
Commercial gene testing: the need for professional and public debate
Authors: Kirk Maggie
Published: December 2014

Commercial gene tests are currently available in the UK and the range of tests offered is likely to increase. While knowing their genetic status may bring benefits to individuals and their families, genetic testing also brings its own unique problems. Commercial ventures may do little to resolve these and adequate safeguards are needed to ensure that clients undergoing testing are not disadvantaged. The availability of gene tests can only serve to heighten public awareness of the relevance of genetics to health care, and there is likely to be an increased demand for information and advice from healthcare professionals before, and following, testing. Nurses should be prepared to acquire adequate knowledge to maintain their role as health educators, and to participate in public and professional debate on the issues that commercial testing highlights.
Lower limb amputation 2: once the decision to amputate has been made
Authors: Donohue Samantha Jane
Published: December 2014

This is the second of four articles on lower limb amputation. The first article (Vol 6(17): 970-7) discussed the indications for amputation and briefly outlined the treatment options that may be tried before the amputation stage is reached. This second article examines the factors that need to be addressed once the decision to amputate has been made. It stresses the importance of preparing the patient and his/her family both psychologically and physiologically for the operation. The techniques and rationale for selecting the optimum level of amputation are then discussed. Finally, the specific levels of lower limb amputation are outlined. The next article in this series will explore the nurse's role in preparing the patient for an amputation, and the final article will address the issues raised when a patient decides that death is preferable to living as an amputee.
Can leaflets assist parents in preparing children for hospital?
Authors: Stone Karen J , Glasper Edward A
Published: December 2014

This article outlines the findings and implications of a small study designed to investigate the perceived usefulness of an information leaflet entitled ‘Preparing your child for hospital: a parents' guide’. The study was carried out in an ear, nose and throat unit where children are admitted for elective surgery. A leaflet was developed and field tested before being mailed to a group of parents. An analysis of the data collected demonstrated considerable parental satisfaction with the information contained in the leaflet. The authors believe that similar leaflets should be routinely distributed to families with children awaiting hospital admission.