bluuebunny/crossref_metadata_2025 huggingface dataset:
Legal aspects of consent 22: nurses’ position when obtaining consent
Authors: Dimond Bridgit
Published: May 2014

Staff nurse Fawn was asked to take on the role of getting the patients to sign the consent forms before surgery was carried out. She was concerned at the legality of her being asked to undertake this since she would not be carrying out the operations. What is the law?.
Clinical efficacy of Comfeel Plus Transparent Dressing
Authors: Goodhead Ann
Published: May 2014

Hydrocolloid dressings have been in use for more than 20 years. They are indicated for the treatment of granulating, superficial wounds with low to moderate exudate. There are a number of hydrocolloid dressings available, one of which is Comfeel Plus Ulcer Dressing. This differs from the others by combining a hydrocolloid with calcium alginate in its formulation to increase the absorptive capacity. This article examines another product of the Comfeel Plus range, Comfeel Plus Transparent Dressing (Coloplast A/S) and describes a small evaluation of the product. The conclusion is that Comfeel Plus Transparent Dressing performs well in terms of healing, compliance, adherence and flexibility. Furthermore, it is transparent and it is therefore possible to follow the wound healing process without removing the dressing.
Health professionals keep making the same mistakes
Authors: Tingle John
Published: May 2014

The healthcare professions may be 10 years older since BJN first came into being but it seems that the same clinical mistakes continue to occur. The latest report of the Health Service Ombudsman (HSO, 2002) reveals that errors reported in previous HSO reports are still being repeated, resulting in avoidable deaths and injuries.
Patients need a well educated and rewarded nursing workforce
Authors: Malone Beverly
Published: May 2014

I am delighted to have this opportunity to congratulate the BJN on reaching its tenth anniversary. The excellence and broad appeal of the journal is a credit to those who had the vision to see a place for such a journal in the nursing literature. It has been shaped by its many contributors over the past 10 years, as well as its readership, whose praise, criticism, and constructive suggestions have helped shape the BJN into what it is today.
Introducing the Reflexion pressure-redistributing cushion
Authors: Hampton Sylvie
Published: May 2014

Preventing pressure ulcer incidence and ensuring patient comfort are essential components of providing quality clinical care (Hampton, 2001), and therefore comfortable pressure-redistributing seating should be a prerequisite to care provision. However, even though education in tissue viability has increased, it is only within the last 2 years that chair cushions have been noted for their importance in reducing pressure ulceration. It is not unknown for patients to have excellent pressure-reducing equipment on the bed but have chair cushions that are of an inferior standard (Hampton, 1999). This article, therefore, examines the Reflexion cushion, manufactured by Vitafoam, and the role it may have in preventing pressure ulceration.
10 years on and I fear for the future of nursing
Authors: Castledine George
Published: May 2014

The past 10 years of BJN has been a fantastic experience for me. I want to take this opportunity to not only thank you the reader and all those involved in the BJN, but also reflect on the situation nursing finds itself in today.
Good practice in continence care: development of nurse-led service
Authors: Williams Kate S , Assassa R Philip , Smith Nigel , Rippin Christine , Shaw Christine , Mayne Chris
Published: May 2014

The implementation of evidence-based interventions in clinical practice is often alluded to in the literature; however, the development of these interventions is rarely documented. Within continence care, there is a large body of relevant literature on which primary clinical interventions can be based. The Leicestershire Medical Research Council (MRC) Incontinence Study is a series of inter-related studies exploring the epidemiology of urinary symptoms, including incontinence, and evaluating service provision and treatment options for these symptoms. This article describes one aspect of the Leicestershire study, namely the development of evidence-based intervention protocols for use in a new nurse-led continence service. This service is currently being evaluated in a randomized controlled trial.
Injecting drug use: implications for skin and wound management
Authors: Finnie Alison , Nicolson Paul
Published: May 2014

This article, the first of two parts, introduces the difficulties facing nurses working with injecting drug users with skin problems. Drug abuse is increasing globally, and has huge implications for healthcare practitioners. Increasing numbers of tissue viability nurses are also encountering drug injection-induced wounds in their practice, but there is a lack of evidence for management of chronic skin problems in this patient group. Together with rising numbers of injecting drug users, there are increased health implications such as bacteraemia, septicaemia, amputation and skin breakdown. Abscesses and chronic wounds as well as prolonged leg ulceration are common. Drug users may demonstrate chaotic lifestyles which may inhibit access to usual healthcare provision. Issues relating to healing of these wounds are explored. The second part, which will appear in the next Tissue Viability Supplement, will describe the development of a specialist wound care clinic for homeless drug users.
Pressure ulcer classification: the systems and the pitfalls
Authors: Russell Linda
Published: May 2014

The classification of pressure ulcers constitutes an essential part of patient assessment and forms a baseline on which to monitor patients'progress and measure the outcomes of care. Four classification systems — Torrance, National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, and Stirling — are discussed. Many classification systems have been adopted by trusts despite insufficient research in their use in clinical practice. Regardless of which classification system is implemented, nurses need to be familiar with the one they are using and how to stage accurately a pressure ulcer. This can only be attained through regular education.
Hyperbaric oxygen in the management of chronic wounds
Authors: Wood Zoe
Published: May 2014

This article reviews the role that hyperbaric oxygen therapy (HBOT) plays in the field of wound healing. HBOT, although not seen as a common method of wound management in the UK, can perhaps offer another avenue to managing recalcitrant wounds. In order for the healing of chronic wounds to progress, the practitioner must address all the factors impeding the healing process, one of which is oxygenation. HBOT is thought to improve many aspects of poor healing by supplying high levels of oxygen at normal atmospheric pressure. It has been suggested that increasing the availability of oxygen does not necessarily stimulate the healing process, but that perhaps the pressure at which the oxygen is delivered is the responsible stimulus.
Cross-infection and the use and decontamination of placebo inhalers
Authors: Clancy Karen
Published: May 2014

Historically, inhaled placebos have been provided by pharmaceutical companies and have been widely used by nurses both in primary and secondary care to teach respiratory patients how to use prescribed inhaled therapy. Over recent years, the author of this article has had concerns about the potential risk of cross-infection as a result of reusing placebos with disposable mouthpieces. This concern has been heightened by the lack of verbal and written guidance from the pharmaceutical companies that provide these placebos. There are no recognized protocols or guidelines on the most effective cleaning methods that would minimize or prevent cross-infection. The cleaning of large volume spacers, which are used to enhance a patient's inhaler technique, are particularly problematic as it is not possible to use a disposable mouthpiece with this device. In response to this problem, a cross-sectional, multicentre, regional audit was designed to identify the decontamination process adopted by nurses working in the fields of respiratory care and infection control. The audit outcome confirmed that nurses were using a number of different cleaning methods, with no sound evidence base to support their chosen methods of decontamination. This is an issue that requires further investigation and clarification if nurses are to continue assessing patients' techniques with inhaled devices.
Ward nutrition coordinators to improve patient nutrition in hospital
Authors: Hayward Jackie
Published: May 2014

It is important that patients receive adequate nutrition while in hospital. Reports and research over the past 10 years have highlighted the problems in the NHS of managing the nutritional needs of patients (King's Fund, 1992; McWhirter and Pennington, 1994; Edington et al, 2000). This article describes a successful pilot study addressing nutrition at the ward level. It resulted from a multidisciplinary team forming to share their specific nutritional concerns; through creative thinking they devised a new role of nutrition coordinator. In the study a healthcare assistant was used from the existing ward establishment and given one week intensive multidisciplinary induction before commencing the role in the wards. The main focus of the role was to facilitate, rather than undertake, the nutritional care of patients throughout their stay. Following a 6-month trial, the role demonstrated a significant impact on nutritional screening, nutritional service, patients' perceptions of their nutritional care and staff satisfaction.
Patients’ and nurses’ perceptions of quality nursing activities
Authors: Conley Harriet , Kubsch Sylvia M , Ladwig Jennifer , Torres Carmen
Published: May 2014

Nurses and patients come from varying backgrounds, and have different life experiences. Their perceptions regarding what comprises quality nursing care may differ. The objective of this article was to determine whether there is a difference in the perceived importance of nursing activities from the point of view of patients and nurses. If differing perceptions were found, the goal would then be to increase nursing awareness of these differences. A convenience sample of 30 nurses and 30 patients on a medical-–surgical unit were surveyed about nursing care using a 41-item questionnaire. Data obtained were divided into four classes of nursing activities: psychosocial, physical, safety, and indirect. There was a significant difference in the perceived importance of nursing activities by nurses and patients in the psychosocial and safety categories. Nursing activities that may not be recognized as such by patients, or which are not seen as important to quality care, should be clarified for patients. Clarification may also be useful in helping patients to understand the professional nursing role. In addition, this insight may heighten patient satisfaction with caregiving.
A model for patient-centred nurse consulting in primary care
Authors: de Lusignan Simon , Wells Sally , Russell Cathie
Published: May 2014

A model for patient-centred nurse consulting, developed in the context of secondary prevention of cardiovascular disease, is reported in this article. The model was created in the absence of any existing model for nurse consulting. Heart disease clinics are increasingly being used to implement the National Service Framework for Coronary Heart Disease and it is anticipated that this model will be of practical use to nurses running these clinics. The model consists of eight steps, broadly following the chronology of the consultation. Each step contains a question for the nurse to ask him/herself and a task to complete. The model was developed as part of a research project on the influence of customized computer software used on nurse consultations with patients with heart disease.
Every child matters: some key issues for health services
Authors: Powell Catherine
Published: May 2014

The recently published Green Paper Every Child Matters (Department for Education and Skills, 2003) outlines wide-ranging proposals to reform services to children and their families. It aims to strengthen child protection services for the most vulnerable children and at the same time give all children the best opportunities and start in life. Importantly, the authors recognize that child protection cannot be separated from policies to improve children's lives. Hence, the proposals centre around outcomes that help to ensure that children: enjoy good physical and mental health; are kept safe from harm; develop the skills for adulthood; are involved in a positive way with their local community; and are not prevented from reaching their full potential by economic disadvantage.
Interventions to avoid maceration of the skin and wound bed
Authors: White Richard J , Cutting Keith F
Published: May 2014

In the course of managing exuding wounds, particularly chronic wounds, failure to deal adequately with exudate can lead to exposure of the peri-wound skin to exudate and hence damage. This results in maceration of the skin and wound bed. Maceration is a largely under-recognized problem and one of the causes of delayed wound healing. Previous articles have focused on the nature and causes of maceration. This article describes a wide variety of wounds and skin conditions in which maceration might be present, or develop, during treatment, together with some strategies for avoiding maceration and the evidence base supporting them. It is only by becoming familiar with the various presentations of maceration, and with prophylactic treatment measures, that practitioners can avoid the increased costs and morbidity associated with it.
The effects of stress on wound healing and leg ulceration
Authors: Norman Debbie
Published: May 2014

Stress is a universal phenomenon, which has been the focus of much investigation over the past five decades. Much has been discovered about the physiological responses to stress. This review examines the concept of stress in relation to its effect on wound healing. An online literature search was carried out using the databases Medline, Cinahl and Pubmed and the key words stress and wound healing, and stress and leg ulceration. The rationale for specifically examining leg ulceration resulted from the author's interest in this wound type and also the volume of associated literature on the topic published to date. Stress has been demonstrated to have an adverse affect on a variety of natural resistance responses and specific immunological modifications in animal and man alike, causing, for example, reduced inflammatory response, susceptibility to infection and decreased cytokine production (Cohen et al, 1988; Sheridan et al, 1991). Stress and its effects on growth factor regulation have led theorists to examine whether stress adversely affects wound healing (Glaser et al, 1999). Much of the research has examined acute wounds, although causal inferences may be drawn from the wealth of qualitative research examining the effects of venous ulceration. To date, very little has been conducted in the relatively new area of stress and wound healing. Further investigations are required to prove that stress elicits an immunological response affecting the biological markers of wound healing and thus validates the theory that stress may have a negative impact on healing itself. Causal relationships may be postulated between stress and healing in leg ulceration.
Randomized comparison trial of the RIK and the Nimbus 3 mattresses
Authors: Russell Dr Linda , Reynolds Tim M , Towns Amanda , Worth Wendy , Greenman Alan , Turner Ruth
Published: May 2014

A randomized comparison trial was carried out at Queen's Hospital, Burton-on-Trent, to compare patient outcomes on the RIK mattress (KCI) and the Nimbus 3 mattress (Huntleigh Healthcare). One hundred and fifty-eight patients, who were assessed to be at particular risk of development of pressure ulcers using the Waterlow score (75 on RIK mattress, 83 on Nimbus), completed the trial. There were no statistically significant differences in baseline parameters at recruitment or pressure ulcer progress. Lack of difference can be as useful as evidence of superiority. Other factors such as nursing interventions required, accessible equipment, and costs are important when making equipment choices. For a significant proportion of patients, a static (RIK) mattress can be as effective as an active (Nimbus 3) mattress for management of pressure ulcers.
Autonomy, privacy and informed consent 4: surgical perspective
Authors: Scott P Anne , Taylor Anne , Vlimki Maritta , Leino-Kilpi Helena , Dassen Theo , Gasull Maria , Lemonidou Cryssoula , Arndt Marianne
Published: May 2014

This is the fourth article in a four-part series that considers the issues of patient autonomy, privacy and informed consent. The article discusses these issues in the context of surgical patients and their nurses. There is an abundance of references to issues of autonomy and informed consent within the healthcare literature, although there are few empirical studies investigating these issues within practice. The issue of privacy has been somewhat less explored than that of autonomy or consent, particularly in the UK literature. This article reports the findings of a Scottish study that formed part of a multisite comparative study funded by the European Commission. A convenience sample of surgical patients (n=282) and their nurses (n=260) participated in the study. Data were collected by means of a self-completion questionnaire for both patients and nursing staff. Results indicated that there are significant differences in patient and staff perceptions on issues of patient autonomy, privacy and informed consent. However, the most marked differences in perceptions of patients and staff were found on the information-giving element of the autonomy subscale. Implications for nursing practice, education and research are highlighted.
Simpla Plus leg bag: approval by the National Customer Group
Authors: Hudson Linda , McNicoll Diane
Published: May 2014

The choice of the right product for the right patient is fundamental in the adequate care of incontinent patients; therefore, it is important that nurses and healthcare professionals are aware of all the products that are available and that these products meet the required standards. The Simpla Plus leg bag, manufactured by Coloplast, is an example of one such product which has been officially approved by the National Customer Group for inclusion on the NHS purchasing and supply contract.
Evaluation study of the properties of two adhesive foam dressings
Authors: Viamontes Louis , Jones Annie M
Published: May 2014

The primary objective of this study was to assess the skin stripping of wounds (defined as periwound skin blistering; Fowler, 1990) when treated with an adhesive hydrocellular foam dressing (Allevyn™ Adhesive, Smith & Nephew) and a self-adherent soft silicone foam dressing (Mepilex™ Border, Mölnlycke Health Care). The secondary objectives were to assess wound healing, wound appearance and pain. Data were collected over 1 year from 403 wounds in 206 patients treated in nursing homes. At follow-up assessment, there was some evidence of skin stripping with both products — 5% (5/106) with the adhesive hydrocellular, and 4% (4/100) with the self-adherent dressing. The results of the study reveal that the closure rates achieved with the two dressings were similar, and that both dressings were equally safe in terms of skin stripping. Independent nurse evaluations highlighted the failure of the self-adherent soft silicone foam dressing to either initially adhere to the wound area, or to remain in contact for more than a few days, and frequently needed the application of additional tape to ensure adhesion. The failure of the self-adhesive soft silicone foam dressing to adhere to the periwound area was a significant deterrent to staff to use this type of dressing routinely.
The effects of flying: processes, consequences and prevention
Authors: Shepherd Laura , L Edwards Sharon
Published: May 2014

The dangers of flying have recently been highlighted in the media; however, the available literature is contradictory, as are current recommendations for travellers. The purpose of this article is to provide an account of the research that has been undertaken to investigate the possible consequences of air travel. It will examine the effect that flying has on the body, especially the respiratory and circulatory systems, by studying the theoretical and empirical literature. The aim is to provide nurses with a sound insight into the effects of long-distance flying on the body, and the potential adverse effects/complications, such as deep vein thrombosis and pulmonary embolism, that may occur as a result. In addition, it provides information on the treatment options available and should enable nurses to give sound prophylactic advice after discharge. By encouraging passengers to take precautions, the number of people affected by flight could be reduced.
Nursing tools and strategies to assess cognition and confusion
Authors: Aird Thomas , McIntosh Michelle
Published: May 2014

Terms used to describe a patient's mental state, such as ‘confused’, are often considered to be ambiguous and the meaning personal to individuals describing what they observe. Cognitive deficits are often subtle in their presentation and can easily be overlooked in the arena of acute nursing, with its focus on physical status. Clinicians are reported as not adequately assessing cognitive status and yet such deficits may impact on a patient's activities of living at all levels. Identification of alterations in a patient's mental status is important in maintaining patient safety and dignity. This article aims to review bedside assessment of a patient's mental status and the implications for nursing practice.
Improving the nutritional status of colorectal surgical and stoma patients
Authors: Fulham Juliette
Published: May 2014

This article describes an initiative to improve the quality of nutritional support and information provision to patients undergoing colorectal surgery and stoma formation. It was identified that several aspects of the established hospital routine and catering system overlooked the specific nutritional needs of this group of patients during the postoperative period. This led to the formation of a multidisciplinary strategy group responsible for focusing on the nutritional needs of both those with new stomas and those undergoing colorectal surgery without stoma formation. To ensure that patients had the opportunity to eat suitable foods at regular intervals, a ‘colorectal patients’ snackbox' was introduced, together with a strategy for individualized nutritional support and advice before admission and on discharge.
Cardiac rehabilitation: goals, interventions and action plans
Authors: Child Alison
Published: May 2014

Cardiac rehabilitation services are now well established in the UK. There is a growing evidence base for cardiac rehabilitation interventions but, despite this, there remains much variation in service models and delivery. The National Service Framework for Coronary Heart Disease sets out goals for cardiac rehabilitation interventions based on lifestyle change; however, many people do not have access to cardiac rehabilitation programmes and there is evidence that those who need them most may be able to access them least. There is a move within cardiac rehabilitation towards menu-driven approaches, which may suit individual need more than a standardized approach. Nurses play a crucial role in the delivery of cardiac rehabilitation services and hold the necessary skills and expertise so to do. Future challenges to cardiac rehabilitation include developing increasingly patient-focused services across the boundaries of primary, secondary and social care, and increasing patient and public involvement in services.
Caring for people with a learning disability, colorectal cancer and stoma
Authors: Black Pat , Hyde Christine
Published: May 2014

Longevity in people with learning disabilities has increased substantially over recent years and as life expectancy increases for this population so does the risk of colorectal cancer. Today, with the transition from institution to the community for people with learning disabilities, conscientious and competent medical and nursing care is a necessity. This article examines autonomy, consent, treatment, palliative care and death relating to people with profound learning disabilities and challenging behaviour, who also have colorectal cancer and a stoma. Lack of written information, knowledge, and organizational planning need to be addressed to bring cancer services for the patient with learning disabilities to the level that it is for the general population.
The use of practice guidelines for urinary incontinence following stroke
Authors: Brooks Wendy
Published: May 2014

Incontinence is common following stroke, but there is little stroke-specific evidence to guide treatment and interventions for this condition. National clinical guidelines for stroke specify that all wards should have management protocols for urinary incontinence and yet, according to the recent Sentinel Stroke Audit result, many wards do not have this information available. This article describes the implementation of guidelines on a stroke unit within an NHS associate teaching hospital and describes the impact on patient care using clinical audit. The results indicate that patient care and outcome is improved following implementation. Recommendations are made for information sharing and further research.
Harmonic sounds: complementary medicine for the critically ill
Authors: Cardozo Margaret
Published: May 2014

Anxiety is a common phenomenon among hospitalized patients, and over the past few decades there has been a growing interest in using music as an anxiolytic agent on patients in intensive care undergoing ventilation. Critically ill patients experience both anxiety and pain related to their illness and injury, but the implementation of music can help provide a supportive role for relief of symptoms that interfere with the healing process. This article aims to review music therapy as an aid to reducing anxiety and pain levels within an intensive care unit setting. By observing the literature, music therapy as a non-pharmacological intervention will be discussed and the benefit of promoting a healing environment for patients will be addressed.
Integrating foot care into the everyday clinical practice of nurses
Authors: Howell Mandy , Thirlaway Susan
Published: May 2014

Foot care is an integral part of a patient's daily hygiene requirements, yet the authors have found it to be an area often neglected by nurses. Foot and toenail problems present a considerable challenge to nurses in all healthcare settings, especially for patients with diabetes. However, patients without diabetes also suffer from minor foot abnormalities or injuries that may have been preventable. One acute hospital ward has worked closely with the chiropody department to improve the nursing team's competence and confidence in foot hygiene assessment and toenail clipping and has, therefore, improved the patient experience during hospital admission. This article describes how the nursing team used education to improve the foot care services offered to patients.
A review of the use of silver in wound care: facts and fallacies
Authors: Lansdown Alan BG
Published: May 2014

This review traces the use of silver in wound care, discussing its merits as an antibacterial agent and constituent of many new dressings, which are increasingly tailored to the treatment of wounds ranging from acute surgical lesions to chronic and diabetic leg ulcers. Misconceptions regarding the biological properties of silver, its possible physiological value in the human body and wound bed, absorption through the skin, and safety factors are addressed. The article aims to present silver and the new range of sustained silver-release dressings as important features in the management of skin wounds, providing effective control of wound infections while ensuring patient comfort and quality of life.
TIME principles of chronic wound bed preparation and treatment
Authors: Dowett Caroline , Ayello Elizabeth
Published: May 2014

Managing chronic wounds has progressed from merely assessing the wound to understanding the underlying cellular abnormalities and associated clinical problems. The concept of wound bed preparation offers a systematic approach to removing barriers to healing such as tissue (non-viable), infection/inflammation, moisture (imbalance) and edge (non-advancing or undermining). The principles of wound bed preparation as outlined in the tissue, infection, moisure, edge (TIME) table are explained in this article, with examples and recommended treatment interventions. The TIME table is recommended for use at the bedside when assessing patients with wounds.
Pressure ulcer research: where do we go from here?
Authors: Gebhardt Krzysztof S
Published: May 2014

The physiology and pathology of pressure defence mechanisms have been little studied and are not understood. No critical risk factors have been identified and populations of patients identified as being ‘at risk’ by risk calculators and clinical impression often have small numbers of patients who are really susceptible to pressure ulcers (PUs). Prevention trials must therefore have large sample sizes to enable significant results to be observed, or must be carried out in patient populations with a high PU incidence. Many trials have been carried out in orthopaedic patients but results may not be generalizable. Measurement of physical parameters (e.g. interface pressure), useful for adapting support surfaces for individual patients and designing new support systems, is unlikely to identify the aetiology of PUs and, without validation from clinical trials, predict the efficacy of interventions. In future it may be better to sample other groups, such as critical care patients for trials, as the findings might prove more generalizable. The effects of interventions should also be researched at the healthcare system level rather than that of product or risk factor. However, only the physiological study of PU aetiology is likely to advance our knowledge and ability to prevent PUs more effectively.
The long-awaited Mental Capacity Bill has arrived
Authors: Dimond Bridgit
Published: May 2014

After a long journey, the Mental Capacity Bill has reached its final stages in Parliament with the discussion of the report stage having taken place in the House of Commons on 14 December 2004. The Law Commission (1995) published recommendations for legislation on mental capacity following consultation on all aspects of decision making on behalf of the mentally incapacitated adult. The report was followed by a new consultation in 1997 (Lord Chancellor's Office, 1997) and a White Paper in 1999 (Lord Chancellor's Office, 1999). The present Bill received scrutiny by the House of Lords and House of Commons Joint Committee (2002–2003) which made significant recommendations including the change of title from Mental Incapacity to Mental Capacity.
Clinical skills: how to remove and change a suprapubic catheter
Authors: Robinson John
Published: May 2014

Suprapubic catheterization is becoming more widely used to drain the urinary bladder either short or long term or is inserted where initial urethral or recatheterization is problematic. No matter where you work as a nurse, either in the hospital, community, hospice or nursing care home, sooner or later you will have to deal with a patient with a suprapubic catheter in situ. One of the concerns nurses encounter when changing the suprapubic catheter is what action to take when the catheter appears to have become stuck when removing it. The main cause of this problem is owing to a ‘cuffing’ effect occurring to the deflated catheter balloon, especially if using 100% silicone catheters. This article looks at the problem of removing a suprapubic catheter that has become stuck and how to change such catheters safely.
The factors that influence patients' choice of hospital and treatment
Authors: Dealey Carol
Published: May 2014

The Government has published a series of papers that aim to turn the NHS into a patient-led service. One aspect of this change is to allow patients choice in their selection of a hospital for elective surgery. This programme hopes eventually to extend choice to other areas of care. This article reviews the literature surrounding patient choice and identifies the issues that affect how patients will reach a decision. Although there is limited information on the subject, a clear difference has been identified between those with acute conditions and those with chronic conditions. Nurses need to be aware of both the policy and the underpinning concepts and patients' views of the topic because it will bring about a major change in the culture of the NHS.
The development of the nurse biopsy role
Authors: Godsell Gillian Anne
Published: May 2014

Research shows that nurse surgery posts strengthen continuity of care and allow collaboration with other health professionals to ensure patients receive appropriate and timely care. The consistent and integrated approach provided with the nurse biopsy role fills gaps in service provision and avoids duplication of services. Skin cancer is the most common cancer in the UK and at Queen's Medical Centre in Nottingham they see approximately 160 suspected cases each week. Before the introduction of the nurse biopsy role there was an 8-week wait for a biopsy by the doctor and a further 8-week wait for the removal of the tumour. Now, a patient with a suspected skin cancer can have a biopsy on the first visit to the clinic, reducing the wait from 8weeks to 0weeks. This reduction in waiting time facilitates improved mortality and morbidity from the skin cancer. It took 3years to develop the nurse biopsy role in Nottingham and another 2years to provide the service that is currently available. The nurse-led biopsy service is now being adopted nationwide, as recommended by the All Parliamentary Group on Skin (2003). The dermatology department at Queen's Medical Centre in Nottingham also runs an annual course to teach the surgery skills required to primary- and secondary-care nurses.
Hand-washing and methicillin-resistant Staphylococcus aureus
Authors: Collins Fiona , Hampton Sylvie
Published: May 2014

Effective hand-washing, including drying to decrease skin surface microbial counts, is recognized as a critical factor in infection control policies. It is also recognized that hand-washing is not always undertaken as it should be. Spending large amounts of time with the hands in water is not enough to control infection as the technique of washing hands is more important than merely the length of time under water. Therefore, ways of promoting hand hygiene must be found, as well as finding ways of ensuring that healthcare workers follow hygiene guidelines.
Haemoglobinopathies and health-care provision for ethnic minorities
Authors: Khattab Ahmed D , Rawlings Barry , Ali Ibtisam S
Published: May 2014

The level of training and competence in dealing with haemoglobin-opathies (which mainly affect ethnic minorities in the UK) may not be totally adequate among nurses. Nurses indicated that they received little or no information in their teaching for working from a multiracial perspective and what they had learned was through experience and personal research since qualifying as nurses. Knowledge of the biological basis of inheritance, methods of acquisition of thalassaemia and sickle-cell anaemia and the ethnic profile of people affected by these conditions may not be totally adequate among nurses. Many nurses wanted more training, including those who had already received instruction, since this was described as ‘far too vague’, ‘not constructive’, ‘minimal’, or ‘embarrassingly insufficient’, recommending that instruction be given by a sickle-cell anaemia/thalassaemia counsellor with a contribution from patients. A combination of poor quality, or lack, of instruction, together with time and resource pressures, is responsible for this limited understanding, resulting in insufficient awareness of the health needs of ethnic minorities leading to inequalities in healthcare provision.
Clinical supervision: beginning the supervisory relationship
Authors: Sloan Graham
Published: May 2014

While much has been written on clinical supervision (CS) in the nursing literature, there appears to be minimal attention afforded to the supervisory relationship and in particular the early phases of this relationship. It is understood that the quality of the supervisory relationship has a significant contribution towards the efficacy of CS. In acknowledging the struggles in demonstrating the effectiveness of supervision it seems reasonable to turn attention towards the relationship between supervisor and supervisee. This article begins by providing an overview of the supervision literature concerned with the supervisory relationship. Following this, attention is focused on the commencement of this alliance by describing the processesand attributes needed to commence a supervisory relationship.A comprehensive template for establishing a supervision agreement is presented. However, it is suggested that this template does not have to be confined for use in this particular clinical context but may be applicable to a variety of nursing environments. It is proposed that such an agreement/contract facilitates healthy beginnings for the supervisory relationship and goes some way towards enhancing the trajectory of this alliance.
Personal experience of aeromedical evacuation of patients in the Balkans
Authors: Harper Phil
Published: May 2014

Nurses in the Princess Mary's Royal Air Force Nursing Service (PMRAFNS) undertake a variety of different roles in providing nursing care to Armed Forces personnel wherever they may serve. One such role is the evacuation by air of sick or injured personnel. This article discusses the experience of a nurse lecturer in the PMRAFNS who undertook the role of aeromedical evacuation liaison officer in the Balkans for a 4-month period during winter. The role is described and details of how the aeromedical evacuation of patients was organized is presented. The benefits of evacuating patients by air are discussed along with some of the potential problems that were encountered in the Balkans, including logistical problems and the vagaries of the weather. Finally, several examples of the types of patients evacuated are presented.
A balanced approach to dealing with violence and aggression at work
Authors: Rew Maggie , Ferns Terry
Published: May 2014

The Government has introduced tough measures in dealing with violence and aggression in the workplace. Employers have a duty to provide adequate safety measures and training to reduce risks and ensure, where possible the health, safety and welfare of their employees. This article highlights the responsibilities of employers and the pressures in both hospital and community environments on staff at risk from violent or abusive incidents. The patient's perspective is discussed, suggesting that more understanding between patients and staff is needed. The article looks at the ‘NHS Zero Tolerance Zone Campaign’ and whether this can be enhanced by introducing training of an empathetic nature along with other practical environmental issues. It suggests that there are alternative, and more effective, techniques in dealing with violence and aggression that can be used to defuse a situation before it ever becomes a physical altercation. The philosophies of eastern martial arts can teach us a lot about personal self-esteem and confidence which are two key elements in managing conflict situations.
Review of mental health nursing is long overdue
Authors: Morris Mervyn
Published: May 2014

The Department of Health (DoH) has announced a major review of mental health nursing as part of the move to a ‘new era of mental health care’. The DoH's Chief Nursing Officer, Christine Beasley, reassuringly states that: ‘Mental health nurses play a vital role in the NHS. It’s extremely important that the profession is supported and is given a clear direction and sense of its future role.'
The effects of smoking on the reproductive health of men
Authors: Peate Ian
Published: May 2014

This article discusses the impact smoking can have on men's sexual and reproductive health. There is evidence to suggest that smoking can result in alterations of the male sex hormones and is a key cause of and contributor to erectile dysfunction. Smoking can therefore endanger the man's ability to have a family and enjoy sexual activity. A reduction in sperm quality and a reduced response to fertility treatments has also been linked with those men who smoke. The damaging effects of smoking are apparent throughout the lifespan of a smoker. The benefits associated with cessation of smoking are wide and varied with respect to the reproductive health of men; these benefits can include a reduction in the risk of male impotence and an improvement in sexual potency.
Caring for the carers: quality of life in Huntington's disease
Authors: Aubeeluck Aimee
Published: May 2014

Huntington's disease (HD) is a dementia that is genetically inherited as an autosomal-dominant trait with complete lifetime penetrance. For individuals who develop HD, it is generally the immediate family that take on the responsibility of caring. However, there is a paucity of research into the impact of HD on the quality of life (QoL) of the spousal carer and the possible benefits of quantifying the HD carer's experience. Therefore, the purpose of this article is to describe the experiences of family carers of HD patients, specifically in relation to their QoL and to introduce the Huntington's Disease Quality of Life Battery for Carers (HDQoL-C). This is a valid and reliable QoL measure that has been developed to quantify the care-giving experience in HD in order to implement and assess therapeutic interventions.
Reducing pressure ulcer incidence in a long-term setting
Authors: Hampton Sylvie , Collins Fiona
Published: May 2014

Selection of appropriate pressure prevention equipment relies on risk assessment and clinical assessment of the resident/patient. Decisions are then made in combination with manufacturer's recommendations, such as interface pressure testing. However, risk assessments can over-predict and laboratory investigations do not necessarily provide an accurate picture of how individual patients will react to pressures from support surfaces. There are few studies on visco-elastic mattresses and their benefits in reducing pressure ulcer incidence. Therefore, a small study was undertaken to review the efficacy of a pressure-reducing visco-elastic foam mattress. For the benefit of the study, a 20-bedded nursing home was provided with 20 visco-elastic mattresses (Pressurease) and 20 pressure-reducing cushions (Mediform Visco). The study aimed to demonstrate a reduction in pressure ulcer prevalence. The study involved 21 residents over a 6-month period. There was a 53.8% prevalence (of Stirling grade 1–2 pressure damage) at trial initiation. The results showed an 85.7% decrease of pressure ulcers within 4weeks, and an overall decrease of 82.5% over the 6-month period. Comfort levels, scored by residents on a visual analogue scale, demonstrated the Pressurease mattress to be superior to the nursing home standard mattress.
The role of silver in wound healing
Authors: Graham Caroline
Published: May 2014

Bacteria present in wounds can have a negative impact on healing, so the increase in multi-resistant bacterial strains is a cause of concern for wound care. Silver has been demonstrated to have anti-microbial effects and has not as yet been shown to suffer from bacterial resistance, so an increasing number of manufacturers have launched wound care products utilising silver. A number of research studies have examined the effectiveness of silver-based products in reducing bacterial burden and treating wound infection. The general conclusion of these studies is that silver can be a useful tool in treating infected wounds, but the effectiveness of silver-based products is dependent upon the form of silver used and the delivery mechanism.
Nutrition and wound healing: the necessity of assessment
Authors: Anderson Beverley
Published: May 2014

Wound healing is an intricate affair and good nutritional status is essential to promote effective growth and repair of body tissue. Nutrients play vital roles in the constitution of a well-balanced diet and any depletion in a person's nutritional intake, especially proteins, can lead to malnutrition and protein-energy malnutrition, conditions which are known to have considerable impact on health and well-being and on the wound healing process. A holistic nutritional assessment is paramount to the early detection of nutritional deficiency and the use of recognized nutritional assessment tools can significantly increase practitioners' awareness in its undertaking. While nurses are renowned to have a central role in the management of the patient who, nutritionally are at risk, it is equally important to remember that overall management is essentially a multidisciplinary task.
Analysis of patients'rights: dementia and PEG insertion
Authors: Dennehy Christine
Published: May 2014

The decision to provide or withhold artificial feeding in patients with advanced dementia presents a multifaceted ethical dilemma. This article analyses the issues of rights regarding such patients and explores the ethical principles of beneficence, non-maleficence, respect/autonomy, justice and veracity. Evidence points strongly to hand-feeding being the method of choice for these patients (Finucane et al, 1999; Li, 2002). However, for each case there is no right or wrong answer and the physical and psychological wellbeing of the individual patient must be taken into account.
Audit of catheter-associated UTI using silver alloy-coated Foley catheters
Authors: Seymour Coral
Published: May 2014

Catheter-associated urinary tract infection (CAUTI) is the most common and most costly healthcare-associated infection, and possibly the most preventable (Salgado et al, 2003). The Cochrane Review of silver alloy-coated Foley catheters concluded that they are successful at reducing the rate of this healthcare-associated infection, which can be potentially fatal (Brosnahan et al, 2004). This article discusses the merits of using the silver alloy-coated Foley catheter in reducing the risk of CAUTI in an acute general hospital. A pre- and post-intervention design was used to audit CAUTI rates. During the pre-intervention period of 10weeks, the Trust's standard catheters were used and CAUTI rates captured. Silver alloy-coated Foley catheters were introduced and their use monitored for a further period of 10weeks. A total of 117 newly catheterized patients were actively monitored for signs and symptoms of CAUTI. The audit met and exceeded its aim of reducing the CAUTI rate by 20%. The CAUTI risk rate and device rate fell during the evaluation period. The use of the silver alloy-coated Foley catheters proved to be cost-effective given the recognized additional costs of CAUTI and prolonged in-patient stay (Plowman et al, 1999). Given the results of this audit it is recommended that the silver alloy-coated Foley catheter be the catheter of choice for use with acute patient admissions requiring short-term catheterization.
Development and organization of child and adolescent mental health services
Authors: Davies Jane , Lowes Lesley
Published: May 2014

Against the backdrop of involving children and families in their own care and the clear need to protect their interest, this article will consider care within child and adolescent mental health services (CAMHS). Following a brief overview of the incidence and prevalence of mental health problems, the development and organization of CAMHS will be explored, giving consideration to some of the literature that discusses the effectiveness of services. A review of the literature revealed that, while there is some evidence of how children feel about the services they receive, there is not currently a significant amount of literature available. Nevertheless, these views are of value in relation to the development of service provision.