bluuebunny/crossref_metadata_2025 huggingface dataset:
Understanding key issues in gender-variant children and young people
Authors: Peate Ian
Published: May 2014

Children, parents and other family members are often concerned if the behaviour of the child is more like that of children of the opposite gender, or when they show signs that they are uncomfortable with their physical sex appearance. Gender identity disorders in children and young people (those up to the age of 17 years) are rare. According to the Department of Health, they are best understood as a natural, although unusual, variation in human development. Gender variance is complex and involves psychological, biological, family and social issues. A multidisciplinary approach to care and treatment is advocated. This article provides nurses with some understanding of gender variance in children and young people in order for them to begin to help children, young people and their families.
Clothes and character: who’s who on hospital wards
Authors: Castledine George
Published: May 2014

Frustration is growing I feel over the issues of ‘banding’ and identity on hospital wards. Traditionally, when you visited a ward, you expected to immediately see a nurse in a coloured uniform, which gave you a clue as to who was in charge and who the person was. Today, there is no national agreement as to what may identify the person in charge from anyone else. In fact, I visited one hospital recently where the ancillary staff looked so much smarter than the nursing staff, that at first I mistook the cleaning supervisor for the ward manager.
Experience of analgesic use in patients with low back pain
Authors: Banbury Paula , Feenan Kate , Allcock Nick
Published: May 2014

Back pain affects a large proportion of the population. It can impact on an individual’s ability to function and on their quality of life, and can also incur significant economic, NHS and personal costs. The approach to the treatment of back pain has undergone significant changes in the past 10 years. Current guidelines emphasize the importance of maintaining activity and support the role of analgesics in facilitating active rehabilitation. There is evidence that many patients with chronic conditions do not use medication in the way they were prescribed. Fears associated with analgesics may compound this in those experiencing pain. There is limited research into the attitudes and experiences of sufferers of low back pain who have been prescribed analgesics. This qualitative study explored, through interviews, the attitudes to analgesic use of 16 patients referred to a communitybased back pain programme. A thematic analysis was conducted and identified five key themes. The findings suggest that patients are generally confused about the value of complying with their analgesic regime as healthcare professionals do not give them sufficient explanation when the prescriptions are issued.
Supporting the significant other in women undergoing abortion
Authors: Lipp Allyson
Published: May 2014

Abortion remains an ethical, legal and professional challenge to nurses. In the last decade there have been many innovations in abortion care and nurses have developed woman-centred, responsive services. Despite this progress, the needs of significant others – particularly partners attending with women – have yet to be fully met. A significant other is encouraged to stay with the woman during certain parts of the procedure if it is a surgical abortion, or may remain with the woman continuously during a medical abortion. There are benefits in encouraging significant others to stay with the woman, including the provision of additional support during the procedure as well as health promotion opportunities. The nurse has a vital function in assisting them in their role, as it is essential that significant others are adequately prepared and supported throughout. Providing they are managed proactively, involving significant others in supporting the woman undergoing abortion is commended.
The Mental Capacity Act 2005 and decision-making: Code of Practice
Authors: Dimond Bridgit
Published: May 2014

Continuing the series of articles on the Mental Capacity Act 2005, which for the most part came into force in October 2007, this article considers the significance of the Mental Capacity Act 2005 Code of Practice(Department of Constitutional Affairs, 2007), and its implications for nursing staff. The Secretary of State is required to provide a code or codes of practice on the Act covering specified areas. A draft code was prepared and was revised that came into force on 1 April 2007. The article sets out who is bound to follow the Code of Praticeand the consequences if it is ignored. Informal (unpaid) carers are not required by the Act to follow the Code but it is hoped that in practice they will do so. The Ministry of Justice (replacing the Department of Constitutional Affairs) is responsible for monitoring the Code and will revise it from time to time.
Medication management in older adults: a critique of concordance
Authors: Snowden Austyn
Published: May 2014

This article shows that the terms compliance, adherence and concordance are used interchangeably in the medication management literature. As such, it is argued that nurses should focus on those interventions that are demonstrably effective in enhancing medication management for the older adult rather than attempt to make sense of a meaningless ideal. In this article the concepts of concordance, compliance and adherence are first critiqued and it is then argued that all the terms remain valid for practical purposes. That is, a literature search of all the terms is required to comprehensively discuss medication management. Focus then switches to factors that have been shown to be beneficial as well as detrimental to medication management in older adults. While many factors appear to correlate with good and bad management of medication the conclusion is that individual, tailored approaches are most effective. For the purpose of this article, the term ‘older adult’ refers to those over 65 years where not otherwise specified
Total hip and total knee replacement: preoperative nursing management
Authors: Lucas Brian
Published: May 2014

Total hip replacement (THR) and total knee replacement (TKR) surgery are carried out for the relief of hip or knee pain, usually caused by osteoarthritis. This is the first of two articles on THR and TKR. It will outline the different types of replacement used in lower limb joint replacement surgery. Preparation of patients for surgery requires attention to physical, psychological and social factors and these are explored in detail. The organization of services along the patient pathway to ensure comprehensive preparation is considered and the nursing role highlighted. The second article, to be published in the next issue, will discuss recovery and rehabilitation from THR and TKR surgery.
Fiscal fiasco: a time of reckoning for the NHS
Authors: Pollard Tom
Published: May 2014

Winter storms have been few and far between so far, but 2008 is ending in a maelstrom of uncertainty. The threatening cloud of economic downturn has become a gloomy reality, and hundreds of thousands of people across the UK, and millions more around the world, are facing the threats of unemployment, home repossession and economic hardship.
Total hip and total knee replacement: postoperative nursing management
Authors: Lucas Brian
Published: May 2014

Patients having total hip replacement (THR) or total knee replacement (TKR) surgery require skilled nursing care in order to recover from surgery and anaesthesia. The first part of this article will outline the key nursing management issues during the postoperative stage of recovery. The second part will consider the longer term recovery, including the risk of THR dislocation and failure of the prosthesis due to loosening or infection. The role of the nurse in primary and secondary care in monitoring and identifying complications will be highlighted. This is the second of two articles on nursing care for patients undergoing THR or TKR surgery. The first article (Lucas, 2008) looked at preoperative nursing care.
Joint appointees’ experiences within a school of nursing and midwifery
Authors: Fowler John , Mills Maria Frances , North-Rose Angela , Hamilton Mary , Johnson Mark , Anthony Denis , Power Kevin , Ashton Mandy
Published: May 2014

This study evaluated the experiences of joint appointees within a school of nursing and midwifery. The nature of joint appointments has evolved, particularly since nurse education moved from the NHS into higher education institutions. Anecdotal evidence suggests that joint appointments are viewed as a bridge between clinical services and university teaching. Although joint clinical and academic appointments are the norm within medical schools, they form a minority of the appointments within most nursing schools. The general findings were that joint appointees need to be committed to the role, flexible, open to new working cultures, independent and self-supporting. The benefits to the individual and the organizations were perceived as very positive. Staff recruited into current joint appointment posts need to be clinically experienced, professionally aware, socially sensitive and politically astute.
Chemotherapy-induced oral dysfunction: a literature review
Authors: McGowan Donna
Published: May 2014

Oral mucositis is one of the most common symptomatic doselimiting complications associated with chemotherapy. However, advice regarding the effectiveness of treatment is often conflicting and subjective. Oral dysfunction may affect the quality of life of patients diagnosed with cancer, resulting in taste aversions and associated impaired nutrition, infection, and most importantly treatment delay. This creates a challenge for healthcare professionals to develop clear, research-based mouth-care protocols, with enhanced education and recommendations for both healthcare staff and patients. This article provides an overview of the common oral complications that are often associated with chemotherapy for cancer, supporting healthcare professionals in making prompt and appropriate diagnoses, and identifying the most effective management strategies.
Outlining and defining the role of the epilepsy specialist nurse
Authors: Higgins Sue
Published: May 2014

The epilepsy specialist nurse (ESN) role is complex, diverse and multifaceted, with nurses working with different patient groups in various settings. In this article, recently undertaken national audit studies into ESN services have been combined with key NHS/United Kingdom Central Council for Nursing, Midwifery and Health Visiting directives to outline the role. The main aim of the role is to provide high-quality effective assessment and care for patients/families/carers; to work collaboratively with professionals and other agencies; and to continually develop services/practices, professionals and non-professionals and themselves. Unfortunately the future of the ESN is being threatened; national audit data has identified that nurses are feeling undermined and devalued, having to take on greater workloads and more responsibilities, which they feel are not being recognized. In order to start to rectify this situation, ESNs need to collate the relevant data to prove and advertise their worth. Hopefully this vital resource will survive.
Idiopathic hirsutism: excessive bodily and facial hair in women
Authors: Elghblawi Ebtisam
Published: May 2014

Hirsutism is the excessive and increased bodily and facial hair growth in women in locations where hair is normally minimal or absent. It refers to the growth of hair in a pattern normally occurring only in men, and therefore primarily raises psychological, cosmetic and social concerns. Idiopathic hirsutism (IH), where the cause of excessive hair growth is unknown, is considered to be the most common form of hirsutism. It is suspected that this type of hirsutism may be familial, as there is often a family history of the condition. Women with IH will generally have normal menses and normal levels of testosterone. There are many treament modalities that fall into two broad groups: medical and mechanical treatment. An example of a medical treatment is when an agent is used, which interferes with the synthesis of androgen at the ovarian or adrenal level, or by inhibiting the effect of androgen at the receptor level. An example of a mechanical treatment is laser hair removal, where the hair follicle is destroyed; however, much depends on the on the skill of the treating practitioner, laser type, laser spot size, skin type, hair colour, and the stage at which the hair follicles were during their hair growth cycle, and the delivered wavelength. Laser offers the fastest method of hair loss. Other mechanical treatments include electrolysis, depilatory creams, plucking and waxing. This article presents a general overview of IH, including a definition, diagnostic measures, clinical manifestations, normal and abnormal physiology, and treatment options
Recommended follow-up for the ileo-anal pouch patient
Authors: Perry-Woodford Zarah , McLaughlin Simon
Published: May 2014

One of the greatest advances in colorectal surgery over the past 30-years has been the development of restorative proctocolectomy with ileal pouch-anal anastomosis for patients suffering with ulcerative colitis and selected patients with familial adenomatous polyposis. This has coincided with a proliferation of new and exciting advanced clinical roles for nurses in the United Kingdom and subsequently has led to an increase in the responsibilities and professional status of nurses. Staff development is necessary to maintain the unique contribution that nurses make to health care in the terms of practice, education and research. Nurse specialists in gastroenterology are taking their place alongside medical specialists, and more importantly establishing themselves as the principle carer in many diverse roles. However, as these nursing roles expand, a recognized framework needs to be designed, which takes into account the educational, ethical and legal issues related to accountability of running nurse-led clinics, offering support, advice and follow-up for patients. This article provides nursing staff with researchbased recommendations and practical guidance on running a successful nurse-led pouch clinic and follow-up service in collaboration with the consultant surgeon, gastroenterology teams and nursing staff involved specifically with the ileo-anal pouch patient
Diabetes and chronic kidney disease: a complex combination
Authors: Marchant Karen
Published: May 2014

Diabetes and chronic kidney disease (CKD) are two disease processes that remain with patients from diagnosis to the end of their lives. Both are destructive conditions that must be diagnosed early to prevent longer-term complications, such as retinopathy and neuropathy. Diabetes remains the single most important cause of kidney failure. Diabetes in hospital accounts for 10% of all admissions, but this figure is much higher within renal medicine with diabetes significantly increasing length of stay, with excess bed days suggested at 20%. Inpatient care is currently the largest single component of medical costs for diabetes, while diabetes costs 10% of the NHS budget. The number of patients with both diabetes and CKD are increasing, and to help slow down the progression to complications patients must receive education on how to control their diabetes. Training packages are designed to facilitate this educational process but the NHS needs to invest in refresher courses as the educational structure needs to support lifetime learning. It is vital from first referral that all patients lead in the decisions made about their health. Healthcare professionals have a duty of care to ensure patients are given clear, concise and accurate information in language they understand with the use of medical terminology and jargon limited. Patients must then be allowed to gather their thoughts and ask any further questions before supporting them in the choices that they make.
Preceptorship: facilitating student nurse education in the Republic of Ireland
Authors: Gleeson Madeline
Published: May 2014

Nursing is a practice-based discipline and clinical practice is considered to be an integral part of nurse education. The pivotal role that preceptors play in the socialization, teaching and assessing of student nurses, is vital in helping students to integrate theory with practice. However, some evidence suggests that there can be minimal contact between the stakeholders involved in the students’ education process, namely the university lecturers and preceptors. The focus of this article is on exploring the literature on models of support for student nurses with particular emphasis on the concept of preceptorship.
LBF®‘no-sting’ barrier wipes: skin care using advanced silicone technology
Authors: Voegeli David
Published: May 2014

The past decade has seen a huge growth in the application of silicone-based products to the healthcare market, with this technology finding its way into diverse areas ranging from the manufacture of disposable contact lenses to urinary catheters, and the development of a new generation of wound and skin care products. However, the current development of topical silicone treatments to protect the skin is not a new idea, but rather a renaissance, with the first of these products being developed in the 1940s as a substance known as ‘water glass’ or sodium silicate. Although the years have past, the challenges for nursing remain the same, with the need to protect vulnerable areas of the skin and the prevention of skin breakdown forming one of the cornerstones of professional care across all spheres of practice. This article considers the role that silicone-based barrier films, such as CliniMed’s LBF®, can play in the prevention and management of skin breakdown.
Development and evaluation of CliniFix®, a catheter/tubing fixation device
Authors: Orme Lesley A , Smith Rory JM , Berry Jeanette C
Published: May 2014

There are a plethora of clinical situations in which the fixation or securement of catheters and tubing are important. Many of these become critical, especially where dislodgement of the catheter/tube can compromise the treatment regimen for the patient, or cause pain and discomfort. In other situations, tube fixation is important for patient discretion and convenience. It is recognized that no matter what the specific application, there are several key criteria which any catheter/tube fixation system should meet: it must offer skin friendly attachment to the body; offer secure, but adjustable attachment for a range of catheter/tubing types, especially non-adherent silicones; must not present risks to users, such as creating pressure points or constriction; and must be convenient and uncomplicated to apply. This article discusses the need for securement or in some cases the total fixation of catheters and medical tubing. It outlines the present methods of securement or fixation currently available to clinicians and then goes on to cover the development and evaluation of a new device – CliniFix®. Case studies demonstrate the usage of this new product within urological and stoma areas.
Investigating and profiling the leadership behaviours of Jordanian nursing leaders
Authors: Mrayyan Majd , Khasawneh Israa
Published: May 2014

‘Leadership’ is a social process in which a member or members of a group influence the interpretation of events, choice of goals/ outcomes, organization of work activities, motivation, abilities, power relations, and shared orientations. This study identifies leadership behaviours of Jordanian nursing leaders. A descriptive comparative design was used to collect data from four governmental and three private hospitals. Data were collected during April 2005. The total number of recruited nursing leaders was 140 with a 70% response rate. T-tests and chi-squares were performed to compare the phenomenon of interest. The mean reported leadership behaviours were slightly higher in private hospitals than those in governmental hospitals. However, more than half of the time, leaders in both types of hospitals used supportive leadership behaviours. There were significant differences between governmental and private hospitals in most demographics of the sample. Based on types of hospitals and gender, differences in leadership behaviours were advantageous for nursing leaders in private hospitals, while differences based on units and wards were advantageous for nursing leaders in governmental hospitals. In general, Jordanian nursing leaders used supportive leadership behaviours. Differences in leadership behaviours have implications for nursing practice, research, and education.
A service evaluation of the use of silicone-based adhesive remover
Authors: Rudoni Caroline
Published: May 2014

Evidence-based practice has become a priority for nurses, but until the publication of Caring for Stoma Patients, Best Practice Guidelines(Clinimed Resource for Education and Specialist Training, 2006), there was very little evidence published for many aspects of stoma care nursing. This document provides best practice information for many specific areas of stoma care, but there is still a lack of evidence on which clinical decisions regarding subjective issues can be based. As a result, the stoma care department at St George’s Healthcare NHS Trust undertook a study on the use of a silicone-based adhesive remover. Dykes (2001) highlights the trauma that can occur as a result of skin stripping during pouch removal. The use of a silicone-based adhesive remover allows for the rapid and painless removal of a stoma pouch without the associated problems of skin stripping (Cutting, 2006). Results from the study conclude that patients experience great benefit from the use of a silicone-based adhesive remover and that all patients should be offered the use of one.
Recessive dystrophic epidermolysis bullosa. Part 2: care of the adult patient
Authors: M Abercrombie Elizabeth , A Mather Claire , Hon Jennie , Graham–King Pauline , Pillay Elizabeth
Published: May 2014

This article is the second in a series of three focusing on the causes, clinical presentation, complications and care of adult patients affected by epidermolysis bullosa (EB) – a group of rare genetic skin fragility disorders. The emphasis of this article will be on the nursing care of adults with recessive dystrophic EB (RDEB). RDEB patients are never ‘wound free’ and the challenge to provide effective wound care is immense. This article details some of the basic practical wound care issues to be considered when caring for a patient with EB, particularly RDEB, emphasizing the need for a holistic approach, with strong patient involvement. Minimizing and preventing trauma, generating an optimal wound healing environment, and the management of pain and pruritis will also be discussed.
Promoting social continence using incontinence management products
Authors: Dingwall Lindsay
Published: May 2014

Urinary incontinence (UI) is a common problem which affects men and women for a variety of reasons. For some people with UI cure is not achievable. For others, time is required to accurately diagnose and treat their urinary symptoms. In order to improve quality of life for people with UI, health professionals require awareness of the products available to achieve social continence. Continence products and devices fall into three categories: collective devices, containment products and occlusive devices. This article provides a brief overview of the more common products available and discusses some of the common benefits and drawbacks to their use.
Colostomies and the use of colostomy appliances
Authors: Cronin Elaine
Published: May 2014

The surgical formation of a colostomy is indicated as part of the treatment of various conditions, primarily colon cancer, requiring the patient (ostomist) to wear a colostomy pouch. Today’s stoma appliances bear no resemblance to those worn three or four decades ago when colostomy, ileostomy and urostomy bags were made entirely from rubber. The patient, who would have two to three bags in circulation at a time, would interchange them allowing for the washing and drying of the previous one, thus minimizing odour and potential perishing of the rubber. The design of these appliances was simple, but they were large and bulky and the outlet resembled that of a hot-water bottle stopper or a cap from an old soda bottle that required the insertion of coinage (2p) to open it. This article explores the range of colostomy appliances and management options available to the nurse when caring for patients with a colostomy.
Intravenous therapy: a guide to good practice
Authors: Scales Katie
Published: May 2014

This article provides an overview of the principles of good practice that underpin intravenous (IV) therapy. The indications for choosing the IV route and selecting an appropriate vascular access device (VAD) are explained. Common insertion sites for VAD placement and the care and management of VADs are reviewed. Infection control aspects of IV therapy are be highlighted, including the management of IV equipment and the importance of the nurse’s role in the prevention of infection associated with IV therapy. Common complications of IV therapy are explained and strategies suggested for their prevention. The article addresses the issues associated with general IV therapy, it does not address specialist subjects such as parenteral nutrition, chemotherapy or blood transfusion.
The use of medical grade honey in clinical practice
Authors: Acton Claire , Dunwoody Gillian
Published: May 2014

In the current healthcare environment, clinicians are increasingly under pressure to use wound care products that are cost-effective. This includes products that can be used in a variety of wounds to achieve different outcomes, depending on the wound-bed requirements. Medical grade honey has emerged as a product that can achieve a variety of outcomes within the wound and is safe and easy to use. This article reviews the use of a medical grade honey (Medihoney™) in various clinical applications, with a view to placement on the wound care formulary in both primary and secondary care. It provides an in-depth account of case studies featured in a poster presentation at the 2008 European Wound Management Association meeting in Lisbon, Portugal.
Specialist healthcare law for nurses: an introduction
Authors: Tingle John , McHale Jean
Published: May 2014

Nurses are increasingly concerned with legal and ethical dilemmas in clinical decision-making. The law impacts across a wide range of issues in nursing practice. It is important for healthcare professionals to be aware of the way in which the law regulates their professional practice. In this article John Tingle and Jean McHale introduce a new series of articles on law for nurses. The series will feature contributions by legal academics who are specialists in the area of healthcare law. The series will outline basic issues such as the English legal system. It will then consider a wide range of issues, including nursing negligence, legal issues of expanded role, patient safety, consent to treatment, adults lacking mental capacity, mental health law, end-of-life decision-making, law and nursing research, resource allocation law and human rights.
Mental health nurses’ diabetes care skills – a training needs analysis
Authors: Nash Michael
Published: May 2014

This article explores mental health nurses’ diabetes training needs. A survey of inpatient and community mental health nurses was undertaken using a 16-item self-reporting questionnaire. Two hundred and twenty questionnaires were sent out and 138 returned, providing a response rate of 63%. Analysis shows that mental health nurses are currently involved in a range of diabetes care activities, however, their knowledge and skills may not be up to date. Mental health nurses also report the growing impact of diabetes care on their workload. Areas of identified training needs include taking blood glucose readings, giving dietary advice, liaison with diabetes nurse specialists and weight management. Mental health services and education providers need to consider developing specific training courses for mental health nurses.
Swine flu panic is being spread by ignorance
Authors: Castledine George
Published: May 2014

Influenza, commonly referred to as ‘flu’, is a severe infection caused by the RNA viruses of the family orthomyxoviridae, which affects birds and mammals. In the UK it is often seasonal – its intensity depends upon the type of virus and the susceptibility of the population. Transmitted by air, bird droppings, saliva, nasal secretions, faeces, blood, bodily fluids and contaminated surfaces, influenza can be dangerous and sometimes fatal. Usually it is the old or young vulnerable person who will have the most difficulty in coping with the illness, so it is important to protect them by vaccination. New strains of the virus develop when existing flu viruses spreads to humans from other animal and bird species, or when an existing human strain picks up new genes from an ‘A’ virus that usually infects birds and/or mammals. The two viruses which are currently making headlines are bird flu influenza A (H5N1) and swine flu influenza A (HIN1).
Developing methods for solving drug dosage calculations
Authors: Wright Kerri
Published: May 2014

This second part of a three-part series of articles examining drug calculation skills, focuses on the different methods that can be used to solve drug calculations. It builds on Part 1 (Supporting the development of calculating skills in nurses, 18(7): 399–402), and provides examples of different methods that can be used to plan and solve a range of common calculations, such as weight-based calculations and weight and volume calculations. The framework introduced in Part 1 is used to support the planning and solving of drug administration calculations.
Abortion – ending the taboo
Authors: Greenway Jane
Published: May 2014

Statistics recently published by the Department of Health (DH) revealed that in 2008, for women resident in England and Wales, the total number of abortions was 195,296 (DH, 2009). Media reporting around the statistics focused on the ‘remorseless’ rising of the rate of repeat abortions (Daily Mail, 2009), and the general public were quick to comment on such articles, giving rise to yet another round of debates about the rights and wrongs of abortion.
Cultural and religious beliefs in stoma care nursing
Authors: Black Pat
Published: May 2014

Health-care delivery does not happen in a vacuum. Health is very much part of a person’s life that also incorporates upbringing, culture and faith. One challenge in stoma care is to achieve a high level of care that meets the needs of all patients in a multicultural society. Knowledge of cultural differences is essential if sensitivity and competence are to be provided. The way people feel about themselves and others and their openness to learn about different cultures are central to cultural sensitivity. Cultural diversity is a fact of life. As the world responds to easier and faster global travel it is inevitable that nurses will meet and care for people from different countries. In a multicultural, multi-faith society, it is essential that care is offered in a way that respects and accommodates everyone’s cultural and religious needs.
Skin barrier breakdown: a renaissance in emollient therapy
Authors: Cork Michael J , Danby Simon
Published: May 2014

Breakdown of the skin barrier is the first event in the development of atopic eczema (atopic dermatitis). Research over the past five years has indicated that this arises as a result of the interaction of environmental agents such as soap and other detergents with the products of changes in several genes. These genetic changes predispose to the breakdown of the skin barrier, which allows the penetration of allergens, triggering a flare of atopic eczema. This new understanding of how breakdown of the skin barrier is the first event in the development of atopic eczema provides a rationale for a renaissance in the use of a complete emollient therapy regimen in atopic eczema and related skin barrier breakdown diseases, such as asteatotic eczema and irritant contact dermatitis.
When is negligence a crime?
Authors: Huxley-Binns Rebecca
Published: May 2014

This article considers the crime of gross negligence manslaughter and explains how the criminal offence is based on the civil form of negligence, but where the negligence is very serious and involves a risk of death. It also considers the offence of corporate manslaughter.
Patient safety is improved by early training
Authors: Robson Wayne
Published: May 2014

Making care safer for patients is currently a top priority for the NHS. Nurses, as the biggest group of health-care workers, have countless opportunities each day to contribute to this aim. One of the first challenges that arises is: how do we ensure that all nurses are aware of the size and extent of the problem? We must also ask what is being done locally to reduce avoidable harm and deaths.
Practical issues for emollient therapy in dry and itchy skin
Authors: Lawton Sandra
Published: May 2014

Managing atopic eczema and other dry and itchy skin conditions is a skill required in all nursing specialties. Nurses need to assess and address their patients’ skin-care needs. Atopic eczema and all dry and itchy skin conditions require emollient therapy to restore the skin barrier. Nurses are ideally placed to educate patients in the importance of emollient therapy and provide practical information on the individual selection of bath additives, soap substitutes and moisturizers, as well as education on application and self-management. Nurse prescribers will benefit from understanding specific individual patient needs and individual emollient properties to enable them to make informed prescribing decisions and foster patient choice in selecting the best emollient therapy for the individual. This will restore the skin barrier function, reduce itch and suit the patient.
Managing chronic oedema in the morbidly obese patient
Authors: Todd Marie
Published: May 2014

The obesity epidemic has become one of the major challenges for health and social policy makers around the world. The increase in obesity is commensurate with the rise in associated complications, including type 2 diabetes, cardiovascular disease and some types of cancer (breast, colon, endometrium, prostrate, kidney and gallbladder). There are also increased cost implications for health services, welfare services and employers. A crude estimate of approximately 15 000 patients attending a US clinic showed almost 75% of morbidly obese patients have chronic oedema of the legs. An audit of body mass index of patients attending a specialist lymphoedema clinic showed 36% were clinically obese and 23% were morbidly obese. This has major implications for lymphoedema practitioners in terms of allocating time and resources, and health and safety issues relating to providing a safe environment for both patients and practitioners. This article investigates the financial and health consequences of the rising obesity problem and outlines some of the strategies implemented to halt this trend. The effects and management of chronic oedema in the morbidly obese patient are also presented.
Nanotechnology: the revolution of the big future with tiny medicine
Authors: Meetoo Danny
Published: May 2014

The historically unprecedented developments of nanoscience and nanotechnology (NT) promise to revolutionize the diagnosis, treatment and prevention of disease and traumatic injury, to relieve pain, and to preserve and improve human health, using molecular tools and molecular knowledge of the body. This article focuses on what is known as nanomedicine, referring to a definition of NT, its historical overview and developments as well as its application to medicine. In revolutionizing the manufacturing process to a nanoscale, NT promises to resolve the problems currently faced by the human race. However, in embracing this panacea, its implications, particularly within health care, cannot be ignored. This article, therefore, provides a thought-provoking consideration of how NT is likely to impact on nursing, together with the issues likely to be encountered during the care delivery process. Finally, some of the ethical questions nurses need to debate has been raised.
Testicular cancer: addressing the psychosexual issues
Authors: Moore Annamarie , Higgins Agnes
Published: May 2014

Testicular cancer is the most common malignancy in men aged 15–35 years and predominantly occurs at a time in a man’s life when important decisions about marriage, starting a family and a professional career are being made. While treatments for testicular cancer are very successful, they can have a major impact on the person’s sexuality and sense of self. The focus of this article is on exploring the impact of cancer treatments for testicular cancer on men’s sexuality and how nurses can respond to their concerns in a sensitive and informed manner.
Blended learning in education: effects on knowledge and attitude
Authors: Ireland Jillian , Martindale Sheelagh , Johnson Neil , Adams David , Eboh Winifred
Published: May 2014

This article evaluates a blended learning approach in terms of the knowledge, attitude and experience of participants who completed an undergraduate module ‘Research and evidence-based practice’. This article considers a longitudinal cohort study of learning approaches using mixed methods, and had three phases. Phase 1 involved a questionnaire, phase 2 a focus group, and phase 3 involved a telephone questionnaire. Phase 3 is not reported on here. The study found that the blended approach was generally well received. There were some gaps in learners’ knowledge which appear to be explained by the focus group as being linked to their relative lack of experience at the time of questionnaire completion. Overall, using a blend of teaching and learning methods was generally a positive experience for students in terms of knowledge and ‘usefulness’.
Conscientious objection and the nurse: A right or a privilege?
Authors: V McHale Jean
Published: May 2014

This article examines to what extent nurses can at present opt out of clinical procedures on the basis of conscience in English law. It considers the current rights to opt out on the basis of conscience contained in section 4 of the Abortion Act 1967 and section 38 of the Human Fertilisation and Embryology Act 1990. It examines how through codes of practice and guidance, there is recognition of the ability to opt out beyond theses statutes. It suggests that rather than let practice evolve to enable persons to opt out, the fundamental issues as to whether it should be a right or a privilege needs careful consideration across healthcare professions as a whole and a broader public debate.
Nanotechnology: is there a need for ethical principles?
Authors: Meetoo Danny
Published: May 2014

Nanotechnology (NT) is concerned with materials and systems whose structures and components exhibit novel physical, chemical and biological properties due to their nanoscale size. This new scientific discipline is fast becoming a major driver of the future direction of health care and is likely to have a significant impact on society, medicine and nursing. This article demonstrates that ethical reflections lie at the heart of nursing. In contextualizing the ethics of NT, this article questions the conclusion reached by others that ethical reflections on NT lag behind its scientific developments. Instead it proposes that the ethical issues raised by NT are similar to those relating to biotechnology, considered by ethicists since the 1970s. Consequently, this article argues that a foundation of ethical reflections already exists that can be transferred to NT. Finally, this article asserts the need for nurses to be proactively involved in interdisciplinary discussions likely to extend the current ethical reflections of autonomy, nonmaleficence, beneficence and justice to NT.
Diagnosing and treating acute myocardial infarction in pregnancy
Authors: Merrigan Orla
Published: May 2014

Acute myocardial infarction (AMI) in pregnancy is a very rare occurrence. However, statistics indicate high mortality rates, with a maternal death rate at 20–37%. Nursing and medical care of AMI in pregnancy is a very complex issue. Risk factors such as stress, smoking, obesity, high cholesterol and family history of heart disease may increase the risk of AMI in pregnancy. There are a variety of challenges for the nurse caring for this patient, as the presenting signs and symptoms of AMI in pregnancy can mimic regular pregnancy symptoms and therefore may be misdiagnosed. There is limited nursing literature on this topic to guide and educate nurses. Recommendations need to be implemented across multiple nursing settings. There is a need for both national and international guidelines on care of this type of patient. There is also a need for policies to be in place and links within the hospital setting and the community.
Nurses ‘must’ control of the nutritional needs of stroke patients
Authors: Mould Jacqui
Published: May 2014

The aim of this observational study was to review nutritional practice within an acute stroke unit (ASU) and compare practice against National Institute for Health and Clinical Excellence (NICE) guidance, National Patient Safety Agency (NPSA) guidelines, and the National Stroke Agenda. ‘Observations of Care’, a well recognized approach and part of the Royal College of Nursing clinical leadership programme, was undertaken along with a traditional audit to review nutritional care in the ASU. Usually undertaken by persons outside of the team to prevent bias, in this situation the bias was minimized as the auditor was new to the team. Current practice was evaluated and it was important for the team to have ownership of the assessment process. This article also reviews the prevalence of malnutrition in hospitals and the importance of nutritional assessment, the use of screening tools and types of diet that best maintain optimum outcomes. Patients who have experienced a stroke can face a range of problems that influence dietary intake. On admission, 16–31% are already malnourished.
The management of children with Hunter syndrome – a case study
Authors: Little Catherine , Gould Rachel , Hendriksz Chris
Published: May 2014

Hunter syndrome (mucopolysaccharidosis type II) is a rare lysosomal storage disease caused by a deficiency of the lysosomal enzyme iduronate-2-sulphatase and the subsequent progressive cellular accumulation of glycosaminoglycans. Children with this debilitating disease can now be offered enzyme replacement therapy (ERT) with idursulfase to manage the signs and symptoms of the disease and to improve quality of life. As therapy involves a weekly infusion of enzyme, travel to the few designated specialist centres that provide treatment can be highly disruptive for both patients and carers. Providing ERT outside the hospital setting therefore offers a convenient alternative that can be delivered effectively with specialist nursing support. The authors report their experience of providing ERT to a patient with Hunter syndrome in a school. Through careful planning and the development of close working relationships between nurses, schools, local hospitals and patients’ families, the authors found that managing patients outside the hospital setting can greatly benefit their quality of life.
The psychosexual implications of menopause
Authors: Rani Shobha
Published: May 2014

Menopause is a natural phenomenon among middle-aged women and most go through it without any difficulty. However, it can be associated with multiple problems – physical, sexual, psychological and psychosocial. One of the areas less often discussed in most cultures is that of psychosexual problems, such as decreased frequency of sex, a lack of interest in sex, painful intercourse and feeling compelled to have sex. These problems may be associated with several physical factors such as oestrogen deficiency, menstrual difficulties or surgical menopause. Furthermore, some of the psychological and psychosocial factors, such as a negative attitude towards sex and menopause, conflicts between partners, lifestyle factors and culture, can also cause psychosexual problems in menopausal women.
Supporting the development of calculating skills in nurses
Authors: Wright Kerri
Published: May 2014

This article discusses a well-known model in mathematical problem solving developed by Polya (1957) and suggests that this could be a beneficial framework to support the development of medication calculation skills. The model outlines four stages to problem solving: understanding the problem, devising a plan, carrying out the plan and examining the solution. These four stages are discussed in relation to the teaching and assessing of medication skills, drawing on literature from nursing, mathematics education and cognitive psychology. The article emphasizes the importance of clinical experience and knowledge and the cognitive structures that support the development of medication skills. This is the first part of a three-part series. Part two will examine the different methods that can be used to solve medication calculations and part three the resources that are required to support use of these methods.
Long-term prognostic factors in the diagnosis of gestational diabetes
Authors: Hayes Catherine
Published: May 2014

Gestational diabetes mellitus (GDM) is an increasingly common condition, affecting 7% of all pregnancies in the UK. With an array of associated complications both for mother and foetus, early detection and diagnosis of the condition is pivotal to successful intervention strategies and long-term management. This article looks at diagnosis, treatment and management of GDM and examines the impact of an initial diagnosis of impaired glucose tolerance (IGT) and/or GDM and how the prognosis for long-term health is influenced by such a diabetogenic manifestation. It is fundamental to the prevention or delayed onset of type II diabetes mellitus that patients are aware of the risk factors associated with their general health. With rising cases of maternal obesity, later age of gestation and increasingly sedentary lifestyles in women of child-bearing age, health-care professional future involvement with IGT and GDM patients is guaranteed.
Understanding panic disorder in chronic respiratory disease
Authors: Hallas Claire , Wray Jo , Howard Claire
Published: May 2014

As well as being physically debilitating, respiratory diseases present significant challenges to the psychological well-being of individuals and their families and are recognized to have an impact on health-care services, resources and time. Panic attacks and disorder are particularly prevalent in people with respiratory conditions and appear to be associated with reduced lung function. However, recent evidence suggests that the aetiology of panic in this area may be related more to underlying psychological processes, which can influence cognitions that are related to the experience of respiratory disease and its symptoms. The aim of this article is to give a brief overview of the literature to identify key psychological factors associated with panic and respiratory diseases. The article concludes that panic has a complex aetiology, which requires the presence of specific respiratory-related cognitions. The self-regulatory model can foster understanding of the combination of beliefs/cognitions that can increase the prevalence of negative mood for patients with respiratory diseases.