bluuebunny/crossref_metadata_2025 huggingface dataset:
Nurse assessment of oral health: a review of practice and education
Authors: White Richard
Published: May 2014

The assessment of oral health status and related care of patients is a largely neglected area of nursing practice. With the notable exceptions of high-risk patient groups, such as those receiving chemotherapy in neonatal and intensive care units, and in terminal care, few patients enjoy regular, formal, oral assessments and care. Such interventions — nurse administered oral hygiene — should not be reserved only for high-risk groups but ideally be provided to all patients, whether in hospital or in the community, as they can reveal signs and symptoms of oral disease, manifestations of systemic disease, drug side-effects, or trauma; they may also provide important diagnostic clues. This article sets out to emphasize the need for nurse education in oral health care and provides a literature review and introduction to common oral health problems. It also sets out to establish the rationale for assessment in all contexts of patient care.
Collaboration between nurses and doctors in clinical practice
Authors: Lockhart-Wood Karen
Published: May 2014

Several authors have identified collaboration between nurses and doctors as problematic. Benner (1984) stressed that teamwork and collaboration between the disciplines was crucial for both patient care and team morale. The purpose of this article is to evaluate critically and discuss the research studies which have been conducted into the dynamics of the nurse/doctor relationship. A number of characteristics are significant in influencing the collaborative process. These include excellent communication skills, respecting the value of colleagues' roles, the ability to share points of view and trust.
Testicular cancer: testicular self-examination and screening
Authors: Cook Neal
Published: May 2014

Testicular cancer represents a significant threat to the health of males aged between 15 and 34 years. As there has been significant focus on early detection of cancers in order to intervene at the earliest opportunity to improve treatment outcomes, the detection of testicular cancer through secondary prevention merits careful consideration. This article discusses two health promotion approaches to dealing with the subject of optimizing men's health: the merits and disadvantages of testicular self-examination education; and screening for testicular tumours in high-risk populations. Recommendations for adapting traditional approaches are also discussed.
Pathways for continence care: background and audit
Authors: Bayliss Valerie , Cherry Maggie , Locke Rachel , Salter Liz
Published: May 2014

This article is the first in a series of three covering the use of care pathways for continence care. Trusts in Basingstoke, Swindon and Salisbury have collaborated in supporting their continence advisers in moving from finance-driven assessment data to evidence-based care pathways and the provision of patient information. This article identifies the background and approach to care pathways and addresses the quality issues. It details the issues facing continence advisers and how care pathways may help to address them. Furthermore, it describes a baseline audit which was carried out to ensure that facts rather than beliefs were being used and this demonstrated that little advice or treatment was actually reaching the patient.
Treatment of a heel blister caused by pressure and friction
Authors: Reed Sarah
Published: May 2014

The treatment of heel blisters caused by pressure, friction, and shear is a complex subject. Issues such as whether to aspirate the blister, how to protect it from further pressure, friction, and shear, and which dressing to choose, need to be considered. As nurses are increasingly aware of the emphasis that has been placed on the importance of ensuring that clinical practice is based on evidence, this article attempts to shed some light on these areas of debate. It is important to highlight that during the literature search very little research was found to exist on blister care and it became clear that further research into the nursing care of a blister caused by pressure would be useful to aid nursing care and patient comfort.
Matrons are not going to solve all the problems
Authors: Close Ann
Published: May 2014

Most nurses would support the view that patients in hospital do not always get the level of care they need in an environment best suited to healthcare delivery. This situation has arisen because of lack of investment in the ward infrastructure. At the same time the workload has increased because of more highly dependent patients, a quicker throughput, increasing demands to meet targets and escalating bureaucracy.
Neonatal intensive care: communication and attachment
Authors: Cox Carol L , Bialoskurski Maria
Published: May 2014

Birth has traditionally been recognized as a family-centred event where immediate exposure to the infant occurs and where the family begins, through direct contact, touch and voice, to form an attachment to the infant. In high-risk pregnancy and delivery, medical and technological advances distance the family from the birth event. This article describes some aspects of a research project which identified factors that facilitate and hinder family and mother attachment to the infant during periods of separation subsequent to premature delivery or other problems which require management in a neonatal intensive care unit (NICU). The project was exploratory. It involved observation of care, participation in care, individual unstructured interviews, focus group interviews and also use of Leske's (1986, 1991a,b) critical care family needs inventory, which was modified and responded to by family members (n = 109) in an attempt to quantify and validate their needs. Six constructs were derived from the inventory and then ranked by mothers (n = 100). The findings from this process were triangulated to observation and interview data in order to confirm factors that facilitate and hinder the process of attachment during family and mother-infant separation. The results of the study imply that when the family and mother are supported by an individualized approach to care and appropriate communication is used, attachment can be facilitated.
Relationship-centred care is the next logical step
Authors: Nolan Mike , Keady John , Aveyard Barry
Published: May 2014

Much has been written about the notion of person-centred care (Kitwood, 1997). Despite the fact that some commentators consider that it is little more than a mantra (Packer, 2000), its impact has been far reaching. Indeed, providing person-centred care is one of the key standards underpinning the National Service Framework for Older People (NSF) (DoH, 2001) in which the emphasis is placed on treating older people as individuals by listening to their needs, respecting their dignity and privacy, and recognizing differences.
Rapid urinalysis assays for the diagnosis of urinary tract infection
Authors: Moore Katherine N , Murray Scott , Malone-Lee James , Wagg Adrian
Published: May 2014

Urinary tract infection (UTI) in premenopausal women is a frequent complaint in general practice. UTI is usually diagnosed on the basis of clinical symptoms and the use of one or more laboratory tests, the most common being rapid urinalysis reagent assays (urine dip) or midstream urine culture. In order to correlate the leucocyte esterase results of a rapid urinalysis assay with direct urine microscopy for pyuria, undiluted non-centrifuged urine samples from 206 volunteer female healthcare professionals were subjected to analysis using direct urine microscopy using a counting chamber and a rapid urinalysis assay. Of the 206 specimens, 74 were positive for leucocyte esterase using the rapid urinalysis assay, and 39 specimens demonstrated significant pyuria (greater than or equal to 10 leucocytes/μl) on direct microscopy. When the leucocyte esterase results were correlated with the direct urine microscopy results, an assay reading of 15 leucocytes/μl (‘trace’ on the visual scale) had a sensitivity of 91%, specificity of 79%, positive predictive value of 53% and a negative predictive value of 97%. An assay reading of 25 leucocytes/μl (‘+’ on the visual scale) or greater had a sensitivity of 63%, specificity of 95%, positive predictive value of 75% and a negative predictive value of 91%. In premenopausal, non-pregnant females, a rapid urinalysis assay result of 25 leucocytes/μl or greater will predict significant pyuria on urine microscopy with reasonable confidence, thereby reducing the need for more costly urine cultures.
Nutrition and the life cycle 4: the healthy diet for the adult
Authors: Coutts Alison
Published: May 2014

The previous three articles in this series reviewed current nutritional advice to help maintain health during pregnancy (Vol 9(17): 1133–8), weaning (Vol 9(21): 2205–16) and in childhood (Vol 10(1): 26–310. This article reviews current thinking on what constitutes a healthy diet for the individual who has left childhood behind, but has not yet encountered many of the changes associated with old age. Most people enjoy food, and also believe that a good diet will improve their health. This article aims to review current thinking on what constitutes a healthy diet for the adult.
Improving the health of older people: what do we do?
Authors: Nolan Janet
Published: May 2014

This article, based on a paper given at the International Network for Studies Concerning Older Adults conference in Brazil, considers the health of older people. It argues that greater efforts must be made both to improve preventive healthcare interventions and enhance quality of life. It is suggested that nurses have a significant but, as yet, largely unrealized role to play and that action is needed if older people are to get maximum benefit from health care.
Wound colonization and infection: the role of topical antimicrobials
Authors: White Richard J , Cooper Rose , Kingsley Andrew
Published: May 2014

Infection and bacterial colonization are important factors in compromised wound healing, particularly in chronic wounds. The current ‘best practice’ for controlling these factors is still unclear. Systemic antibiotics are generally accepted as being the preferred choice for treating infection, provided that ischaemia does not interfere. However, their widespread systemic and topical use is leading to the emergence of resistant bacterial strains such as methicillin-resistant Staphylococcus aureus. Colonization of wounds presents a double problem: possible delayed healing if out of balance with the immune system; and as a source for cross-infection. Managing colonization is not yet defined in best practice. The judicious use of dressings, notably those containing certain antiseptic agents, can be valuable in infection control and in promoting healing. This review states the case for taking the antiseptic route as part of the concerted approach to local wound management and infection control.
The current status of maggot therapy in wound healing
Authors: Thomas Stephen , Jones Mary , Wynn Karen , Fowler Tony
Published: May 2014

The clinical use of sterile maggots under the brand name LarveE has increased steadily in the UK since they were introduced in the UK in late 1995. Some 50 articles have been published in the last 4 years that describe the cost-effectiveness of maggot therapy in a variety of wound types including leg ulcers, pressure ulcers and diabetic ulcers. The ability of these creatures to combat wound infection has been well documented including those caused by antibiotic-resistant strains of bacteria such as methicillin-resistant Staphylococcus aureus. No significant risks or adverse events have been linked to the use of maggots, although their presence may increase pain levels in leg ulcers associated with ischaemic disease.
Value of employment to people with learning disabilities
Authors: Jenkins Robert
Published: May 2014

A key objective of the Government White Paper ‘Valuing People: A New Strategy for Learning Disability for the 21st Century’ is to encourage and assist people with learning disabilities to gain employment. This is because very few people with learning disabilities are in paid work and employment is promoted as a means of improving self-esteem, skills and social integration and acceptability. The aim of this article is to highlight some benefits of, and the risks and concerns around, people with learning disabilities undertaking paid work. Learning disability nurses need to be aware of these issues if they are to advise and support clients effectively. If people with learning disabilities are not able or unwilling to enter the world of work then alternative approaches are needed. Leisure has the potential to offer similar benefits as work to people with learning disabilities.
A new Mental Health Act: where is the evidence for it?
Authors: Morris Mervyn
Published: May 2014

This Government has in many ways demonstrated that it wants to improve mental health services, even so far as to make mental health one of its top three clinical priorities. Recent policy has rightly focused on improving people's health, so the proposed new Mental Health Act jolts because its language and focus is on managing people's diseases.
Point-of-care testing and recognizing and preventing errors
Authors: Terry Louise M
Published: May 2014

Jenny, the practice nurse of a busy GP surgery, was asked to carry out a commercially available test to exclude a diagnosis of Infectious mononucleosis. The test was negative. The patient was prescribed amoxycillin and later developed a severe rash. However, the blood tests from the local pathology laboratory showed that the patient did have infectious mononucleosis. The GP discovered from colleagues that over the last few weeks other patients at the surgery had been recorded as having negative tests but positive laboratory results had later followed.
A survey of nurses’ assessment of peripheral intravenous catheters
Authors: Creamer Eilish , McCarthy Geraldine , Tighe Ita , Smyth Edmond
Published: May 2014

The purpose of this survey was to improve nursing care of patients with peripheral intravenous catheters (PVCs), focusing on assessment of the PVC site for infection. The survey was conducted in 20 wards by an infection control nurse (ICN), recording data on assessment, site infection and removal/resiting of PVCs. Nursing staff were interviewed on assessment of the PVC site and nursing interventions were recorded. A total of 554 PVCs in 397 patients were surveyed of which 28 (5%) had site infection. There was no related bloodstream infection (BSI). Overall, PVCs were assessed 450 (81%) times by nurses. Malfunction was reported 95 (17%) times, pain 28 (5%) times and pyrexia 10 (2%) times. Characteristics that showed significant difference between 28 infected and 526 non-infected PVCs included when nurses assessed PVCs as infected, and nurses' intervention for PVCs inserted for 1–3 days’ duration. Other characteristics were resiting PVCs when associated with malfunction and also resiting because of pain. The involvement of the ICN was likely to have contributed to the low infection rate. While not conclusive this survey identified characteristics between infected and non-infected PVCs that may have been associated with this low infection rate, namely, nurses’ overall intervention in PVC care and assessment that is focused on identifying infection, and resiting for malfunction and pain. These are simple assessment and intervention measures that should not require the assignment of a dedicated ICN, but which are within the capabilities of all healthcare workers entrusted with PVC care.
Modern students suffer from acute reality shock
Authors: Castledine George
Published: May 2014

We are at that time of year when student nurses become registered professional nurses, and when the reality of making the transition from student to employee in the healthcare system starts to have its biggest impact. The name used to describe this phenomenon is ‘reality shock’ and refers to the ‘specific shock-like reactions of new workers when they find themselves in a work situation for which they have spent several years preparing and for which they thought they were going to be prepared and then suddenly find they are not’ (Kramer, 1974).
Consultation to restore public trust following organ scandals
Authors: Dimond Bridgit
Published: May 2014

The breach of trust which was evidenced following the retention and storage of human organs at Alder Hey and Bristol Royal Infirmary will take a long time to repair. The Department of Health (DoH) took steps to respond to the grief of the thousands of relatives affected and set up the Retained Organs Commission (ROC) to oversee the return of tissues and organs from collections around the country, provide information on the various collections, and ensure that suitable counselling is available.
Web Watch
Authors: Mangan Paul
Published: May 2014

This edition of Web Watch looks at sites relating to stroke. While we have been careful to list only sites that have been recommended by specialists in the field, we re-emphasize our usual warning about evaluating any material you get from the internet in the same way that you would with materials you find anywhere else.
Nurses must ensure they communicate with clients
Authors: Castledine George
Published: May 2014

Poor communication is usually at the heart of many of the problems which patients and their relatives face in today's health service. Despite all the emphasis on training, speaking appropriately and listening to people, major problems continue to exist.
Spiritual coping mechanisms in chronically ill patients
Authors: Narayanasamy Aru
Published: May 2014

Addressing spiritual needs is acknowledged as an essential component of holistic nursing care. Findings are emerging that suggest that chronic illness demands significant changes in patients' lifestyle. In such circumstances it is claimed that spiritual care can be therapeutic to patients (Cohen et al, 2000; Sherwood, 2000). This study was carried out in order to understand further the spiritual coping mechanisms of patients suffering from chronic illness. A qualitative methodology based on descriptive phenomenology was used to capture participants' lived experience. The main themes emerging from this study suggest that chronic illness led participants to use the following spiritual coping mechanisms: faith, prayer, and related sources of support. Patients coping with chronic illness were engaged in both a personal and private struggle. Patients may benefit from nursing interventions that are sensitive, supportive, and responsive to their spiritual needs.
Pregnant minors: confidentiality issues and nurses’ duties
Authors: Allmark Peter
Published: May 2014

Abortions in those under 16 years of age raise the issue of what to do in the face of a request that the young person's parents not be involved. The first question in such cases is whether or not the young person is competent to request confidentiality. A young person who is competent is owed the same duty of confidentiality as an adult. In practice this means that some such requests can be granted straightforwardly. However, in many cases the teenager's pregnancy raises concern about child abuse. In the face of a serious crime the obligation to respect confidentiality is overridden. This creates a dilemma. We cannot respect confidentiality fully in such cases, but a policy of failing to do so may lead young people to seek (illegitimate) help elsewhere. Therefore, reform of the current system may be needed.
Patient comfort rounds: a new initiative in nursing
Authors: Castledine George
Published: May 2014

Today the sight of nurses making ward rounds to check patients’ comfort needs, especially in pressure area care, has long gone. In the past, a ‘back trolley’ was prepared containing a bowl of warm water, soap, washing cloths, towels, bed linen and a variety of products such as talcum powder, methylated spirit, zinc, castor oil and silicone cream. Two nurses would then work their way round the ward, starting with the most ill patients. Patients valued them because it was a chance to talk through their concerns and freshen up ready for visitors and/or their next phase of treatment.
Development of a screening tool to assess risk of tardive dyskinesia
Authors: Taylor Jean
Published: May 2014

This article gives an overview of antipsychotic medication and of tardive dyskinesia (TD). It examines the research available on TD as it relates to people with a learning disability (PWLD). The evidence identifies that specific groups of people are at an increased risk of developing TD. It also shows that 45's50% of PWLD who are treated with antipsychotic medication will be affected by TD. The evidence is used in the formulation of an assessment tool designed for use by the community learning disability nurse to identify an individual's risk of developing TD before commencing medication. Litigation in the USA has led to a $6.7m award for negligence after a person developed TD. The present demand for sound, clinically effective practice and evidence-based interventions requires that practitioners are accountable for their practice, but are also seen to transform existing services in a way which improves the delivery of quality interventions and care.
Nurses of all levels can improve patients' experience of health care
Authors: Mullally Sarah
Published: May 2014

This edition celebrates the 10th anniversary of the British Journal of Nursing (BJN) and I am delighted to have been invited to mark the event, and to acknowledge the achievement of the editorial team and all those nurses who have contributed to the journal over the past decade. The journal has pursued the aims and mission set out in the very first edition identifying nursing as a learned profession. It has provided a forum for debate on clinical practice, research, education and management and non-clinical aspects of nursing and health care — emphasizing the wider context with political, ethical, legal, and European perspectives. The need for professional debate and discussion is as strong today as ever.
What is the evidence for specific pressure-reducing mattresses?
Authors: Russell Linda
Published: May 2014

Pressure-reducing mattresses play an integral role in the prevention of pressure ulcers. Every year an everincreasing variety of equipment is launched on to the market. The efficacy of this equipment is traditionally qualified with case studies but rarely with randomized controlled trials. With the advent of The New NHS: Modern, Dependable (Department of Health, 1997) and the National Institute for Clinical Excellence's (NICE's) pressure ulcer risk assessment and prevention guidance (NICE, 2001), clinical governance systems have started to be put into place and hopefully more evidence will be produced by the manufacturers and the NHS.
Nurses should know how to tackle alcohol withdrawal
Authors: Castledine George
Published: May 2014

One of the biggest problems facing nurses today is caring for patients who abuse alcohol. This is because there are not only physical complications but also behavioural manifestations. Thousands of people each day are admitted to hospitals for various medical reasons and a proportion of these will have a problem with alcohol consumption.
A review of thigh-length vs knee-length antiembolism stockings
Authors: Ingram Janet E
Published: May 2014

Knee-length and thigh-length antiembolism (AE) stockings are used to prevent deep vein thrombosis in medical and surgical patients who are at risk because of periods of immobilization while in hospital. The aim of this review was to compare the effectiveness of both lengths of stocking and consider the implications for nursing practice. An electronic search was performed using Medline and Cinahl and a hand search was also conducted. Four studies and a literature review were selected. These studies indicated that knee-length AE stockings were equally effective as, were associated with better patient compliance and were more cost-effective than thigh-length stockings. However, as with thigh-length stockings, they require accurate measurement and correct fitting if associated complications are to be avoided, highlighting the need for better education for both practitioners and patients.
The cost-effective use of BagBath: a new concept in patient hygiene
Authors: Collins Fiona , Hampton Sylvie
Published: May 2014

The future of nursing promises dynamic change and continual challenges, with exciting healthcare reform in progress and technologies as yet undreamed of on the nursing horizon. The modern nurse must offer high-quality patient care and should be constantly striving for cost-effective methods of providing that care. In this product focus, the prevalent practice of ‘bed bathing’ is considered along with cost-effectiveness of the practice and infection control potential when compared with the new concept of BagBath (Westholme Ltd). BagBath is a quick-drying one-step bed bath product offered as an alternative to the bowl of water, soap and flannel.
Infection control: validity and reliability in wound swabbing
Authors: Kelly Fiona
Published: May 2014

Wound infection is initially identified by the recognition of clinical signs and symptoms such as pus and cellulitis. Wounds are, however, cultured in order to establish the causative organism and ensure appropriate treatment. A ‘gold standard’ method for wound sampling has not been established although the literature details wound swabbing and looks at the variations in practice within this method. A number of procedural issues are raised which prompt the need for further study to eliminate these variables and reach consensus as to how to achieve a meaningful result, thereby increasing the validity and reliability.
Do not attempt resuscitation decisions: the nursing role
Authors: Jepson Jacqueline
Published: May 2014

This exploratory study examines the roles of hospital and practice nurses with regard to do not attempt resuscitation (DNAR) decisions. The British Medical Association (BMA) and the Royal College of Nursing (RCN) have published joint DNAR guidelines. One NHS trust responded by developing a local DNAR policy written for use in hospital and general practice. The study focuses on aspects of compliance with the policy and hence DNAR decision making, in particular, the nurse's involvement in the decision-making process. The response rate to self-administered questionnaires to practice nurses was 52% (n=45). Hospital nurses (n=49) were selected for interview using a quota-sampling technique. Comparisons were made of the views of acute and community staff in their use of the DNAR policy. A clear finding is that hospital nurses wish for more autonomy in DNAR decision making and improved methods of communicating with medical colleagues when decisions are made. Practice nurses are currently not involved in DNAR decisions. The appropriateness of developing policies for such complex issues as DNAR, when compliance remains low, questions their validity. This study raises awareness, and adds to the discussion for the need for a multidisciplinary approach to DNAR policy.
The meaning of caring in the practice of intensive care nursing
Authors: Wilkin Kathleen
Published: May 2014

Caring is perceived as human behaviour that includes cognitive, affective, psychomotor and administrative skills within which professional caring may be expressed. It is a vital resource within the highly technological area of the intensive care unit (ICU). The terms care and caring are predominantly used to describe the inherent work and value of nursing. Nursing is a nurturing profession and caring is the essential component of its holistic practice, especially with the critically ill patient. The concept of caring in the ICU is central to the social relationship between the nurse, the patient and his/her relatives. Although caring is not unique to nursing, there is substantive, existing and developing knowledge related to caring in nursing.

The concept of caring has been extensively explored in the literature. However, there is still little clarity in the understanding, description, relevance or function of caring in nursing.
Medicinal products and consent by mentally incapacitated patients
Authors: Dimond Bridgit
Published: May 2014

Agnes Daily is on the medical ward of Roger Park Hospital following a stroke. She is aggressive towards the nurse and frequently refuses her medication. Can she be forced to receive it?.
Language relating to mental health must be used with care
Authors: Allen Cris
Published: May 2014

Doctor Samuel Johnson, the English lexicographer, would be turning in his grave if he were able to review modern society's use of the English language. In 1750 he wrote: ‘I have laboured to refine our language to grammatical purity, and to clear it from colloquial barbarisms, licentious idioms and irregular combinations.’
Nurse manager's persistent neglect of residents in a nursing home
Authors: Castledine George
Published: May 2014

The Nursing and Midwifery Council's (NMC's) remit, like its predecessor the UKCC, is to protect the public. The current council is a transitional body and has recently published its first professional conduct annual report (NMC, 2003).
Nurse who became unkempt and posed a risk of infection to patients
Authors: Castledine George
Published: May 2014

Martin had worked as a senior staff nurse on an intensive care unit for many years. He had been offered chances of promotion but had never performed well at interview. Over the years this failure to gain promotion had started to affect him and he became careless.
Case report: the malfunctioning implanted venous access device
Authors: Schummer Wolfram , Schummer Claudia , Schelenz Christoph
Published: May 2014

Totally implanted venous access devices (VADs) are an alternative to central line placement for those patients requiring frequent intravenous access. Venous thrombosis, infection, extrusion, extravasation and occlusion are commonly encountered complications of central VADs. Fracture with embolization of implantable venous access catheter is a rare complication of this commonly used device, but it may have serious consequences. Clinical manifestation may include infraclavicular or chest pain, paraesthesias in the arm, cardiac arrhythmias, palpitation or an extra heart sound, in addition to withdrawal occlusion, swelling, and resistance to infusion. Nursing staff should be aware of these signs and symptoms and they should immediately stop any infusion if these signs and symptoms emerge. Whenever problems with a VAD occur a chest radiograph or a contrast enhanced angiographic control of the VAD is advised. This article provides two cases relating to malfunction of a VAD. Despite typical symptoms in both cases a catheter fracture with embolization was not taken into consideration, and a radiological control of the VAD was not performed. It was only by chance that the patients did not sustain any harmful sequels from the broken VAD.
Perceptions of the nursing role in spinal cord injury rehabilitation
Authors: Collis Pellatt Glynis
Published: May 2014

In the UK, over the last 50 years there have been many developments in the rehabilitation of spinal cord-injured people leading to improvements in outcomes. In spinal cord injury rehabilitation nurses work as members of a multiprofessional team but their role is not clearly defined and, unlike other professionals, they have a 24-hour relationship with patients. This article presents some findings from a larger ongoing ethnographic research study. The aim of this section of the study was to identify how nurses and patients perceive the nursing role in spinal cord injury rehabilitation. Semistructured interviews were carried out with 14 spinal cord-injured patients and 14 registered nurses. The findings suggest that patients value the nursing contribution as a means of emotional and physical support but that they do not necessarily see nursing input as rehabilitation. Nurses see their role as multifaceted but identify difficulties in crossing over from an acute care philosophy to a rehabilitation philosophy. The 24-hour close relationship with patients may be a source of imbalanced power relationships between nurses and patients and this causes distress to some patients. It is suggested that nurses need to develop their bedrock role in a way that empowers patients in spinal cord rehabilitation.
TENA flex: a new concept in disposable incontinence pads
Authors: Doherty Willie
Published: May 2014

The development of adult or larger-sized all-in-one incontinence products continues to improve. The latest addition to the many products available for the management of moderate to heavy urinary incontinence is TENA flex, manufactured by SCA Hygiene Products. TENA flex is an all-in-one belt-style product, which does not require separate fixation as with a pad and pant system, and relies upon a different measurement process to ensure proper pad selection, fitting and positioning. The range of TENA flex features will be discussed in this article.
Advance directives are challenging for nurses
Authors: Castledine George
Published: May 2014

Advance directives are legal mechanisms that enable people to make decisions about their treatment before a health-threatening event prevents them from such decision making. It is believed by many that advance directives enhance individualism by providing a written document, signed by the person, indicating what that person wants done under certain specified circumstances. Many countries around the world now favour these documents and they are becoming more fashionable in the UK.
People with motor neurone disease not helped by media
Authors: Green Richard
Published: May 2014

Over the past 18 months, there has been an increased awareness of motor neurone disease (MND) among the public and health professionals. Despite its efforts, the MND Association cannot claim all the credit for this increase. In fact, most of it can be attributed to just two people -- Diane Pretty and Reginald Crew.
Role of dangling when moving from supine to standing position
Authors: Dingle Maria
Published: May 2014

This article focuses on the cardiovascular adjustments that take place when an individual makes a change in his/her position, particularly when moving from the supine to the standing position (orthostasis). Some individuals may experience a drop in their blood pressure on assuming the standing position which may lead to dizziness and/or fainting (orthostatic intolerance). Dangling, which is often an intermediary stage of assisting people into the sitting position with their legs hanging over the side of the bed, before moving them into the standing position, is therefore used to ensure that patients are moved safely. This can help to prevent notable reductions in blood pressure. Nurses, therefore, need to be aware of the cardiovascular changes and compensatory mechanisms that take place during orthostasis, in order to be able to make decisions not just about whether their patient can be moved out of bed, but so that it can be done safely without any of the adverse effects of orthostatic intolerance. Those at greatest risk of developing such adverse effects include those with diabetes mellitus, cardiovascular disease and also those with an age-related vagal dysfunction. Some pharmacological agents may also be implicated in contributing to orthostatic intolerance in some individuals. Recommendations for practice include ensuring that dangling the patient is incorporated as part of the procedure of slowly assisting patients out of bed, encouraging leg and foot movement and continually assessing the patient during the procedure. Should any patient show any sign of not tolerating the position change, the procedure should be halted and the patient assisted back into the supine position.
Failure to provide adequate pressure area and personal care
Authors: Castledine George
Published: May 2014

Many complaints these days originate from the close observations of patients' relatives. In the following case, a complaint was made to the Nursing and Midwifery Council (NMC) by Miss M, whose father, Mr M, was a patient on a general medical ward at a hospital.
Traditional Remedies
Authors: Walsh Rachael
Published: May 2014

I left England in January 2002 and went to the tropical country of Belize. I had decided 6 months previously that I needed a change from district nursing, so I became a volunteer on a conservation project in Belize. The project took me to a very remote area of Belize where I slept in hammocks, washed in rivers, built bridges and cleared trails with machetes. I also had a fully equipped medical kit.
TheraPulse ATP for preventing and treating pressure ulcers
Authors: Weston Claire , Hampton Sylvie
Published: May 2014

In the modern healthcare environment where evidence-based best practice is key in seeking quality improvements for patient care, using treatments and therapies that have evidence of clinical efficacy is paramount. The current evidence base supporting pulsating air suspension therapy is excellent and the improved lymphatic flow and enhanced microcirculation along with reduction of pressure ulcer potential (El-Habbal and Smith, 1996; Gunther and Brofeldt, 1996) ensures a firm place for TheraPulse ATP (KCI Medical) in reduction of oedema and pressure ulcers in the critically ill patient.
Managing patients unable to tolerate therapeutic compression
Authors: Bale Sue , Harding Keith G
Published: May 2014

Managing patients with venous ulceration who are unable to tolerate therapeutic compression bandaging is a challenging clinical problem. This study followed a group of 28 such patients who were treated with three layers of graduated Tubigrip as an alternative to therapeutic compression. It also investigated factors that influenced nurses in deciding to use this bandaging system. Patients were followed until their ulcers healed or for a maximum of 12 weeks. The decision to use three layers of graduated Tubigrip was based on 19 patients' desire to wear their normal shoes (67.9%) and the convenience of access to the ulcer by eight patients (28.6%) (to permit frequent dressing changes for large or infected ulcers, and for the daily application of steroidal creams to periulcer skin). Fourteen patients' ulcers had healed within the 12-week study period. The remaining 14 patients had a mean reduction in ulcer area of 4.6cm2 (SD=7.4), and median of 2.3cm2 (range 28.5).The authors found three layers of graduated Tubigrip useful for managing patients who cannot tolerate therapeutic forms of compression.
The importance of palliative care for patients with colorectal cancer
Authors: Black Pat
Published: May 2014

In Westernized countries colorectal cancer is a very common form of cancer, with over 30000 cases registered annually in the UK (Taylor et al, 2002). Cancer of the large bowel is the second most common cause of cancer death, with over 17000 cases per year (Cancer Research Campaign (CRC), 1999). Bowel cancer is related to age, with as many as 80% of cases in people who are 60 years or over. Eighty per cent of patients undergo surgery with curative intent but recurrence will occur in half of these cases (National Cancer Institute, 2001). Palliative care is a person-centred approach that provides essential support to patients with bowel and colorectal cancer with an emphasis on symptom control, and psychological and social support. Care for this group of patients depends on an interdisciplinary approach with mutual respect for all the team members and good communication that enables the patient, where possible, to be involved in any decision-making about care and treatment.
The nursing assessment and management of patients with angina
Authors: Harvey Sharon
Published: May 2014

Coronary heart disease (CHD) is a growing problem in the UK. Angina is just one way that CHD manifests itself in the patient, thus challenging the approach that healthcare professionals use to manage these patients. With approximately 2–4% of all accident and emergency admissions presenting with chest pain, it is important that nurses, who are often the first healthcare professionals to assess the patient, have the appropriate knowledge and expertise to distinguish the aetiology of the chest pain. With CHD being the main cause for illness and death in the UK, it is inevitable that nurses at some point in their career will need to assess and manage patients with this presentation.
Role of the ‘ordinary’ nurse: levels of competencies
Authors: Fulbrook Suzanne
Published: May 2014

In the fourth in her series of commentaries on the current changes taking place in the nursing role, Suzanne Fullbrook looks at the ‘ordinary nurse’ and issues surrounding responsibility and nurses' levels of competencies.
Nurse who compromised patient care through delegating a task
Authors: Khaliullah Kaleem
Published: May 2014

Sheila, a staff nurse, was in charge of a busy surgical ward on the afternoon shift; she was covering for the sister of the ward who had taken a day's annual leave. When Sheila came on duty at noon, she received a handover from Angela, another staff nurse, who had been working on the early shift. When she arrived, Sheila realized that it had been a very busy morning as it was a theatre day and that her own shift was also going to be busy.
Enhancing older people's concordance with taking their medication
Authors: Banning Maggi
Published: May 2014

It has been shown that older people are more likely than younger people to be prescribed a variety and number of medications (Lindley and Tulley, 1992). Older people are especially vulnerable to the effects of medication, particularly because of the possibility of medication mismanagement and non-concordance with prescribed medication regimens. People become increasingly sensitive to the actions of drugs with increasing age and, added to the problems of memory deterioration and physiological changes, medication-taking behaviour can alter quite dramatically (National Prescribing Centre, 2000). Reductions in the quantity of prescribed medication and the use of prescribing indicators aim to improve concordance with medication in older people. Patient education should be an inclusive component of patient care, not a concern before patient discharge. Education can take numerous forms, both written and verbal, and it needs to be patient-centred and specific to the medication being discussed. As healthcare professionals, nurses, pharmacists and medical colleagues should work collaboratively to reduce the frequency of medication mismanagement in older people.
Sexual counselling by cardiac nurses for patients following an MI
Authors: Crumlish Brídín
Published: May 2014

Myocardial infarction (MI) patients often have unanswered questions about resuming sexual activity after this life-threatening event. Coronary care nurses can play an important role in counselling patients in such a sensitive area. However, sexual counselling is an area of nursing practice that is frequently neglected. This article discusses both the patients' and nurses' perceptions of discussing sexual concerns, and explores ways to increase nurses' awareness so that they can offer sexual counselling to patients post-MI.
A collaborative care approach to complex diabetic foot ulceration
Authors: Stanley Stephanie , Turner Lynn
Published: May 2014

This article highlights the complex issues that surround the management of diabetic foot ulceration. It describes how the disciplines of podiatry and tissue viability came together to care for a patient who required complex wound management. The importance of collaborative working is highlighted, which has been shown to reduce amputation rates by 50% (Edmonds, 2002). Through exploration of a case study, certain issues emerged — wound infection, wound management, pyschosocial factors and teamworking — and these are discussed. The link between diabetic foot ulceration and amputation is explored and the argument put forward that amputation should have been the first choice for this patient bearing in mind that 30% of amputees lose their second leg within 5 years (Geary, 2002).
Staff nurse whose lack of competence did not improve after further training
Authors: Castledine George
Published: May 2014

Jean was an experienced staff nurse who went to another ward to help out because of staffing shortages. While she was there some of the patients commented on how long it took her to perform some of the nursing observations. For example, one patient said that when staff nurse Brenda was on duty she carried out the same tasks as Jean did, but in half the time.
Central venous catheters: choosing the most appropriate access route
Authors: Hamilton Helen
Published: May 2014

Intravenous therapy and care is a complex and intricate area of practice, which is being subsumed into the core role of registered nurses. As more patients become recipients of a vascular access device (VAD), particularly those requiring intermediate to long-term central venous access, it is important to ensure that not only the device but also the most appropriate vein meets their clinical, physiological and psychological needs. There is much research and literature on the insertion and care of central venous catheters (CVCs) as well as the detection and treatment of complications. However, apart from a few small studies comparing the performance of devices placed either in the subclavian or jugular veins, there is little to guide doctors or nurses as to which vein is preferable, if secondary complications are to be avoided. This article will describe a number of primary and secondary complications associated with both the subclavian and internal jugular veins and how these can be minimized by selecting the most appropriate vessel. The article concludes with the author's suggestions for correct patient assessment in order that the correct vein is utilized.
New powers to deal with bad practitioners more easily
Authors: Castledine George
Published: May 2014

On 1 August 2004, the Nursing and Midwifery Council's (NMC's) new register and new powers come into force. These are based on the Nursing and Midwifery Order 2001 (SI 2002 No 253). What is particularly interesting and significant about the new rules relating to fitness to practice is that the NMC will have the power to deal with incompetent nurses, and impose new sanctions.
Compensation culture encourages patients to sue
Authors: Tingle John
Published: May 2014

As patients continue to sue the NHS for nurses' and doctors' negligence, steps must be taken to attack the ‘compensation culture’, which may be encouraging some of them to mount spurious claims that block up the system, cause unnecessary expense and stress and lead to defensive clinical practice. Two recently published reports have raised the issue of patients suing their nurses, doctors and NHS trusts for alleged negligence.
But what about mercury in vaccinations?
Authors: Bateson Tony
Published: May 2014

Edward Pursell's article (BJN, Vol 13(14): 834–8) ‘Exploring the evidence surrounding the debate on MMR and autism’ makes a very valuable contribution towards the continuing debate on this subject.
How to survive nursing school: a practical guide
Authors: Castledine George
Published: May 2014

At one time, most nursing students came straight into nursing from secondary schools. Today, however, they come from more varied backgrounds. Whatever their experience, all nurse students must develop survival strategies to help them succeed.