bluuebunny/crossref_metadata_2025 huggingface dataset:
Improving glycaemic control in a metabolically stressed patient in ICU
Authors: Perkins Claire
Published: May 2014

This article describes a clinical experience where the careful application of problem-solving skills has resulted in positive changes in glycaemic care in a critical care environment. The metabolic stress response to trauma injuries leads to episodes of hyperglycaemia. The application of a problem-solving process has resulted in greater understanding of best practice of the management of this problem. The importance of strict control of blood glucose levels in the critically ill patient is highlighted. Although the practice area in this article is a specialized intensive care environment, in light of recent government-led recognition that many patients in hospital are increasingly ill (Department of Health (DoH), 1998a), this situation may arise in many ward environments.
Clinical skills: evidence-based nursing care of people with rheumatoid arthritis
Authors: Hill Jackie , Hale Claire
Published: May 2014

Rheumatoid arthritis is a complex inflammatory disease with an unknown cause, uncertain prognosis and no known cure. The physical symptoms of this chronic disease can impact on the patient's psychological state and also affect the family unit and social/economic viability. Nursing patients with such a multifaceted illness is a skilled and complex task and it is imperative that the care provided is optimal, timely and underpinned by patient education. Evidence-based nursing care founded on an indepth knowledge of the disease and its treatments will help to achieve optimal patient outcome.
Difficulties in developing a nursing research culture in the UK
Authors: Gill Paul
Published: May 2014

Despite the obvious advantages to patient care and professional development, nursing research in the UK is relatively poorly developed and research activity in nursing lags behind many of the more established university disciplines. The reasons for this are complex and numerous. The purpose of this article is to explore the most pertinent issues. For example, there is currently a lack of appropriately qualified research-active staff, the ‘research culture’ in many departments is inadequately developed, dedicated research funding is insufficient and competing demands are commonly placed on nurse academics. In order for research activity to improve significantly many of these problems have to be properly addressed because patient care and professional credibility are at stake.
Clinical skills: importance of nutrition for acutely ill hospital patients
Authors: Brogden Bridgette J
Published: May 2014

Providing good nutrition to patients in hospital has become a primary focus in many NHS trusts. Whether it is provided by hospital food or nutrition support, the impact of adequate food on patient outcome is now well documented. However, the physiological, social and economic consequences of malnutrition in hospitals must be acknowledged. This article provides an overview of the metabolic changes that occur during starvation in health and in illness. The methods used by different healthcare professionals to assess nutrition are summarized. A review of the range of nutrition support options available and indications for their use is provided. Hospital nutrition is considered in the context of recent national and international recommendations.
A nursing perspective on the new plan for the NHS
Authors: Castledine George
Published: May 2014

The Government launched the first plan for the NHS in July 2000 (Department of Health (DoH), 2000). It claims that it has reformed and turned the NHS around and made it more responsive to patients and more in tune with the times. The emphasis has been on producing more doctors and nurses, more new hospitals, reduced waiting times and lower death rates from cancer and heart disease.
Staff nurse who put patients at risk by failing to keep accurate records
Authors: Castledine George
Published: May 2014

One of the most common reasons why nurses are reported to the Nursing and Midwifery Council (NMC) is for failure to keep accurate records of their patients. Ever since 1993, the UKCC, and now the NMC, have published guidelines. Like all publications produced by the nursing regulator, the information is not a rule book which will provide the answer to every question or issue, but a guide to good and safe practice. One of these guidelines documents is on records and record keeping (NMC, 2002).
Clinical skills: a care plan approach to nurse-led extubation
Authors: De Diana
Published: May 2014

Long-term mechanical ventilation (patients who require mechanical ventilation for longer than 24 hours) has been associated with prolonged anxiety, chest infections and high mortality rates. Prolonged mechanical ventilation is also costly, as it tends to be carried out in critical care environments which require high levels of staffing. Therefore, it would appear to be of great benefit to patients, relatives, and all multidisciplinary healthcare professionals concerned in delivering respiratory care, if patient ventilation was kept as brief as possible. Current opinions seem to suggest that nurses can be the key players in reducing the time on a mechanical ventilator for patients and can take the lead on the extubation process of ventilatory weaning.
The refusal of treatment: living wills and the current law in the UK
Authors: Dimond Bridgit
Published: May 2014

David Browne was suffering from motor neurone disease and was anxious to ensure that as his disease progressed and he ceased to be mentally capacitated he would not be given artificial feeding and ventilation. He therefore arranged to draw up a living will in which he gave an advanced refusal of such treatments. The document was duly signed and witnessed. Only 3 months after signing the living will he was severely injured in a road accident and brought into hospital unconscious. He was carrying his living will in his pocket. The doctors were concerned that if they operated and he required ventilation in intensive care, would the living will prevent their providing such treatment and care. What is the law?.
How to run an efficient and safe nurse-led service
Authors: Castledine George
Published: May 2014

Recently I was asked by the Nurses Hypertension Association to give its members some advice about running a nurse-led service. There is no doubt that opportunities abound at the moment for nurses to develop their roles and independent nursing practice. The Government is pushing the modernization of the health service so that there will be a greater emphasis on community care and, in particular, on the ambulatory setting. For example, registered nurses are now being appointed to serve as telephone advice nurses, drop-in clinic nurse practitioners, preoperative patient education and assessment nurses, and to provide special education and monitoring of patients with chronic diseases.
Quality-of-life and asthma control with low-dose inhaled corticosteroids
Authors: Roberts June , Williams Angela
Published: May 2014

Guidelines are available to assist healthcare professionals in the appropriate management of patients with asthma, a highly prevalent and debilitating disease. Despite these guidelines many patients are still not being optimally treated, often resulting in poor asthma control and consequent impact on health-related quality of life (HRQoL). The present study concerns the findings of a multinational survey designed to evaluate the reported level of asthma control and HRQoL of patients with asthma. This analysis focuses on those patients receiving treatment with low-dose inhaled corticosteroid (ICS) alone. The findings confirm that many patients on a low-dose ICS alone are not receiving appropriate treatment to control their asthma, and this has a marked negative impact on their HRQoL. Revising management and treatment can improve asthma control and HRQoL for these patients, liberating them from the burden of this disease.
Managing a breast sinus wound in the community: a care study
Authors: Bell Elaine S
Published: May 2014

The district nursing team had to manage a breast sinus wound which produced copious amounts of exudate and caused further problems because of its shape and position. Using a hydrofibre dressing the wound successfully healed without causing any problems with maceration to the surrounding skin. However, the nurses were unsure as to what was the correct amount of dressing to pack into the wound, as there are no specific guidelines on how tightly to pack wounds and this can influence the successful outcome of wound healing. In addition, this case showed the impact of the patient's altered body image as a result of her mastectomy.
Exploring the relationship between caring, love and intimacy in nursing
Authors: Dowling Maura
Published: May 2014

This article uses the five distinct perspectives on caring proposed by Morse et al (1990) to illustrate the relationship between love, intimacy and caring. Two distinct types of love, namely Agape (altruism/charity) and filia (brotherly love) are utilized in nursing. Only some caring relationships with patients reach an intimate level, and this is determined by patient characteristics to which the nurse responds. It is concluded that caring as a moral imperative is the most relevant to discussions on caring in nursing and the perspective on which the other four viewpoints hinge.
The need for critical care nurse education at preregistration level
Authors: Higginson Ray , Lewis Chris , De Diana , Jones Bridie
Published: May 2014

In order to deliver a comprehensive and high-quality intensive care service, all intensive care providers must be suitably educated and trained. Both the NHS and higher education establishments have been subjected to radical reviews and reforms in order that they meet the educational demands of a changing healthcare system which requires that critical care be delivered to all patients whenever they need it and wherever they are being nursed in the hospital. To be able to deliver critical care throughout the whole of a hospital is a huge challenge. In order to impact upon patient morbidity/mortality, all staff nurses will need to learn, develop and employ critical care skills. In this article, we will explore issues that surround critical care education for all nurses.
Can the underlying principles of art be applied to nursing?
Authors: Paniagua Hilary
Published: May 2014

It is a common assumption that nursing is an art, yet the art of nursing is a term for which there is little definitional agreement and understanding. Problems surrounding the art of nursing are rooted in dilemmas connected to philosophical issues and ideas, as well as the strong value associated with science. The concept of art is embedded within many theories and distinctions, for which there is no consensus of opinion. This article reappraises the literature on the artfulness in nursing, and by examining aesthetic theories, offers a different perspective to that of considering the existence of an art of nursing as a forgone conclusion.
The views of children and their families on being in hospital
Authors: Battrick Cath , Glasper Edward Alan
Published: May 2014

This study aimed to elicit the separate views of children, young people and carers after a period in hospital as an inpatient. Questionnaires were administered to 130 children and their families discharged after a period as hospital inpatients in January 2003. Anonymized data were returned from 50 families. Data analysis indicated that there were differences in the way that the three groups perceived the period of admission. Although parental sleeping and other social arrangements were subject to some critical review, the nursing care experienced by families was highly rated. Although arrangements for discharge were deemed satisfactory, 38% of carers had to wait for medicines to arrive on the ward before they could go home. Only six of the young people felt their ward catered for their age group and five indicated poor levels of privacy. None of the young people indicated that they had used the equipped teenagers' room. Attempts to include the voice of the younger child in this study proved unsatisfactory as parents elected to act as proxies in completing the child-specific questionnaires. Child healthcare professionals attempting to involve all service users in determining optimum levels of care need to consider fully the methods of data collection and their applicability for differing age groups of children. Dependence on adult carers to reflect accurately the voice of the child is not fully satisfactory.
Improving the quality of patient discharge from emergency settings
Authors: Lees Liz
Published: May 2014

This article describes a nurse-led telephone service that was introduced to improve the quality of patient discharge from the emergency assessment area (EAA) of a large NHS acute teaching trust. The service originated from concerns regarding the increasing volume of telephone enquiries received from patients after discharge. In addition, an audit of patients' discharge plans revealed a minimalist/cursory approach to documentation. To improve discharge practice, a nurse-led telephone follow-up was introduced for all patients within 24 hours of discharge from the EAA. Evaluation over the first 12 months demonstrated improvement in the quality of discharge documentation and more explicit discharge plans. The service has successfully addressed issues regarding follow-up arrangements, documentation, new prescribed medications and GP letters. For its second year of operation, the service has been refocused using criteria linked to a new ‘patient-focused’ discharge checklist before discharge, to determine who is most likely to need telephone follow-up.
Clinical skills: the physiological basis and interpretation of the ECG
Authors: Khan Ehsan
Published: May 2014

Electrocardiograph (ECG) interpretation is a complex subject that requires considerable experience. However, an understanding of the principles underlying generation of the ECG can make this learning process easier. This knowledge is necessary if interpretation is to be founded on understanding rather then being a pattern recognition-based process. The aim of this article is to introduce the practitioner to the basic processes and mechanisms that govern formation of the normal ECG. These principles will largely be applied to the normal ECG and include cardiac anatomy applied to the ECG, how the ECG leads look at the heart and how the normal ECG waveform is formed. Examples of how the ECG changes when the underlying mechanisms are disturbed will also be given. Together, this knowledge should help the practitioner to have a clearer understanding of interpreting the abnormalities seen on an ECG.
Infection control: maintaining the personal hygiene of patients and staff
Authors: Parker Lynn
Published: May 2014

This article concentrates on the importance of personal hygiene for staff and patients in reducing the risk of healthcare-associated infections for patients. It provides an historical context to the associated risks of ‘basic nursing care’ and how these can be counteracted. With the introduction of modern matrons and directors of infection control, emphasis is again focused on these practices.
What do the public think of the new `nurdoc' role?
Authors: Fullbrook Suzanne
Published: May 2014

In the third in her series of commentaries on the current changes taking place to the nursing role, Suzanne Fullbrook looks at the effects that nurse role expansion are having on the public's expectations of nurses, and issues relating to accountability and remuneration.
Nutrition 1: a vital consideration in the management of skin wounds
Authors: Lansdown Alan BG
Published: May 2014

Nutrition is a provocative subject in tissue repair, particularly in relation to the skin which consists of many different tissues fulfilling various essential functions. This article, the first in a two-part series, will discuss the structure of the human skin and its variations, with indications as to the individual requirements of the cells in fulfilling their normal role in skin physiology and in repair systems. Nutrient gradients seem to play a major role in normal skin physiology and repair systems following injury. The second part will discuss in more detail the importance of major nutrient factors and their inter-relationships in tissue repair. It is clear that much of our available knowledge is derived from experimental studies in animals. Their relevance in human wound healing may be equivocal as the human skin is unique in the animal kingdom.
An online ordering system for therapy beds and mattresses
Authors: Milne Jeanette , Pagnamenta Fania
Published: May 2014

Within this article, the authors have put forward a solution to keep track of pressure-relieving devices using internet-based secure online systems. In partnership with a therapy bed company they set up a system that was able to manage and monitor the requirements of their trust and ensure that products are used for patients who most need them. In using these systems they were also able to gather real-time data on usage and costs as well as time-dependent analysis. The system has also allowed a means of gathering outcome measurement of all products in use. Over a 6-month period the authors have shown how a forecasted 18% budget deficit has been turned into a 10% under spend of the overall budget. It is suggested that these systems could be one way of managing the pressure-relieving needs of hospital trusts ensuring both clinical effectiveness and cost-benefit.
Nursing role in the multidisciplinary management of motor neurone disease
Authors: Skelton Jane
Published: May 2014

Motor neurone disease (MND) is a debilitating and progressive neurological disorder in which degeneration of the motor neurones results in muscle weakness and wasting. Recent high-profile media coverage about assisted suicide and euthanasia has increased awareness of MND and yet still relatively little is known or understood about it, even among the healthcare profession. This article looks at the key areas in management of patients with MND, including the role of the nurse and the importance of a well coordinated multidisciplinary team. Ways to deal with communication problems, respiratory dysfunction, feeding and nutrition, and legal and ethical issues are examined. Good management of patients with MND involves a hospital and community-based multidisciplinary team. The essence of care is good symptomatic management of respiratory failure and nutritional problems that result from difficulties in swallowing and increasing dependency. Palliative care should be introduced before the terminal stages after careful discussion with the patient and carers. Most patients with MND die from pulmonary infections or respiratory failure, but contrary to popular belief, death by choking attacks is rare and the final stages of MND are usually peaceful and dignified.
Peripheral intravenous catheters: considerations in theory and practice
Authors: Trim Joanna C
Published: May 2014

Inserting peripheral intravenous catheters is a clinical skill that is increasingly becoming part of nurses' remit because of a number of changes in the NHS, including a reduction in junior doctors' working hours and role development. To undertake this skill it is important that nurses receive the appropriate education and can provide evidence of training and competence. A hospital policy is essential to standardize practice and ensure an evidence base. However, all practitioners should be aware that it is their responsibility to maintain their practice and keep up to date. This article provides both the theoretical and practical knowledge to assist nurses who wish to include cannulation as part of their clinical remit.
Psychological implications of admission to critical care
Authors: Pattison Natalie
Published: May 2014

Admission to critical care can have far-reaching psychological effects because of the distinct environment. Critical care services are being re-shaped to address long-term sequelae, including post-traumatic stress disorder, anxiety and depression. The long-term consequences of critical illness not only cost the individual, but also have implications for society, such as diminished areas of health-related quality-of-life in sleep, reduced ability to return to work and enjoy recreational activities (Audit Commission, 1999; Hayes et al, 2000). The debate around the phenomenon of intensive care unit (ICU) syndrome is discussed with reference to current thinking. After critical care, patients may experience amnesia, continued hallucinations or flashbacks, anxiety, depression, and dreams and nightmares. Nursing care for patients while in the critical care environment can have a positive effect on psychological well-being. Facilitating communication, explaining care and rationalizing interventions, ensuring patients are orientated to time and place, reassuring patients about transfer, providing patients, where possible, with information about critical care before admission and considering anxiolytic use, are all practices that have a beneficial impact on patient care. Follow-up services can help patients come to terms with their experiences of critical illness and provide the opportunity for themto access further intervention if required. Working towards providing optimal psychological care will have a positive effect on patients' psychological recovery and may also help physical recuperation after critical care.
Improving service delivery for relapse management in multiple sclerosis
Authors: Warner Richard , Thomas Del , Martin RosWell
Published: May 2014

This action research study was conducted over an 18-month period within a district general hospital. The study has improved the quality of the service provided to people experiencing a relapse of multiple sclerosis. The authors now identify and treat a three-fold increase in relapse patients. At least 85% of these patients are treated within 10days of reporting symptoms to a specialist nurse. Before the study, only 12% of patients received treatment within this time. The authors' data identify what patients valued about this service and also inform debate around distress associated with relapse and how services should develop to respond to this. The study is of particular importance to the UK because the National Institute for Clinical Excellence (NICE) has published guidance to the NHS about the management of this specific patient group (NICE, 2003). This study also clearly demonstrates how specialist nursing services can combine a substantial clinical role with instigating and managing change in service delivery that results in improvements in patient care.
Senior nurse who demeaned the spiritual beliefs of patients and staff
Authors: Castledine George
Published: May 2014

It is important in the holistic care of patients to consider their need to pursue their spiritual and religious practices. Illness and old age often awaken or accentuate a spiritual need and nurses need to develop the skill of encouraging the patient to express his feelings and needs for religious observances, such as attending religious services. In the following case Mandy, who was an agnostic, was a senior nurse in charge of a care home in the south of England. The unit was for older residents with severe learning disabilities, who were very heavily dependant on their carers.
Innovative ways of responding to the information needs of people with MS
Authors: MacLean Rhona , Russell Andrew
Published: May 2014

There have been a number of studies looking into the information needs of people with multiple sclerosis (MS). All the studies have shown that people with MS want information tailored to their individual requirements, delivered in different formats and within a time-frame to suit them. This article reviews the studies and demonstrates how two neurology centres in Leeds and York have striven to meet the needs and expectations of the client group. By continuing to include service users in developments, and carrying out audits, these centres are continually aiming to improve services for people with MS, as well as responding to the recommendations in the National Institute for Clinical Excellence guidelines for MS and the recently published Department of Health ‘National Service Framework for Long-term Conditions’.
Utilizing physiological knowledge to care for acute renal failure
Authors: Perkins Claire , Kisiel Maria
Published: May 2014

Nursing can play a pivotal role in promoting positive outcomes in patients who are both at risk of, and experiencing, an episode of acute renal failure (ARF). ARF is potentially recoverable to the extent that 94% of survivors have the potential to be dialysis independent. This article highlights the positive impact ward-based nurses can have on this group of patients through the use of a commonly encountered clinical scenario. Key aspects of renal physiology are utilized to ensure that the aetiology of ARF is clearly understood. Treatment and specific nursing care is discussed in order to enhance the quality of care delivered to this group of patients.
Caring for catheterized patients: urinary catheter maintenance
Authors: Rew Maggie
Published: May 2014

This article brings together the evidence and opinions surrounding the ongoing problem of catheter blockage and how to help maintain catheter life. The reasons behind blockage are examined as well as the roles that pH testing and building a comprehensive catheter history, including all aspects of patients' general health, play in caring for the catheterized patient. The use of catheter-maintenance solutions is addressed with discussion on smaller volumes, the use of double instillations and gentle technique for a shorter time of instillation and improvement in catheter-intervention techniques.
The safety and dignity of patients and nurses during patient handling
Authors: Collis Pellatt Glynis
Published: May 2014

Since the implementation of the Moving and Handling Operations Regulations (Health and Safety Executive, 1992) there has been considerable effort to reduce back injury among nurses by developing patient handling policy that eliminates actual manual handling. Recently, however, there have been challenges to ‘no manual handling’ policies by patients as an issue of dignity and human rights. This article offers a literature-based discussion of patient handling in relation to safety and dignity for both patients and nurses. The literature does not offer a solid evidence base for handling practice, and research, involving patents, is limited. However, nurses' handling practice is governed by legislation and NHS Trust policies. Patient handling that is safe and dignified for both patient and handler is a vital skill that requires knowledge and competence. This article suggests ways of developing practice that is safe and dignified for both patient and handler.
The importance of skin care and assessment
Authors: Holloway Samantha , Jones Vanessa
Published: May 2014

This article discusses the importance of skin care, including the more general aspects of skin care for the whole body. The information provided should be of benefit to both general and specialist nurses who have a specific responsibility for patients at risk of skin breakdown or damage. By outlining the structure and function of the skin, explaining how skin is damaged, examining the effects of incontinence and questioning current skin cleansing practices, the practitioner will be guided through the process of skin assessment and be introduced to skin care protocols.
Blood transfusion and Jehovah's Witnesses: the legal and ethical issues
Authors: McInroy Ally
Published: May 2014

A critical incident is any event that had an effect, or could have had an effect, on the welfare of a patient. Patients must be treated with respect by staff who demonstrate that they are sensitive to individual needs, values, beliefs and cultural background. This article will examine the legal and ethical issues relevant to the right of an unconscious Jehovah's Witness in an intensive care unit (ICU) to refuse a blood transfusion. The concepts of consent, capacity to consent, necessity to act, advance directives, decision making, consequences of failing to obtain consent, ethical principles, human rights and the best interests of the patient will be explored, in the light of relevant statute and case law, in order to demonstrate some of the legal and ethical complexities within acute healthcare delivery.
Palliative care: challenges in caring for dying people
Authors: Burt Jenni , Shipman Cathy
Published: May 2014

On average, 610000 people die in the UK each year, but only one in five of these will die at home (Office for National Statistics (ONS), 2005). Enabling people to die at home, if they so wish and if circumstances permit, is a major focus of the Department of Health's (DoH, 2004) end-of-life strategy.
Benefits of narrative therapy: holistic interventions at the end of life
Authors: Noble Agnes , Jones Colin
Published: May 2014

Clinical experience tells us that the activity of ‘putting the house in order’ as patients reach the terminal stage in their illness is both a common and legitimate exercise. This process can entail many activities, both physical and emotional. For example, arranging financial affairs, making a will, compiling a living will, organizing their own funeral, completing unfinished emotional business, and perhaps most importantly, pondering the very meaning of life itself. In a continual search to find innovative ways of supporting those who are touched by death and dying, this article will discuss how narrative therapeutic approaches could be helpful in supporting the family of a terminally ill patient who is ‘putting the house in order’. Incorporated within this specialist area are perceptions of death and dying, theories of death and dying as well as emotions and the search for meaning. Also under review will be the evidence base for psychotherapeutic interventions, and a review of the narrative therapy approach.
A guide to male catheterization and sexuality and quality of life
Authors: Hampton Sylvie
Published: May 2014

Male catheterization has traditionally been the domain of the doctor and male nurse but, in modern health care, it is seen as a skill that should be part of the general nurses' education, regardless of their gender. This improves the speed of care for the male patient requiring catheterization and increases quality of care. However, the female nurse may find difficulty in asking questions about the patient's sexual health, which should be included in the assessment, and therefore this subject should be included in the nurse's education.
Believing the patient with chronic pain: a review of the literature
Authors: Clarke Kathryn A , Iphofen Ron
Published: May 2014

The aim of this article is to review the literature on studies on the effect of having health professionals treat a patient's pain experience as credible and to propose considerations for nursing practice. A systematic literature search was performed via Cinahl, Medline, British Nursing Index, Cochrane and PsychINFO from 1970–2003 using the key words ‘chronic pain’, ‘attitude’, ‘confirmation’, ‘listening to’ and ‘belief’. Study findings were reviewed in relation to the effect of ‘being believed’. There are no studies that look exclusively at the affects of having a health professional believe a patient’s reported pain experience; however, within the literature there are several references to the need to examine this phenomenon. Future research in this area is needed to provide direction for clinical practice for nurses in this aspect of chronic pain management.
The role of omega-3-fatty acids in the prevention of cardiac events
Authors: Banning Maggi
Published: May 2014

Cardiac disease continues to be a major cause of death in the Western world. Several preventive measures can be implemented to reduce the risk of a cardiac event. One of these measures is diet. A diet that is rich in fatty fish provides a considerable quantity of omega-3-fatty acids. These fatty acids have been shown to reduce the risk of cardiac events such as arrhythmias, stroke and thrombosis. The nurse has a key health education role to play in the promotion of healthy eating in order to reduce the incidence of cardiac events in patients with existing cardiac disease.
Communicating health promotion in nursing
Authors: Narayanasamy Aru , Narayanasamy Mani
Published: May 2014

The depressing comment from a user in a recent BJN article, ‘What makes a good nurse?’ (Rush and Cook, 2006 p384) reflects that nurses may not measure up as credible health promoters:
Student nurses' knowledge and attitudes toward CAM therapies
Authors: Laurenson Mary , MacDonald Julie , McCready Tracey , Stimpson Ann
Published: May 2014

Hessig et al (2004) highlight that nurses value complementary and alternative therapies (CAM) but lack the knowledge regarding their application. They suggest that education can affect knowledge and application of CAM in nursing practice. Complementary and alternative therapy input into the pre-registration nursing curriculum is sporadic and higher education institutions need to incorporate CAM therapies more fully into professional education (Department of Health, 2003). This study investigated the knowledge and attitudes student nurses have to CAM therapies and their use in cancer and palliative care. Ethical approval was sought from the ethics committee at the University of Hull. A quantitative evaluative study using a convenience sample of student nurses in their final semester of pre-registration nurse education was used. Data were collected via a questionnaire; the findings demonstrate the respondents’ acknowledgement of their limited knowledge of CAM therapies and the study has highlighted the need to continue working towards integrated CAM education into the pre-registration nursing curriculum.
Inequality, discrimination and neglect: men's health
Authors: Peate Ian
Published: May 2014

The fifth National Men's Health Week takes place in June under the auspices of the Men's Health Forum, with the theme focusing on men and mental wellbeing. Suicide is the most common cause of death in men under 35years of age; in total over 75% of suicides in the UK are carried out by men (Department of Health, 2002). This stark statistic clearly demonstrates that all is not well for men; this is a plague on our society and our profession.
Foundation training assessments: an education for us all
Authors: Crockard Alan
Published: May 2014

As healthcare professionals, the care and wellbeing of patients is our number one priority. In recognition of the need for improved patient care, Modernising Medical Careers (MMC) is a Department of Health reform which has launched a new structured career framework for doctors. This incorporates the introduction of foundation training for medical school graduates, specialist/GP ‘run-through’ training and new routes for career-grade doctors. The first of these reforms launched with the two-year Foundation Programme in August 2005. The new specialist/GP run-through training programmes will begin in August 2007. The programmes are underpinned by in-work assessments of skills to which nurses have a central and vital part to play.
Nursing education changes and reduced standards of quality care
Authors: Finlay Noeleen , James Christine , Irwin Joan
Published: May 2014

In acknowledging the evidence pointing to decreased standards of care, the authors accept the need to address identified problems. However, quality resolution will not occur by solely overhauling nurse education. The sum and substance of nursing requires that all key players influencing pre-registration nurse education must own their part in the problem. This paper addresses the main players, aims to define their roles and identifies the strategies necessary to address these serious concerns. National debate is required as is specific role identification. However, this will be to no avail if leadership, monitoring and the application of sanctions for non-compliance are not reinstated at both national and local levels.
The environment of nursing care
Authors: Castledine George
Published: May 2014

The appropriate environment is a crucial part of the delivery of nursing care. Much has been made of its importance, and of course Nightingale claimed that the environment should not do the patient any harm. Even in the home the past housekeeping books of Mrs Beeton and her contemporaries all stressed the need for a properly prepared room for the nursing of the sick. Today, of course, we do not go to such extremes but are still aware that wherever the patient is nursed there is a need to consider the environment of care carefully.
Fibromyalgia: aetiology, diagnosis, symptoms and management
Authors: Longley Kathy
Published: May 2014

Fibromyalgia is believed to affect about 2% of the UK population, predominantly women, and is characterized by the symptoms of widespread musculoskeletal pain, persistent fatigue, non-refreshing sleep and generalized stiffness. It is also accompanied by a variety of associated symptoms which can appear baffling to both patient and doctor alike. Research into this often dismissed syndrome has increased exponentially over the last two decades and the evidence is growing to support an underlying pathology involving pain amplification, sleep abnormalities, hormonal imbalance and autonomic nervous system dysfunction. This review looks at diagnosis, research and current treatment options and offers an insight into the patients’ experience wtih the medical and nursing professions.
It's time for nurses to get behind obese patients
Authors: Munro Jane
Published: May 2014

Throughout nurse training and beyond, contemporary themes are reiterated, such as the need for: social inclusion; patient involvement; patients’ rights; the right to fair and equal treatment; human rights and professional accountability.
The dangers of the heat wave for the young, the old and the vulnerable
Authors: Castledine George
Published: May 2014

Lounging about in the sun is a wonderful way to enjoy the summer but there are dangers of course. Every year there are thousands of people who suffer from heat injuries not only in hot countries but also in the UK. In fact, we in Britain are possibly more prone to problems because we are not used to the high temperatures we are experiencing this year. Heat injuries can be very serious and a good knowledge of the mechanisms, signs and symptoms and emergency care procedures is important to prevention as well as intervention.
A care study exploring a patient's non-compliance to haemodialysis
Authors: Murphy Fiona
Published: May 2014

This care study is based on the nursing assessment of a 26-year-old man (MT) who attends a local haemodialysis unit for treatment using Gordon's (1994) functional health patterns. There will be a discussion of this framework and the methods used to assess this patient including an exploration of one of the problem areas identified – that of non-compliance.
A study into the effectiveness of unqualified GP assistants
Authors: Philip Marilyn , Turnbull Betty
Published: May 2014

This article aims to address the potential shortfall in care provision offered by general practitioners (GPs) resulting from pending retirement and the retention and recruitment crisis. An educational module was developed that offered both theory and practise to unqualified general practice assistants. The module content was determined following discussion with local GPs. A small qualitative study of six students was carried out to review efficacy of participants in their new role. Using a grounded theory approach, participant and supervisor views of course content and delivery, role preparation diversity were analysed and compared. Tape recorded interviews were conducted and analysis carried out employing the constant comparative method. Data were coded and emergent themes categorized. Overall, participants agreed that the module had strengthened their knowledge, added new skills, heightened their job satisfaction, added significant diversity to their role and enhanced their employability potential. Five participants communicated that they were more confident in performing clinical skills and advising health improvement techniques. Supervisors also reported that participants displayed a more competent and professional approach to health care, which was complementary to the role of the GP and practice nurse. Ultimately this allowed both GP and practice nurse to focus on dealing with chronic illness targets, as required in the new directive (Scottish Executive, 2004).
Nursing observations: knowledge to help prevent critical illness
Authors: Kisiel Maria , Perkins Claire
Published: May 2014

Early warning scoring systems have made some progress in facilitating the earlier identification of critical illness. Nurses should, however, take a professional responsibility to ensure that they can understand the significance of the patient observations that they have recorded. The authors have illustrated, through the use of a case study, how an understanding of the physiological processes that influence trends in the patient's observations could be vital in the prevention of a serious life-threatening event. Conclusions drawn from analyzing these observations with a problem-solving approach can be effectively communicated to the multidisciplinary team and lead to more appropriate care delivery.
Identifying and managing problem scars
Authors: Pym Karen , Davies Kim , Jimenez Gema , Malloy Lynda , Twyman Lucy
Published: May 2014

A scar is a mark left in the skin by the healing of injured tissue. Outcome depends on the type of trauma causing the scar and how well it is repaired and managed initially. In most people, a scar heals to a fine line, but in others, the scar may grow in all directions, is elevated and remains hyperaemic. Excessive scar tissue is classified either as hypertrophic or keloid. Unfortunately, it is not always easy to predict those patients who will develop problematic scars that require referral to specialist scar management clinics. This article describes the development of a new universal scar risk assessment and management pathway. The pathway was designed specifically to assist practitioners in identifying patients who are at risk of developing problem scars after surgery and to clearly set out evidence-based standards of care that will assist and guide the management for those patients at risk.
Living with venous leg ulceration: issues concerning adherence
Authors: Mudge Elizabeth , Holloway Samantha , Simmonds Wendy , Price Patricia
Published: May 2014

Compression therapy is advocated for the treatment of chronic venous leg ulceration and the proportion of patients whose ulcers heal appears to be directly related to adherence (Moffatt, 2004). The aim of this study was to examine patients' understanding of adherence, in terms of their own experiences of compression bandage systems. Following full ethical approval, a purposeful sample of 6 participants was recruited to take part in a focus group. Free-flowing conversation was encouraged so that the participants could discuss issues that were important to them, although a series of prompts were available to stimulate the conversation when necessary. Four major themes were identified using a phenomenological approach: frustration with the healthcare system leading to a feeling of complacency with primary healthcare teams; functional limitations leading to adaptation of everyday life situations (e.g. bathing and coping with pain); emotional reactions affecting wellbeing and body image, and perception of others; and avoidance of transport, shopping and holidays.
Survey of student nurses and midwives: smoking and alcohol use
Authors: Watson Hazel , Whyte Rosemary , Schartau Elgin , Jamieson Elizabeth
Published: May 2014

This article presents findings from a survey of 186 first year nursing and midwifery students that relate to their smoking and alcohol consumption. Of the students sampled, 28% were cigarette smokers. This is higher than the smoking rate of 25% for the adult population in the UK. The majority of the students who smoked said that they would like to stop smoking. Most of the students (86.5%) reported having drunk alcohol on at least one occasion during the previous week, with 26.5% having had a drink on three or four days. The amount consumed over the week ranged from no drinks to 90, with the mean being 13.72. Worryingly, 74% had exceeded the daily benchmarks for low-risk drinking on at least one occasion during the week for which consumption was reported, and 55% were drinking at binge levels. The findings raise concerns for the future health of many of our students and for their roles as health promoters.
Nurses' experiences of caring for their own family members
Authors: Mills Jayne , Aubeeluck Aimee
Published: May 2014

There is a wealth of literature that addresses the needs of informal caregivers and the needs of health professionals caring for someone with a life-threatening illness. However, there is a paucity of research that deals with nurses who are caring for their own relative who has a life-threatening illness. This qualitative study explores the information needs, support systems available, and the impact that this experience has upon the nurse's quality of life. Individual semi-structured interviews were transcribed and analysed using interpretative phenomenological analysis (Smith and Osbourne, 2003). Four superordinate themes emerged from the data: quality of life, personal and professional boundaries, disempowerment and positive aspects to the role. These themes were then linked to validated models of caregiving (Caron and Bowers 2003; Sherwood et al, 2004) to further explore their impact upon the nurse in his/her role as family carer. This study has established that nurses providing care for their own relatives have specific needs with regard to their dual role as a health professional and family carer. In understanding these specific needs, it may be possible to provide a more effective and equal level of support for these individuals. Implications for practice and future research are discussed.
Constipation services for children: the role of health visitor teams
Authors: Smith Denise , Derrett Sarah
Published: May 2014

Constipation among children is a prevalent condition, yet poorly understood. There is little empirical evidence for ‘best possible’ configurations of services. This article presents a survey of Walsall health visitor team members (HVTMs) which aimed to identify the types of advice and care provided to young children with constipation, pathways to care and ideas for service improvement. Most HVTM consultations were parent-initiated. Few GPs referred children to HVTMs. HVTMs most commonly provided advice about fluids and diet – only one prescribed medication. HVTMs identified the need for early intervention, consistent information for parents and a clear pathway for all health professionals to follow. Currently, a team from the local primary and hospital NHS trusts is developing an integrated care pathway for paediatric constipation. Success of such pathways depends on their adoption by GPs and hospital-based health professionals, and on evidence of efficacy arising from their evaluation.
The management and nursing care of cirrhotic ascites
Authors: Sargent Suzanne
Published: May 2014

Over 3000 deaths from cirrhosis/chronic liver disease are reported in England and Wales each year. However, these figures may underestimate the true extent of liver-related mortality by between 30–60% (Devlin and O'Grady, 1999). As more patients with advanced cirrhosis are being nursed outside of specialist centres, it is essential that health professionals are aware of the management of cirrhotic-related complications. Defined as fluid within the peritoneal cavity, ascites is one of the most frequent complications of cirrhosis, and is considered as the marker of the transition from compensated to decompensated liver disease. The development of ascites is associated with a poor quality of life, increased risk of infections, renal failure and poor long-term outcomes. In recent years, however, there have been several advances in the management of ascites. This article will discuss both the pathophysiology, and the current medical, surgical and nursing management of this condition.