bluuebunny/crossref_metadata_2025 huggingface dataset:
The modified WHO partograph: do we need a latent phase?
Authors: Kwast Barbara E. , Poovan Pia , Vera Edita , Kohls Elaine
Published: May 2014

The objective was to study the frequency and mode of delivery of women admitted in the latent and active phase of labour in St. Luke's Catholic Hospital in Wolisso, Southwest Shoa Zone, Oromia Regional State, Ethiopia. It was a descriptive, retrospective design. Admission phases of labour and mode of delivery were collected for seven months. The modified World Health Organization (WHO) partograph was introduced in Wolisso in January 2007. Analysis of mode of delivery of women admitted in the latent and active phase, showed that women admitted in the latent phase had more operative (both abdominal and vaginal) deliveries as labour progressed to the right of the alert line in active phase compared to women admitted in the active phase of labour. Partographs were generally plotted very well, with 86% of those eligible for partography available for analysis. Application of the management protocol needs to improve as the average monthly C/S rate is 22.5% and augmentation of labour is rarely applied.

It is recommended that a management protocol for women admitted in the latent phase is formulated and applied. Space for these women needs to be organized closer to the labour ward for regular observation in the latent phase and earlier diagnosis of the onset of the active phase of labour.Considering the mean number of 5.857 hours until the active phase was diagnosed, re-introduction of the latent phase on the WHO partograph remains a controversial subject. However, development of, and adherence to, a management protocol for these women is strongly recommended. One-third of the women were admitted in the second stage of labour which means that frequency of partograph use should not be used as a quality of care indicator in management information
Milk production during pregnancy and beyond
Authors: Hilton Sioned
Published: May 2014

The following article will discuss the basic physiology of breast development during pregnancy, the production of milk and hormones involved and the relationship between supply and demand during this time. It also touches on breast milk composition, the changes it goes through following birth and the problems faced by some women as their bodies adjust to motherhood.

The article will introduce the challenges faced by new mothers especially during the transition from feeding in the early days to learning to manage feeding when they become more independent. It offers suggestions on how midwives can support these women.

The article also discusses various methods of expressing and presents a guide to help encourage and support new mothers to feed. This is a vital process to be managed following birth which can greatly affect a newborn's development and if problems occur they must be dealt with immediately.
Nobody wins
Authors: Symon Andrew
Published: May 2014

A recent anonymous ‘Personal View’ in the British Medical Journal highlighted the tensions inherent in the system when a dissatisfied patient tries to obtain information. The circumstances were these: a woman had undergone an emergency hysterectomy to control massive postpartum haemorrhage. She recovered well and was discharged home with her baby, but did not attend for a postnatal follow-up. No further hospital appointments were made.
‘Soft’ forceps—the way forward?
Authors: Wedisinghe Lilantha
Published: May 2014

If a pregnant mother was given an option to choose between forceps and ventouse delivery, the former is unlikely to be the first choice (Murphy et al, 2003). However, as an obstetrician, forceps can be my first choice for some operative vaginal deliveries (Patel and Murphy, 2004). I have been dreaming of some method of balancing the patient's and obstetrician's choice without compromising the outcomes. I met a SHO colleague who had bad experience with a forceps delivery. His first daughter was delivered with a pair of forceps. He was unhappy about the ‘forceps marks’ which were lying across his daughter's lovely face. Consequently, we created the concept of ‘soft forceps’.
Leadership theories relevant to the role of the supervisor of midwives
Authors: Hinchliffe Julie
Published: May 2014

The beginning of the 21st century has seen the importance of strong clinical leadership, at all levels of the NHS, with the result that the quality of care and the safety of services can be improved (King's Fund, 2007; Department of Health, 2008a).

Supervisors of midwives (SOMs) are well placed to provide leadership within the maternity services. The focus of this article is to explore the leadership component of the role of the SOM, and analyse it in relation to leadership strategies and theories, while acknowledging its impact on the quality of care and the reduction of risk that it generates.

Various leadership techniques and models will be offered that can be used by the SOM to execute their leadership role more effectively. Transformational, situational and action-centred leadership is discussed alongside emotional intelligence, and the influence that a group of supervisors can have within an organization.
Caesarean births increase
Authors: Daniel Lincia
Published: May 2014

New figures revealed that nearly one woman in three gives birth through caesarean section in Switzerland and midwives are concerned because there is no medical explanation behind this increase.
Opportunities to improve practice
Authors: Clift-Matthews Victoria
Published: May 2014

The purpose and application in practice of statutory supervision of midwives causes much debate among midwives, from those in the early stages of their careers to those at the top of the profession. There are many who view supervision positively, as a suitable and valued way of governing all midwives and ensuring women receive high-quality maternity care. It is seen as a vital part of the support system and ensures that midwives are appropriately educated. There are also a few midwives who view supervision as punitive and as a way of disempowering midwives under the guise of protection. This issue focuses on supervision and its importance in supporting midwives and contributing to their professional development. Clare Capito explains on page 700 how a period of supervised practice does not have to be difficult, it can be a positive learning experience for everyone involved.
The Glamorgan Gauge: an audit tool for the contact supervisor of midwives
Authors: Davies Janine
Published: May 2014

Midwifery supervision is a vital part of the support system for midwives. This article outlines the development of an audit tool to help improve the effectiveness of the contact supervisor of midwives role. A brief overview will be made of the increased scrutiny and accountability that has become usual in caring for women and their families. The role of the supervisor of midwives will be discussed and its input in clinical governance and risk management will be considered. The role of the contact supervisor of midwives will be explained and acknowledged for its links to the importance of postregistration education and practice to ensure practitioners and supervisors of midwives keep abreast of current issues in theory and practice.
Medicine in pregnancy: whose advice should women trust?
Authors: Bainbridge Jane
Published: May 2014

Pregnant women want the best for their baby and receive a constant stream of advice on what they should and shouldn't do, but how do they know what is really safe when mistakes have been made in the past?
Book Reviews
Authors: Slevin Gary , Pride Jilly
Published: May 2014

Breastfeeding an illustrated guide to diagnosis and treatment is aimed at lactation consultants, midwives and allied health professionals who support breastfeeding mothers.
Care pathways and the latent phase of labour
Authors: Walsh Denis
Published: May 2014

One of the weaknesses in the system regarding research publications is that universities require papers to be published in high calibre journals that are peer reviewed. Sadly, many of these papers never find their way into the hands of clinicians. The journals are either too expensive to subscribe to, papers adopt an off-putting academic style, are in generic nursing/health care journals and, quite frankly, are often structured in rather dull ways.
Nipple confusion in neonates
Authors: Hargreaves Kelda , Harris Anna
Published: May 2014

Breastfeeding is influenced by social factors, some of which motivate women to seek additional feeding solutions, including feeding formula milk or expressed breastmilk (EBM) by bottle. Anecdotal evidence indicates that some women offer bottles of EBM during and after the establishment of breastfeeding and continue to breastfeed successfully. The World Health Organization (WHO) recommends that breastfed infants should not be offered artificial teats during the establishment of breastfeeding. This is due to concerns regarding nipple confusion.

This article confirms that the evidence supporting nipple confusion is inconclusive and that other issues such as supplementation with formula milk can lead to problems labelled as nipple confusion. Breastfeeding advice advocated by WHO may not meet the needs of all breastfeeding women and prescriptive advice from health care professionals may lead to early cessation of breastfeeding which is avoidable. Midwives should be flexible in their approach to breastfeeding and take women's individual needs into account.
Improving development of premature babies
Authors: Bainbridge Jane
Published: May 2014

Premature babies can suffer degrees of mental retardation but researchers in Australia believe this can be significantly reduced by introducing high doses of the fatty acid DHA into the maternal diet.
Quality care is more than a set of processes
Authors: Gould Debby
Published: May 2014

If maternity services can learn anything from the recent report on Mid Staffordshire NHS Foundation Trust (Healthcare Commission, 2009), it must be that ‘quality’ care is much more than a set of processes, and although having systems in place may help improve quality they can never guarantee it.
Routine vaginal examination to check for a nuchal cord
Authors: Jefford Elaine , Fahy Kathleen , Sundin Deborah
Published: May 2014

Many midwives routinely perform a vaginal examination during birth to check for the nuchal cord. Such an invasive procedure would only be consistent with midwifery philosophy if it was common to find a nuchal cord so tight that the only alternative is to cut in order to allow the birth of the baby. A tight nuchal cord, however, seems to be rare. So how did it happen that the invasive procedure of checking for the nuchal cord vaginally became a ritualized practice in contemporary midwifery? The historical literature on the significance of finding a nuchal cord is reviewed in this article.

Checking for the nuchal cord has been advocated by medical textbooks. The call to make this procedure routine for all women was not made in medical texts until the late 17th century onwards. Though an exploration of the historical origins of the procedure it is demonstrated that the arguments used act as a model for the way in which all aspects of birth have been medicalized through fear.

It is hypothesized that when the midwife avoids routine invasive checking for the cord and instead makes individual clinical decisions for each particular woman and baby this may be a marker of her willingness to practice as an autonomous decision maker and not just of follower of ritual.
A privilege to be there
Authors: Stephens Liz
Published: May 2014

I found the recent celebration of the International Day of the Midwife, profoundly moving; the lighting of candles and then extinguishing one every minute brought home, in a very symbolic way, the death of a woman in childbirth every minute of every day. It is absolutely right that we support women and midwives in countries that are less well-resourced than our own. The needless death of a woman in childbirth is a tragedy not only for her but for the family she leaves behind. This also led me to reflect on the fact that, in this context, we can see ourselves as well-resourced. Many of the lives lost in disadvantaged countries could have been saved, not with shiny new hospitals with state-of-the-art equipment and with one midwife for every 28 births. They could be saved by third stage drugs, antibiotics and birth attendants with little more training than our support workers.
Obesity: implications for labour and puerperium
Authors: Veerareddy Sukrutha , Khalil Asma , O'Brien Patrick
Published: May 2014

Obesity is a major public health problem in maternity care. The prevalence is increasing, particularly in economically developed countries, and few interventions are evidence based. Obesity is associated with an increased risk of multiple maternal and perinatal complications. These complications seem to be partly mediated by increased birth weight and increased rates of co-morbidities such as gestational diabetes, and partly mediated by other poorly defined mechanisms. The objective of this review article was to describe the implications of obesity for labour and delivery, and discuss interventions aimed at preventing peripartum complications in this group of women.
Macrosomia: effective management of the newborn
Authors: Dixon Annie
Published: May 2014

A commonly accepted definition of macrosomia is an infant weighing greater than 4 kg at birth, which equates to the 90th centile at 40 weeks gestation (Jollya et al, 2003). This weight is often a marker for an increased incidence of complications. This article will identify the common factors linked with excessive fetal weight gain and briefly describe the physiological processes contributing to this. The potential risks to which the neonate is exposed will be explored and discussion of how appropriate prenatal care can minimize risks and identify effective management for these babies is included.
A critical two minutes
Authors: Symon Andrew
Published: May 2014

How often is a two-minute interval that crucial when summoning obstetric help?
The price of greatness is responsibility
Authors: Gould Debby
Published: May 2014

The need to motivate and inspire, coach and influence are the new leadership mantras infusing the NHS, as they aspire to expand and develop an empowered, intrinsically motivated workforce where work becomes a reward in itself (Gill, 2006). The underlying assumption being that greater performance, and hence improved quality care, is best delivered by an inspired self-motivated team.
Australia closes maternity wards despite a rising birth rate
Authors: Daniel Lincia
Published: May 2014

Lack of funding and difficulties retraining staff has led to the closure of birth centres meaning women living in remote areas must travel greater distances to receive maternity care, putting them at a disadvantage.
Freedom of choice in childbirth: women need time to make a decision
Authors: Rogers Imogen
Published: May 2014

I am a final-year student at the University of Plymouth. The first two years of my clinical training were spent at a consultantled unit which, in 2007, introduced an integrated pattern of midwifery with a core team of hospital-based midwives and four separate teams of integrated midwives who deliver care to women antenatally and during the intrapartum and postnatal periods. Even in its infancy, this integrated pattern of care was soon recognized by both women and midwives as one that provided continuity of care. As a first-year student, I readily accepted it as being the only way care was provided to women. In discussions with fellow student midwives, however, it soon became clear that this model was not replicated in all areas in the southwest.
Risky pregnancy and labour for women with endometriosis
Authors: Bainbridge Jane
Published: May 2014

Research shows that not only do women with endometriosis have difficulty getting pregnant, when they do they have greater risk of going into labour early, as well as a number of other pregnancy conditions.
Criminal and professional ‘guilt’
Authors: Symon Andrew
Published: May 2014

The Nursing and Midwifery Council's (NMC) Fitness to Practise (FtP) panel hears evidence about alleged poor practice on the part of midwives and nurses, and is a crucial feature of the UK government's plans for professional regulation (cf. Health and Social Care Act 2008). The NMC's disciplinary function is organized very much along the lines of the General Medical Council (GMC), which oversees medical practitioners. Criminal convictions are automatically notified to the relevant regulatory body: the ‘FtP hearings and decisions’ section on the NMC's website shows that in July 2009 a number of convictions were considered by the NMC in relation to the competence and conduct of NMC registrants. These included cannabis cultivation, actual bodily harm, child pornography, and false accounting, among others. However, an acquittal in a criminal case does not mean that the regulatory body will not take any action against a practitioner. A recent medical case in the Court of Appeal highlights this. Although it concerned a doctor, the same process would be applied had it involved a midwife or nurse.
‘People make safety’: empowering health professionals to speak up
Authors: Gould Debby
Published: May 2014

Hadden-Chave's report (Haddon-Chave, 2009) into the loss of Nimrod XV230 which crashed in 2006, draws organizational parallels across other disasters worldwide, including the Space Shuttles Challenger and Columbia, King's Cross Fire and Marchioness Disaster. He states that process alone does not ensure safety and asserts that ‘people make safety’. The role of people in ensuring safety is glaringly obvious, yet it is an element that is lost within many patient safety initiatives unfolding within the NHS. Anyone reading the Nimrod report could grasp the similarities in our health-care incidents.
‘Mutual newness’: mothers' experiences of student midwives
Authors: Snow Sarah
Published: May 2014

Women describe establishing a trusting relationship with the midwives caring for them as a key feature of effective care. In most maternity settings, women will frequently receive this care from student midwives, yet their contribution has not been explored from the women's perspective, or its value discussed. This is part 2 of an article exploring the application of phenomenology in midwifery research. This article critically discusses the key findings from a small study that explored the experiences of 7 women, both primigravid and multigravid, who received care from student midwives during labour and birth. The meaning, or essence, of the encounter between woman and student midwife was sought and described. Women rated their care from the student midwives very highly and found them to be consistently kind, supportive and helpful. In particular, women valued the uniqueness of their relationship with the students. The essence of the experience has been conceptualized as ‘mutual newness’; both women and learners are on separate journeys to motherhood and professional status, yet encounter similar losses and gains along their respective paths.
Computers and CTGs: where are we at?
Authors: S Barber Vicki , Lean Katie A , Shakeshaft Clare E
Published: May 2014

The latest National Institute for Health and Clinical Excellence guidelines on intrapartum care include advice on the appropriate use of cardiotocographs. This technology has become, rightly or wrongly, commonplace as an increasing number of women are receiving CTG monitoring during their labour. The technology is now over 50 years old, however, it has still to be proven effective.

The cardiotocograph monitors are not monitors per se—they are used as a recorder and signal display to be then reviewed by an observer. Increasingly computers have been used to improve this technology, both display and interpretation and computers are now to be used to help interpret traces in real time. This article addresses whether the potential in CTG monitoring technology has finally materialized.
Updating practice to meet women's needs
Authors: Clift Victoria
Published: May 2014

Maternal age is increasingly discussed, not only among those with a career in the maternity services, but also among any women hoping to have children at some point in their future or, indeed, a second or third baby after the age of 35. Numerous stories are reported in the media about multiple pregnancies through IVF treatments, as well as poor outcomes for singleton pregnancies of older mothers, such as eclampsia, pre-term labour and stillbirth. A higher prevalence of Down’s syndrome is often found in older mothers who say they receive little up-to-date information about the condition from health professionals. To update your practice on giving support for parents having a child with Down’s syndrome turn to page 700.
The road to change: finance, funding or clinical autonomy
Authors: Lewis Paul
Published: May 2014

The Department of Health (DH) Spending Review 2010 gives a commitment to protect our health services with an increase in spending in real terms over the course of the spending review. This includes a 1.3% increase in the resource budget and a 17% decrease in capital spending. The administration budget will be reduced by 33% and reinvested to support the delivery of NHS Services (DH, 2010a).
Empowering fathers to be active parents
Authors: Clift-Matthews Victoria
Published: May 2014

On a recent trip to South Africa I visited a number of health-care facilities, one of which was Baragwanath Hospital in Soweto. The hospital sees and treats around 70 000 patients a year and deals with 50–70 deliveries a day. Given the high number of women who make use of the maternity services it's not surprising that there are not enough delivery beds, never mind delivery rooms. Women go through labour together in a long corridor with wooden benches and with little support. I must add that all the midwives I met worked tirelessly and enthusiastically to provide the best service they could. But what struck me at the time was the absence of any birth partner because there is no room for partners, mothers or sisters when there is barely room for the women themselves.
Reproductive health kits to help pregnant women in Haiti
Authors: Daniel Lincia
Published: May 2014

The recent earthquake has decimated health services in Haiti, which already has one of the highest maternal mortality rates in the west, so pregnant women are being given kits for giving birth without medical support.
Letters
Authors: Miller Alison
Published: May 2014

CMACE: assessing care at the Albany Group Practice.
Fewer than half of women giving birth in Uganda have access to a midwife
Authors: Bainbridge Jane
Published: May 2014

Lack of skilled help to assist women giving birth in Uganda is having a major impact not only on maternal and infant mortality but also on the transmission of HIV from mother to child, which could be reduced with aid.
Promoting confidence in maternal intuition
Authors: Clift-Matthews Victoria
Published: May 2014

A recent story about hospitals closing their doors to women in labour because of a lack of staff beds must send alarm bells ringing in the ears of hundreds of pregnant women who are already fearful about going into labour. Throughout pregnancy they have been carefully monitored by midwives and/or other health professionals, they might have adhered to all sorts of recommendations to do with their diet, had numerous blood and urine tests, scans and palpations to check their baby, all of which have provided some degree of reassurance. It must be a shock, particularly when aspects of the birth have been carefully planned, to find that the chosen maternity unit likely visited by the parents beforehand, has temporarily closed its doors to women in labour. In the story it is reported that some women were forced to travel up to 99 miles to find somewhere they could give birth (Campbell, 2010).
Access to midwifery-led care for pregnant teenagers
Authors: Warwick Cathy
Published: May 2014

Any midwife keeping an eye on emerging research findings and policy themes would agree that teenage pregnancy is a hot topic. Recently published research identifies that women less than 19 years old completing education early have a poorer experience of maternity care (Department for Children Schools and Families, 2010) and emerging evidence from Family Nurse Partnerships (Raleigh et al, 2010), which focus on the most at risk, young, first-time parents, demonstrates how intensive interventions during pregnancy can help to reduce childhood disadvantage.
Improving the service: working together to promote normal birth
Authors: Stephens Liz
Published: May 2014

So, we have a new government, welcomed in with a high profile and many promises. But what does this mean for the NHS, and in particular, for the maternity service—for women and for midwives? One thing that has been made clear is a determination to tackle the budget deficit and it is likely that this will increase the need for efficiency savings within the NHS. The new Secretary of State for Health, Andrew Lansley, spoke at the Royal College of Midwifery's (RCM) Annual Conference in November last year, supporting maternity services and arguing against mergers. He will be under pressure to reduce costs within the NHS—so how likely is it that maternity services will be protected from the hard times ahead? I would suggest unlikely. But I believe we need to be proactive as midwives in helping ourselves, and by this I mean improving the service that we offer to women, even in times of budget cuts.
Modern simulation-based training in obstetrics
Authors: Wedisinghe Lilantha
Published: May 2014

Dear Editor

Management of obstetric emergencies is difficult. Managing a rarely occurring obstetric emergency would be challenging, even for a very experienced accoucheur. This highlights the importance of obstetric emergency management courses. In most of these courses, for example, advanced life support in obstetrics (ALSO) and managing obstetric emergencies and trauma (MOET), simulation-based training is provided. Such training with the use of novel simulators appears very productive and perhaps, ideal.
Poor quality care: the dangerous effect of silent collusion
Authors: Gould Debby
Published: May 2014

It may seem that the NHS is struggling with one scandal after another with regards to how individual and systemic errors are compromising quality care. Last week saw the report into Anne Grigg-Booth, the night nurse who was accused of killing three patients at Airedale Foundation Trust Hospital by illegally administering opiates (Thirwell et al, 2010); and last year there was the scandal of unnecessary deaths at Mid Staffordshire Hospital.
Afghanistan: the ‘worst’ place in the world for pregnant women
Authors: Bainbridge Jane
Published: May 2014

Maternal mortality rates in Afghanistan are estimated to be 1600 per 100 000 live births, earning the country a reputation as the ‘most dangerous place to be born’.
Midwives should support women to mobilize during labour
Authors: Baker Karen
Published: May 2014

This article analyses why midwives should encourage and support women to mobilize during labour and maintain upright positions during labour and childbirth. A systematic analysis of the literature regarding this issue will be constructed. An outline of the role of the midwife and why it is important that they encourage and support women to mobilize during labour and maintain upright positions is presented.
A quarter of risky pregnancies go unidentified in The Netherlands
Authors: Bainbridge Jane
Published: May 2014

Researchers in The Netherlands suggest that poor risk screening in pregnancy is to blame for one of the highest infant mortality rates in Europe.
Pre-course preparation in a virtual world: An evaluation
Authors: Edwards Alison , Faulkner Samantha
Published: May 2014

Commencing a new course of study very different from a current position can be challenging. In light of this, various approaches to pre-course preparation have been developed by higher education institutions with the aim of aiding students’ transition from practitioner to student. Evidence is readily available to support their use, although specific evaluation of the methods used has yet to be published. The method chosen here utilises a virtual media platform to provide activities and information to support new students. This article results from an evaluation of the site after it has run for over a year.
National survey of supervision of midwives: Time for reflection?
Authors: Rogers Cathy , Yearley Carole
Published: May 2014

The Nursing and Midwifery Council ( NMC 2010a ) raised concerns about the variation in the number of supervisors of midwives (SoMs) both within and between local supervising authorities (LSAs). Problems with recruitment and retention were postulated as important contributing factors. These concerns provided the impetus for this survey to explore the current structure and profile of supervision. Method: A postal questionnaire was forwarded via the local supervising authority midwifery officers (LSAMOs) in England for contact supervisors to complete on behalf of their SoM team. Ethical approval for the study was not obtained but ethical principles applied. The questionnaire was designed to identify the structure, profile and remuneration packages for supervisors as well as the opinions of SoMs with regard to the factors that promote or constrain their recruitment and retention. Data analysis: Responses were entered on an excel spread sheet and % calculations made. Results: Responses were received from 115 (77%) of SoM teams. More than 95% of SoM’s undertake their supervisory duties in organisations where they hold substantive midwifery posts. Approximately half of LSAs across England have not achieved the required SoM to midwife ratio as recommended by the LSA (2005); the highest ratios of supervisory caseloads have been in London, East of England, South Central and Southeast Coast LSAs. Remuneration for the role and the amount of remuneration varied significantly between and within LSAs. The average amount of protected time for supervision was 7.5 hours per month and the average financial remuneration received was £750 per annum, though this varied from £400 to £2000 per annum. A third of all respondents reported difficulty with recruiting supervisors. The main factors were competing demands with their substantive posts and personal lives, as well as the on-call commitment. Recommendations: Given the variation in the number and ratio of supervisors to midwives both within and between LSAs we recommend that more equitable supervision would be achieved if SoMs were not undertaking the function of their role within the organisation where they hold their substantive role. Separating the role of supervision from that of employee would also aid clarity about the roles as well enable SoMs to be more effective in monitoring and escalating concerns about standards in maternity care. Furthermore, given the findings there is a need to review the selection, structure and remuneration for supervisors of midwives to enable them to be more effective in their role.
The hypothermic term infant
Authors: Booker Helena
Published: May 2014

Neonatal hypothermia in the term infant is an ongoing, avoidable and inexcusable complication, and is a prominent cause for readmissions to neonatal units. The systemic functions that enable the infant to adapt to extrauterine life are not inexhaustible, and the subtle signs and symptoms of hypothermia are frequently mistaken for sepsis. Whether professional negligence is to blame has been questioned: staff shortages, rising birth rates and increasing complex conditions are not acceptable justifications. While controversial, using early warning scoring systems for healthy term infants with risk factors combined with promotion of family centered care, may reduce incidences of neonatal hypothermia, thus protecting the infant from further complications.
Lower back pain in labour
Authors: Rubio-Batanas Maria Del Carmen
Published: May 2014

Maria Del Carmen Rubio-Batanas discusses the use of sterile water injections to alliviate lower back pain in labour.
Assessment of fetal presentation: Exploring a woman-centred approach
Authors: Walker Shawn , Sabrosa Ruth
Published: May 2014

This article explores the core midwifery skill of fetal presentation assessment from the perspective of women's meanings and experiences, including the social and relational aspects of antenatal palpation. Brief background information is provided, explaining the clinical purpose of determining presentation antenatally, and the key debates surrounding the available interventions applied when babies present breech. In order to make the screening process transparent, women need to know the accuracy (or rather, inaccuracy) of abdominal palpation, and what her options will be if her baby is found to be presenting breech, either before or during labour. Specialist midwifery care may help meet women's increased needs for counselling and reassurance, and provide continuity throughout the breech care pathway, which for low-risk women begins with palpation.
PAT: advanced nursing interventions for eating disorders
Authors: Holyoake Dean-David , Jenkins Mike
Published: May 2014

Passive activity time (PAT) is a nursing intervention that was developed for young people with eating disorders. This development was a pioneering attempt to examine the nursing care for this client group and improve treatment programmes. Nursing practice before PAT was dominated by a biomedical model which directed a set procedure of care for all patients, focusing primarily on weight restoration. The prominent interventions were bed rest for any patient who was under weight and a strict dietary regimen. PAT was the result of a change in nursing practice towards a more holistic philosophy of care. This article will describe the rationale behind its development and discuss its potential in future nursing practice for people experiencing anorexia nervosa.
Role of the nurse: introducing theories and concepts
Authors: Crossan Frank , Robb Alna
Published: May 2014

This article is a descriptive analysis of the work of nurse theorists in relation to the role of the nurse. It is clear from the literature that nursing is difficult to define but it is possible to identify the core values of nursing and the commonalities that run through the profession. The core components identified by an examination of the literature are the development of systems for the delivery of care, coordinating care, teaching, defending the frail and vulnerable, caring for the ill and the well, and providing technical care. This article aims to provide a baseline picture of what nursing is and how it is described in nursing models allowing readers to examine and compare their own values and image of nursing with what the theorists have written.
Prison services are in need of urgent reform
Authors: Castledine George
Published: May 2014

Whenever I have visited a prison during the course of my work I am always left with a feeling akin to unease. This is probably due to the slammed doors that are locked behind you, the bars on the windows, the tall concrete walls and the sheer sterility of the surroundings.
The Clear Advantage urinary incontinence sheath for men
Authors: Doherty Willie
Published: May 2014

All too often in the past urinary sheaths have been dismissed as having failed their user and carer simply because they have been poorly fitted or incorrectly measured. This article looks at the progressive development of the urinary incontinence sheath, from the various ‘home-made’ appliances that people with bladder problems conjured up, to today's more effective, more reliable products, such as the Clear Advantage all-silicone urinary incontinence sheath from Seton Continence Care.
People's dependence on the NHS must change
Authors: Castledine George
Published: May 2014

On July 5, 1948, the first patients were admitted for treatment in the NHS. Sylvia Beckingham was 13 years old at the time and posed with Aneurin Bevan for a photo call at her bedside in a Manchester hospital. She recalls the great man saying: ‘This is a milestone in history, you won't appreciate it now, but you will when you are older’ (Rayner, 1998).
Nurses must start writing so as to be understood
Authors: Scott Helen
Published: May 2014

The Foundation of Nursing Studies, a charity that aims to put research findings into practice, has just launched a campaign to promote plain words for nurses as it is felt that the nursing literature is dominated by language that is inaccessible to the everyday practising nurse. The gap that exists between the ideals stated in the theory of nursing and the actual practice of nursing gives weight to the argument that nursing theory and its academic writing remains either useless or unused.
Clinical risk management: is it just a sham?
Authors: Dimond Bridgit
Published: May 2014

Recently, clinical risk management has been the essential prerequisite for each health authority and NHS trust to adopt to reduce the powerful incoming tide of litigation and complaints. It is therefore surprising that Wansbroughs Willey Hargrave Solicitors within a press release has claimed that ‘clinical risk management does not reduce litigation’.
Development of a community nurse-led continence service
Authors: Shields Noreen , Thomas Cathy , Benson Kate , Major Kirsten , Tree June
Published: May 2014

Extrapolations from prevalence studies suggest that on average 56 000 adults experience urinary incontinence in Glasgow, a third of whom will have been incontinent during the last week. A review by a multidisciplinary health gain commissioning team concluded that existing continence services in Glasgow had developed opportunistically and that problems exist, e.g. prescription of products without full assessment of continence problems. In response to this situation, a new community nurse-led continence service was introduced in 1995. This article describes the development and evaluation of this new service. For the past 3 years the service has employed five staff nurses and a physiotherapist. The team is solely employed to promote continence. It carries out assessments both in nursing and residential homes and community clinics. The planned evaluation will assess the effectiveness of this team in promoting continence and the future demand for continence nurse-led services.
The implications of head injury for family relationships
Authors: O'Neill Linda Jane , Carter Diana E
Published: May 2014

Many of those sustaining head injury recover to the point that they no longer require hospital care. However, the family frequently has to cope with an individual with varying degrees of disability involving physical, psychological, cognitive and social dysfunctioning. This review of the literature briefly considers the possible effects that head injury may have for the injured person before going on to discuss the consequences that such an injury may have for the family of that individual. The family's need for information and education is highlighted and it is suggested that the nurse has an important role to play in this context.
External pneumatic compression therapy for DVT prophylaxis
Authors: Capper Carole
Published: May 2014

Thromboembolic disease is a common cause of perioperative death. Emphasis should be placed on prophylactic treatment and therefore this product focus looks at intermittent pneumatic therapy in the form of the Flowtron DVT garment from Huntleigh Healthcare. While anticoagulant therapy is the main prophylactic method for deep vein thrombosis (DVT) the benefits of intermittent pneumatic compression warrant serious consideration. Responsibility for DVT prophylaxis, patient assessment and the monitoring of the effectiveness of the prophylactic therapy lie with the nursing staff. A reliable assessment tool should be used in conjunction with clinical judgment and accurate documentation.
Nursing is not a very attractive career option
Authors: Scott Helen
Published: May 2014

An ENB report (ENB, 1998) has highlighted that the number of students in preregistration nursing education has decreased by 15% in the past 4 years. The reason for this is a decline in applicants. There were 45 589 nurses training in March 1998, 2447 fewer than in the previous year, and the number of trainees has fallen by 8188 since 1994.
Clarifying the UKCC's position in relation to higher level practice
Authors: Waller Sarah
Published: May 2014

The UKCC is currently consulting on its proposals to recognize and regulate a higher level of practice (UKCC, 1998a). These proposals follow the work undertaken by the UKCC from 1996–1998 on advanced and specialist practice and seek to build on the current postregistration education and practice (PREP) framework (UKCC, 1994). This article outlines the background to the consultation and puts the proposals into context. It is hoped that it will encourage practitioners to respond to the consultation, as the UKCC is very keen to hear the views of specialist nurses, midwives and health visitors. Copies of the UKCC's consultation document are available from Katrina Neal, Professional Officer (0171 333 6542) and are also available on our web site ( http://www.ukcc.org.uk. ). Responses should reach Sarah Waller, Director of Standards Promotion at the UKCC, by 20 October 1998.
Nurse consultant idea is not the answer
Authors: Farmer Betty
Published: May 2014

Just when I think I have suffered all the psychological injuries that thinking, caring nurses could possibly have to endure, Tony Blair launches another missile. He claims he does not want nurses to be cast in the role of doctors' handmaidens but then proposes a system that will perpetuate the image he, allegedly, seeks to destroy. I am not opposed to a career structure that keeps nurses in practice, nor am I unhappy with the title ‘nurse consultant’, but these developments can only be beneficial to the profession if located within a framework for nursing – not medicine. In a climate where the biomedical model dominates, and where the Government is under pressure to reduce junior doctors' hours, it does not take genius to work out what these ‘super nurses’ will be doing. The move is guaranteed to perpetuate the abuse of power in nursing through the addition of an elite group whose members are likely to be selected on the basis of their allegiance to the values of doctors and managers rather than nursing.
Mefilm: an adherent polyurethane dressing for superficial wounds
Authors: Williams Clare
Published: May 2014

Research has demonstrated that wounds heal faster in a moist environment. Film dressings are used to promote a moist environment. Mefilm is part of the Mölnlycke Health Care chronic wound care system and is a gentle, adherent polyurethane dressing. This product focus discusses the development of the semi-permeable film dressing, Mefilm, examining its uses, application and removal.
Interventions for confusion and dementia 3: reminiscence
Authors: Woodrow Philip
Published: May 2014

The aims of reality orientation, which was discussed in the previous article of this series (Vol 7(17): 1018–20), are to achieve behavioural improvements. The aims of reminiscence, however, are empowerment and the provision of pleasure and it is therefore more associated with quality of life and quality of care. Reminiscence can be an enjoyable activity. Used in a structured way, it can achieve a sense of wellbeing, and increase empathy between healthcare workers and clients. This article discusses the benefits and problems of reminiscence, and suggests means to develop reminiscence skills and materials.
Non-consensual sterilization of the adult with learning disabilities
Authors: Knifton Christopher
Published: May 2014

Community nurses may be asked for advice on sterilization operations for adults with learning disabilities by worried parents/carers. This article sets out the legal position advocated by the English courts. Sterilization for adults with learning disabilities is generally non-consensual. The courts cannot consent on behalf of the adult but can rule on the lawfulness of the operation. Cases need not be brought before the court when the operation is to be carried out to treat a specific menstrual malady and where sterilization is an incidental result. However, the Law Commission (1995) has set guidelines which recommend that such operations require a certificate from an independent medical practitioner. In operations where the sole purpose is contraception the courts will always need to be involved. Their decision on the lawfulness of the operation will be based on what is in the persons best interests which in turn will be determined by reference to standards set by a responsible body of medical practitioners.
Medical interventions during pregnancy and childbirth
Authors: Rodgers ME
Published: May 2014

The right of the medical profession to intervene during childbirth, contrary to the wishes of the patient, has been the subject of considerable legal debate during the 1990s. However, recent judicial comment in R vs Louize Collins and others [1998] seems to have reached a clear conclusion on the rights of the pregnant woman, and also the steps that can be taken to treat when a pregnant woman has refused intervention.
RoHo Dry Floatation system: an alternative means of pressure relief
Authors: Williams Clare
Published: May 2014

Pressure sores are believed to occur as a result of two pressures, external pressure leading to occlusion, and disruptive shearing forces causing endothelial damage to the micro circulation. One of the main principles, therefore, of pressure sore prevention is relief or reduction of pressure. Scandinavian Mobility produces a range of systems — therapeutic cushions, specialist cushions and products, and mattresses — that can reduce the pressure, reportedly achieving interface pressures of 21–28 mmHg. These systems have been shown to be cost-effective in the clinical setting and provide pressure relief in low-, medium- and high risk patients.
Nursing professionalism: is it decreasing?
Authors: Castledine George
Published: May 2014

Since the days of Florence Nightingale nurses have tried to behave in a professional manner. However, the degree to which they have achieved this has been subject to much debate both within and outside nursing. In sport, professionals are distinguished from amateurs by virtue of their being paid. However, money is not the only criteria for professionalism.
Parenteral nutrition: an overview of current practice
Authors: Reilly Helen
Published: May 2014

Nutritional support should always be provided via the gastrointestinal tract if possible, but parenteral nutrition, i.e. infusion of nutrients directly into the venous circulation, can be a safe and effective method of nutritional support when used in carefully selected patients and monitored appropriately. A multidisciplinary team approach to patient selection, assessment and monitoring is recommended. Access for parenteral feeding is traditionally via a central vein, but the peripheral route can be used for short-term feeding and should be considered for the majority of patients. Nutritional requirements should be assessed on an individual basis and a feeding regimen designed using standard formulations where possible. The transition back onto oral or enteral nutrition should be closely supervised by a dietitian. Parenteral feeding can be provided in the community if appropriate, but thorough training, monitoring and support are essential.