bluuebunny/crossref_metadata_2025 huggingface dataset:
Nurse-led clinics: accountability and practice
Authors: Griffifth Richard
Published: May 2014

The numbers of nurse-led clinics are continuing to grow in primary and acute care, and they provide timely intervention for patients. The clinics provide exciting opportunities for nurse prescribers but also carry an increased risk of exposure to liability. In this article, some of the key areas of accountability underpinning the duty of care of nurse prescribers working in nurse-led clinics are discussed.
More cardiovascular health innovation needed in Europe
Authors: Lindsay Charlotte
Published: May 2014

Charlotte Lindsay reports on the Cardiovascular Round Table raising concerns about the lack of investment in treatment despite the growing number of people suffering cardiovascular problems
ECG of the month
Authors: Regan Claire , Regan Martin
Published: May 2014

Claire Regan and Martin Regan present an ECG for you to analyse. The answer is given on page 458
Early warning scores in cardiac arrest patients
Authors: Harris Polly
Published: May 2014

Background:

Significant physiological deterioration in the 8 hours pre arrest is evident in 84% of in-hospital cardiac arrests. The modified early warning score (MEWS) is an example of a physiological ‘track and trigger’ system designed to identify patients at risk of clinical deterioration.

Aims:

The primary aim of this study was to describe the use and characteristics of the MEWS score in the 24-hour period preceding cardiac arrest to establish any pattern and its relationship to the subsequent deterioration of patients.

Methods:

A retrospective case note review was conducted of all cardiac arrests in the study hospital occurring over a 6-month period.

Results:

The majority of cardiac arrests occurred out of hours (69.7%). Of the nurses recording the final MEWS preceding cardiac arrest, 13 (39.9%) were registered nurses and 20 (60.6%) were healthcare assistants. The majority of MEWS recorded immediately preceding cardiac arrest were 1 (15; 45%); the mean MEWS was 2.24, the median was 2 and the mode was 1.

Conclusion:

This retrospective case note review has examined the use and characteristics of the MEWS on the medical wards of one district general hospital in the 24 hours preceding cardiac arrest. Key issues have been identified regarding MEWS at the point of cardiac arrest, and the use of the referral pathway by healthcare professionals. Communication of deterioration is imperative to the management of deterioration on the general wards.
Hyperacute stroke care provision in London
Authors: Fitzpatrick Maria
Published: May 2014

Over the past two decades, stroke care has been directed toward a rehabilitation and social focus. Initially, much attention was paid to what can be done for a patient in the days after their admission, with little attention given to the ‘hyper acute’ stage of admission. A diagnosis of stroke formerly elicited a nihilistic approach, but this has substantially changed in the past decade. Currently ‘time is brain’, and it is important for all disciplines to work together to initiate acute stroke protocols in the emergency department and identify patients within the therapeutic time window for thrombolytic and neuro-protective therapies. Evolving protocols, management, and nursing care all have important implications during the acute phase of ischaemic stroke. In the past few years, timely assessments and interventions have been the focus of government strategies. With recent research emphasising ways to reduce length of stay and post-stroke complications, the spotlight is now on providing stroke care in centres with the appropriate equipment and trained staff. This new research focus addresses an important need in stroke care and provides challenges and opportunities that can be used to improve patient outcomes.
A case study of apical hypertrophic cardiomyopathy
Authors: Sandalakis Andegoni M
Published: May 2014

Apical hypertrophic cardiomyopathy (AHCM) usually involves the apex of the left ventricle and rarely involves the right ventricular apex or both. AHCM is distinguished by the electrocardiogram hallmarks of giant T-waves and the presence of an ‘ace-of-spades-shaped’ left ventricular cavity on cardiac imaging. This paper aims to increase practice nurse awareness of the differential diagnoses of acute coronary syndrome and AHCM by reviewing the case study of a non-Asian patient who presents with dyspnoea on exertion, fatigue, and has a positive nuclear stress test. The correct diagnosis and understanding of AHCM is important for specialist nurses when managing patients presenting with typical chest pain and dramatic T-wave inversions, as these frequently result in inappropriate hospitalisations and testing for suspected coronary artery disease. AHCM often presents as an acute coronary syndrome, therefore these clinical hallmarks warrant the correct diagnosis and medical management when compared to the other varieties of hypertrophic cardiomyopathy.
ECG of the month
Authors: Regan Clare , Regan Martin
Published: May 2014

Clare Regan and Martin Regan present an ECG for you to analyse
A new tool to estimate CVD risk and more
Authors: Jennings Catriona
Published: May 2014

Catriona Jennings explains what the new Joint British Societies' recommendations on the prevention of cardiovascular disease (JBS3) mean to nurses
Tuberculosis: an update for practice
Authors: Shaw Theresa
Published: May 2014

Tuberculosis has once again become a leading healthcare problem. Despite the increasing knowledge and profile of this disease, many nurses are unclear about the disease process, transmission, and the measures used to control and prevent tuberculosis. Nurses may also be unaware of the contribution they could make to the management of the disease at local level. This article provides an update on the nature of the disease and gives an overview of the current problems associated with tuberculosis. It also discusses the potential role that nurses working in the community have in the control and prevention of tuberculosis.
Skin allergy problems in patients with chronic leg ulcers
Authors: Cameron Janice
Published: May 2014

Although many causes of leg ulceration have been reported over 70% are related to venous insufficiency associated with venous hypertension. Contact sensitivity (allergic contact dermatitis) is a frequent complication in patients with chronic venous leg ulcers affecting between 51–81% of patients. Complications associated with contact sensitivity in patients with non-healing leg ulcers are increased morbidity due to eczema and irritation which may result in delayed healing. This article reviews the frequency of contact sensitivity. Research has shown that lanolin and topical antibiotics, such as neomycin and framycetin, are the most common leg ulcer sensitizers and should be avoided in treatment. Creams have also been shown to contain sensitizers and therefore ointments should be used in preference to creams. The avoidance of allergens is important in the prevention of contact sensitivity and the promotion of ulcer healing.
Guidelines for use of the MS26 daily rate syringe driver in the community
Authors: Wilson Vicky
Published: May 2014

Many patients cared for in the community have complex care and treatment needs and syringe drivers are commonly used to administer a range of drugs to patients at home. However, serious problems have been associated with this route of administration. In Scotland between 1989 and 1994 there were 23 incidents including 4 fatalities associated with the use of small volume syringe pumps reported to the Common Services Agency supplies division (Scottish Office Home and Health Department (SOHHD), 1995). The four fatalities were attributed to over-infusion (SOHHD, 1995). In those fatal incidents no fault was found with the infusion device, suggesting that an inadvertent error had been made by attendants in setting up or in using the device, or that some form of tampering had taken place. The Department of Health issued a hazard warning in 1994 (DoH, 1994) about confusion between the two Sims Graseby syringe drivers the MS16A and the MS26. This article outlines guidance on the use of the Sims Graseby MS26 in the community. Community nurses have a vital role to play in management of syringe drivers, and it is through increased awareness of correct procedures that incidents and fatalities will be avoided.
A study of district nurses experiences of continuous ambulatory chemotherapy
Authors: Turner Claire , Pateman Brian
Published: May 2014

As a result of technical developments and policies that promote shorter hospital stays, patients are increasingly receiving high-technology treatment in the community. The administration of ambulatory intravenous chemotherapy at home is an example of such treatment. Despite being generalist nurses, district nurses (DNs) are involved in what could be viewed as ‘specialist’ care — advising and supporting patients while they are receiving treatment. This article reports on a study of 20 DNs from one community trust and examines the sources of the knowledge and skills used in caring for these patients and the communication links with the regional cancer centre.
Medicines and older people: a nurses’ guide to administration
Authors: Strachan Ian
Published: May 2014

Older people represent only 18% of the population but receive approximately 45% of all prescribed medication in the UK (Offerhaus, 1997). Problems arising from drug therapy are numerous as medication will often act in a number of complex and even surprising ways. As the number of older people grows, it becomes increasingly necessary for nurses to recognize and understand the legal and professional issues relating to the administration of medicines. This article outlines some of the potential problems confronting the nursing profession and offers some practical solutions to common dilemmas.
The role of the primary care team in support of informal carers
Authors: Simon Chantal
Published: May 2014

Caring for an elderly, frail or disabled person has effects on physical and psychological health as well as financial and social consequences. There are 6 million informal carers in the UK and the primary care team together with other community services is expected to provide the support they need. However, most primary care team members feel ill equipped to do so and there is very little evidence about which interventions are effective. This article reviews the reasons for this problem and suggests a strategy primary care team members could adopt until new evidence about effective strategies is available.
Innovations in district nursing: the use of a first dressing starter box
Authors: Ellis Janet , Harker Judy
Published: May 2014

Since the advent of nurse prescribing many district nurses have raised concerns about having only a simple non-adherent dressing available to apply to a wound while waiting for a prescription to be dispensed. This type of product does not meet the criteria for an ideal wound dressing. Using dressing products acquired from other sources, for example surplus dressings prescribed for another patient, is considered unacceptable clinical practice. This article describes a pilot study carried out to determine the feasibility of providing a ‘starter box’ filled with a selection of dressing products for use at the first dressing consultation. The results of the pilot study show that the availability of such a starter box could lead to a better wound care service for patients, and that cost savings could be made from avoiding unnecessary additional return visits or clinic appointments.
Maintaining and developing competencies in nurse prescribing
Authors: Picton Catherine , Granby Trudy
Published: May 2014

The development of nurse prescribing in England has taken a step forward with the introduction of the new extended curriculum in January 2002. However, the extension will refocus attention on the safety and quality of the care delivered by nurses who prescribe. Individual nurses have a responsibility to practice safely, while their employing organizations have a responsibility to put in place the systems to ensure this. The recently-published document Maintaining Competency in Prescribing: An Outline Framework to Help Nurse Prescribers (National Prescribing Centre, 2001) aims to help both parties achieve this aim.
Nursing patients with variant Creutzfeldt-Jakob disease at home
Authors: Barnett Fiona
Published: May 2014

Variant Creutzfeldt-Jakob disease (vCJD) is a rare variant of a rare neurodegenerative disease, with a rapid and fatal course. The emergence of vCJD in humans in 1996 is believed to have resulted from the consumption of bovine spongiform encephalopathy (BSE)-infected meat. By July 2002, the number of vCJD cases in the UK had increased to over 120 and it is not yet known how many more people will be affected. The majority of affected individuals are cared for within their own homes with the support of their families. Community nurses face several challenges in managing the rapid deterioration and complex emotional, cognitive, behavioural and physical problems associated with vCJD. In her capacity as a National CJD Care Coordinator for the UK the author outlines the pathogenesis of vCJD, identifies key caring issues that emerge during the clinical course of the disease and makes suggestions about the nursing care required.
Treatment of an atypical leg ulcer: pyoderma gangrenosum
Authors: Knock Karen , Butcher Martyn
Published: May 2014

Mrs B was referred to the Skin and Woundcare Department at the start of January 2002 with a chronic non-healing ulcer to her lower right leg proximal to the medial aspect of her right knee. The ulcer was diagnosed as pyoderma gangrenosum, a condition which Mrs B had suffered from previously. Assessment and management of this atypical ulcer are discussed. Once the progression of the lesion was halted, conservative treatment could be undertaken, and led to a successful outcome.
Child physical abuse: health professionals’ perceptions, diagnosis and responses
Authors: Russell Mary , Lazenbatt Anne , Freeman Ruth , Marcenes Wagner
Published: May 2014

The objectives of this cross-sectional survey were to assess primary health professionals’ perceptions of and ability to recognize child physical abuse in their practice. A random sample was taken of 979 nurses, doctors, and dentists working in primary care in Northern Ireland. The response rate was 44%, and the results showed that 59% of respondents had seen a suspicious case of child physical abuse, of which 47% (n=201) had reported it. Ability and willingness to recognize and report abuse varied across the three professions. The findings suggest a professional reluctance to engage in recognizing and reporting abuse. The barriers could be reduced by providing multi-professional and inter-agency training, support for the primary health professionals in practice, as well as higher education programmes at undergraduate and postgraduate levels for nursing, dentistry and medicine
Hyoscine vs glycopyrronium for drying respiratory secretions in dying patients
Authors: Lawrey Helen
Published: May 2014

The ‘death rattle’ is a common symptom among among dying people, and causes a great deal of anxiety and upset to relatives and carers, including nurses. A mini-review was carried out to evaluate the effectiveness of two drugs – hyoscine hydrobromide and glycopyrronium – in drying up respiratory secretions in terminally ill patients. Searches were made of the Cochrane Library, Medline, Embase, Cinahl and Pharmline. Reference lists, trial databases and professional colleagues were also consulted. There was a scarcity of research material directly comparing the effects of the two drugs in the clinical setting. Two papers were used for comparison in the review but these produced conflicting results. Many discrepancies existed in terms of research methods, and in results. One paper demonstrated that hyoscine hydrobromide was the more effective drug; the other favoured glycopyrronium. There is no clear evidence to support the choice of one drug over the other, based on the clinical outcome selected for this review. Although clinical trials are difficult to conduct in this vulnerable patient group, more research is needed to facilitate the best management of this distressing symptom and allow clinical guidelines to be produced.
Supporting older people: Help and advice with housing
Authors: Oldman Joseph
Published: May 2014

In the first of a series of articles brought to you in association with Help the Aged, Joseph Oldman looks at the housing problems faced by many older people, and emphasizes the need for individual advice and support.
End-of-life dilemma for health professionals
Authors: While Alison
Published: May 2014

The Assisted Dying for the Terminally Ill Bill being considered in the House of Lords provides an opportunity for careful consideration of a complex, fraught moral issue. Current law clearly states that it is unlawful to assist in the termination of life, regardless of circumstances. This provides no latitude for occasions when a mentally competent terminally ill individual wants to end his or her life to avoid unbearable suffering, but is physically incapable of administering their own lethal dose. Following the 1961 Suicide Act it is no longer a crime to attempt or commit suicide, but it is unlawful to aid, abet, counsel or procure a suicide. Yet a patient may refuse treatment and so cause their own death, and it is not murder to relieve pain with a drug that has a side-effect of shortening a patient's life.
Research to combat urinary incontinence
Authors: Layward Lorna , Holmes Pamela
Published: May 2014

In this article, brought to you in association with Help the Aged, the authors discuss current research into the causes and management of urinary incontinence.
Legal requirements for donating and retaining organs: the Human Tissue Act
Authors: Griffith Richard
Published: May 2014

The Human Tissue Act 2004 came into force on 1 September 2006 and introduced significant changes in the way human body parts, tissue and organs are the removed, stored and used.

The Act seeks to remedy the poor availability of organs for transplant caused in part by laws that date back to the 17th Century and to right the concerns raised by the Liverpool Children's Inquiry that revealed widespread retention of organs without permission by hospitals.

In this article Richard Griffith describes how consent is now the driving force underpinning such activity and how the wishes of the patient remain paramount even after death. He also outlines how the Human Tissue Authority will licence and inspect activities involving human tissue under the Act and discuss how the new law will affect district nurse practice.
Climate change should matter to nurses
Authors: While Alison
Published: May 2014

It is easy to overlook the increasingly loud debate about global warming as irrelevant to primary care practitioners, but that would be a mistake. Not only are we all citizens responsible for electing politicians to govern but our personal and professional practices contribute to the wellbeing of the environment in which we live. Further, we have a responsibility for the most vulnerable in society who will bear the consequences of poor environmental management.
Authorizing the deprivation of liberty of incapable adults in institutions
Authors: Griffith Richard
Published: May 2014

Even before it has come into force the Mental Capacity Act 2005 is to be amended. The government announced in this years Queen's speech that it will use the Act to introduce a power authorising the deprivation of liberty of an incapable person in a care home or hospital where this is necessary to protect them from harm. District nurses will have such patients on their case loads and will need to be aware of the requirements for the lawful detention of incapable adults.
Where is nursing heading?
Authors: While Alison
Published: May 2014

Our Health, Our Care, Our Say (Department of Health (DH), 2006a) set the scene for continuing change within the NHS and the most recent follow-up document (DH, 2006b) confirms the direction of travel. It is contended that current services are falling short by causing frustrating delays and disjointed care journeys to patients.
Policy: what it is, why it matters
Authors: Cook Rosemary
Published: May 2014

Policy is not usually a word that inspires passion, enthusiasm or even interest among nurses. Even though we know that Government policies have a direct impact on every aspect of our lives – from employment, pensions and transport to taxes, childcare and personal safety – it is easy to ignore the policy-making process as something that goes on far away in London, Edinburgh, Cardiff or Belfast, and is beyond the reach of ordinary mortals.
Protecting vulnerable adults and children from sexual abuse
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

The Sexual Offences Act 2003 seeks to strengthen and modernise the law in relation to sexual crimes. The Act's focus is on extending protection from sexual exploitation for children and vulnerable adults by clarifying the key terms ‘consent’ and ‘sexual’ and introducing new offences specifically designed to protect the vulnerable. Child and vulnerable adult protection is an integral part of a district nurse's role so it is essential that you are aware of the key provisions of the 2003 Act in order that you may recognize and report unlawful sexual activity.
Putting policy into practice: the example of COPD
Authors: Pearce Linda
Published: May 2014

Chronic lung disease is one of the commonest reasons for consulting a health professional, and there may be as many as 3 million people in the UK with undiagnosed chronic obstructive pulmonary disease (COPD). This fourth article in a series on long-term conditions examines the policy developments that have been put in place to manage the burden of chronic disease in England and Wales, and argues that more remains to be done if COPD is to be properly addressed.
Order will come out of chaos
Authors: Cook Rosemary
Published: May 2014

Events in primary care over last 6 months have well and truly broken the mould of the ‘see it, do it’ approach to policy implementation.
Improving housing, improving health: the need for collaborative working
Authors: Allen Terry
Published: May 2014

The impact of poor housing on health was recognized 150 years ago, and doing something about it was the first real public health initiative. Today, standards in much of the older housing stock continue to fall and, exacerbated by the current free market boom in fuel costs, many people cannot afford to heat or maintain their homes. In response to this crisis, there is an increasing amount of housing help available which would directly improve the health of patients but, apart from pockets of exemplary practice, most health practitioners seem to do little about it. Yet housing issues feature prominently in nurse training, as well as receiving increasing emphasis through the current national and regional fuel poverty initiatives. In exploring this paradox the author examines the mixed fortunes of an innovative project which tried to stimulate collaborative working between professions by providing a successful combined health and housing intervention. Drawing on his evaluation of this project over 5 years, he considers what some of the barriers to collaboration might be, how they arise and what needs to be done to overcome them.
We all need dentists
Authors: While Alison
Published: May 2014

The current turmoil in dental provision is important to primary care nurses, although it might not be the main topic of conversation in many health centres and surgeries. The new dental contract comes in the wake of the new gms and pharmacist contracts and the current cash crisis in pcts means that the government is anxious not to commit itself to payment without demonstrable outcomes.
Making decisions for incapable adults:the Scottish law
Authors: Griffith Richard
Published: May 2014

With the law in England and Wales relating to incapable adult due to be given a new and improved structure with the implementation of the Mental Capacity Act 2005 in Spring 2007 (see last month's article) Richard Griffith outlines how the law in Scotland meets the needs of adults with incapacity through the Adults with Incapacity (Scotland) Act 2000.
Changing primary care: a guide
Authors: While Alison
Published: May 2014

The recent White Paper (Department of Health, 2006) confirmed the government's intention to shift much of health care away from hospitals to primary care. Primary care is therefore going to need to respond to unprecedented levels of demand for health care ranging from complex chronic disease management and end-of-life care to episodic illness, health promotion and the support of public health initiatives. This will require a transformation of primary care and the various organizations within it.
Education in a policy twilight
Authors: Cook Rosemary
Published: May 2014

One of the functions of health policy is to guide the workings of health and related services to ensure that the government delivers on its promises to the public about health and social care. So policies that set targets on waiting times ensure that people get quicker treatment, and policies on expanding professional roles enable services to be provided in new places by different people.
Beware: technology has its limits
Authors: While Alison
Published: May 2014

The substitution of expensive care delivered by humans is attractive to both public services and families seeking a cheap alternative for care of older people. The quest for substitution has inspired inventors and entrepreneurs to create a variety of devices for use with or by older people who might otherwise need home-care contact to ascertain their wellbeing and to support their activities of daily living.
Pressure ulcers: everyone's business
Authors: Stephen-Haynes Jackie
Published: May 2014

‘Have you read the NICE pressure ulcer guideline?’, I asked an audience of 120 staff at a neighbouring PCT recently. Five hands were raised. ‘Have you looked at the slide set summary?’, I asked. The same five hands went up. This was 5 months after the guideline was released in September 2005.
Evidence, prescribing and the Drug Tariff
Authors: Stephen-Haynes Jackie
Published: May 2014

There is a drive in the NHS to provide clinically effective services to patients that are based on evidence, and it is a responsibility of the government and each NHS trust to ensure that this overall philosophy guides all care.
Implementing the NICE pressure ulcer guideline
Authors: Stephen-Haynes Jackie
Published: May 2014

This article explores the practical implementation of the NICE (2005) guideline on pressure ulcer prevention by those that the guideline was created for, including: service managers, commissioners, clinical governance and education leads, patients/carers and both the specialist and non-specialist.
The staging of lymphoedema and accompanying symptoms
Authors: Honnor Amanda
Published: May 2014

Community nurses are recognized as potentially having a much greater role to play in identifying, referring and helping in the long-term management of lymphoedema. This will require knowledge of all stages of the diagnostic and treatment process. In this article, the author discusses staging, or the assessment of the severity of the disease. Staging can be useful in not only deciding the best course of treatment for the individual patient but also in measuring the progress of treatment.
Flexibility is the key to providing best care
Authors: Sharp Ailsa
Published: May 2014

The Wounds UK conference, recently held in Harrogate, showed that there are many extremely committed professionals out there with a keen interest in the prevention and management of wounds. Presentations from both experienced and new contributors were well supported and there was a real buzz about the exhibition hall. On the face of it, there are exciting times ahead. But…
Leg Club conference report
Authors: Lindsay Ellie
Published: May 2014

It's always exciting to be able to report on new activities taking place around the country, and the Scottish Speyside Leg Club team certainly set the scene for a one day event which was held this November.
Post-qualifying careers in primary and community care
Authors: While Alison
Published: May 2014

Professor Lord Ara Darzi’s review of the NHS has sparked furious debate as sectional interests begin their lobbying for favoured causes including the local district general hospital. However, by commissioning this review it is clear that the Government is keen to bring about substantial change in the current service delivery model through both structural and process changes. Alongside these proposed changes is a consultation (Department of Health (DH), 2007) relating to the future post-registration career framework for nurses which builds upon the earlier Modernising Nursing Careers (DH, 2006) proposals. The consultation seeks views regarding five career pathways related to patient/service user pathways rather than clinical specialisms which it is argued force nurses along narrow areas of practice and reduce the capacity for flexibility within healthcare teams.
Pain relief in osteoarthritis and rheumatoid arthritis: TENS
Authors: Wai Ying Kathryn Ning , While Alison
Published: May 2014

Pain is a common symptom experienced by people with osteoarthritis and rheumatoid arthritis and impacts upon mobility and quality of life. This article reviews the limited evidence relating to TENS for pain relief which suggests that it is beneficial for some patients and does no harm. More research is needed to clarify optimal treatments regimes and its cost-effectiveness compared to conventional analgesia.
House of Lords debate: specialist nurse future
Authors: Toner Louise
Published: May 2014

The past year has seen significant figures from the field of tissue viability lost to the NHS, but thankfully not to the world of tissue viability. Why is this? Perhaps we do not recognize and value the expertise of these specialists or has the recent scrutiny of specialist posts led these individuals to reconsider their career options?
Reduced heel pressure damage when using the Repose® Foot Protector
Authors: Evans Julie
Published: May 2014

An evaluation of the Repose® heel pressure ulcer prevention system was conducted in an orthopaedic setting to establish its clinical efficacy in reducing the incidence of heel pressure damage, following a literature review of appropriate pressure-reducing devices. The study involved patients from a 24-bed orthopaedic ward over a six-month period. The results showed that the use of the heel protector led to a significant reduction in the incidence of heel pressure ulceration from more than 6% to 0%. A significant reduction in cost was also identified. The results indicate that the use of a heel protector alongside individualized pressure ulcer prevention has a significant impact on preventing heel pressure damage.
Self-management of leg ulceration using a compression hosiery kit: considerations for service delivery
Authors: Coull Alison
Published: May 2014

This article describes the experience of a young male who developed leg ulceration, which he treated and managed by himself. In an unusual case, with unusual circumstances, he used a leg ulcer hosiery kit as compression therapy to self-manage from the commencement of treatment to healing, with the assistance of a remotely based health-care professional. The local NHS and private health services that he accessed were unable to provide an appropriately tailored service for this patient in full-time weekday employment.
End-of-life care after the Liverpool Care Pathway
Authors: Middleton-Green Laura
Published: May 2014

This article presents a review of key issues around caring for people in the last hours and days of life. The aim is that community nurses will be able to support patients and families, and to provide and explain decisions and interventions to promote comfort and dignity based on current evidence.
Tissue viability part 1: the effects of ageing on the skin
Authors: Lloyd-Jones Menna
Published: May 2014

To identify the abnormal one must have knowledge of the norm. Therefore before undertaking any activity in tissue viability, be it assessing the skin for the early identification of pressure damage or the application and removal of dressings it is essential to have a basic understanding of the anatomy and physiology of the skin. Ageing, the skin and an understanding of the effects of ageing on the skin is essential in order to ensure that the care given is appropriate and safe.
Ageing and the older person part 1: the brain and the heart
Authors: Peate Ian
Published: May 2014

Globally and nationally there is an ageing population. Ageing is a constant process and begins when a person is born, it is also an individual process, affecting each person differently with regards to the speed at which a person ages and the affects of ageing. In order to provide holistic health and social care for the older person this means that the healthcare assistant/assistant practitioner has to have an insight and understanding of the potential physiological changes that can occur when people age.

Pathophysiological changes will include the changes that are often associated with physical health but also, and just as importantly, are the changes that the person may experience from a psychological perspective. The impact of these changes varies from individual to individual.

This series of articles will look at how ageing affects people in different ways and should provide you with a good understanding of what your older patients are going through.)
Scabies: an overview of the condition
Authors: Nazarko Linda
Published: May 2014

Scabies outbreaks can occur in care homes and can be difficult to diagnose in older people because they do not always display all the clinical symptoms. Additionally, skin problems such as itching and rashes are common in older people and so scabies could easily go unnoticed for a while.

The condition can spread quickly if untreated and if treatment is not carried out to the highest standard, outbreaks can persist for months. This article explains what scabies is, why it causes itching and rashes and how it can be treated.
Restraint part 3: Assessment and planning considerations
Authors: Hughes Rhidian
Published: May 2014

This is the penultimate article in the restraints series. In this issue key principles towards minimizing restraint use are discussed together with some illustrative case examples.
Restraint part 4: issues and dilemmas
Authors: Hughes Rhidian
Published: May 2014

This final article in the current series on restraint takes a broad view of some of the issues raised by restraints for healthcare practitioners. The article covers debates about ‘restraint free’ care, values that support positive practice, and education and training to minimize the unnecessary use of restraints.
Influenza vaccine under delegation
Authors: Sutherland Brenda , Moss Diana
Published: May 2014

The issue of healthcare assistants (HCAs) delivering influenza vaccinations is a contentious one - some believe it should only be administered by registered practitioners while others argue that with appropriate experience, training and supervision, it is a role that can be delegated to the HCA. The Health Protection Agency (HPA) argues that those who administer the flu vaccine ‘should’, not ‘must’ be registered (HPA, 2005) while the Working in Partnership Programme (WiPP) has developed resources for general practices to enable HCAs to deliver it safely (WiPP, 2008). The key issue that must be addressed when delegating the flu vaccine to competent HCAs is that they must follow a strict protocol and Named Patient Group Direction before administering it.

This article explains the process of developing and training HCAs to administer the flu vaccine, with a specific focus on a programme running in Leicestershire.
Paediatrics: nutrition for babies and young children
Authors: Shepherd Alison
Published: May 2014

Nutrition in childhood is of fundamental importance if young children of today are to grow into healthy adults.

This review will give an overview of the basic nutritional requirements, essential in the diets of babies, toddlers and young children, which if addressed will enable this age group to progress through the lifespan, achieving their full potential.

Ensuring that children receive optimum nutrition is everybody's business and nurses and nursing support workers in contact with children are in a prime position to identify nutritional problems and take appropriate steps to rectify these.
From healthcare assistant to endoscopy practitioner
Authors: Gardiner Angela , Coulten Beverley
Published: May 2014

Endoscopy is an area which has seen an expansion in the base of individuals undertaking procedures over recent years. Spencer and Ready (1977) published first descriptions of endoscopy by non-medically qualified personnel in the USA. Duthie et al (1998) articulated the development of nurse endoscopy in the UK in 1998 which has since become accepted practice in many hospitals across England. As pressures on endoscopy increase through target-driven care, bowel cancer screening and the 18week diagnostic agenda, there is a growing need to extend the endoscopy workforce to ensure provisions can continue to maintain service requirements. An initial pilot study undertaken by the Modernisation Agency in 2003 evaluated the possibility of training non-traditional individuals to undertake flexible sigmoidoscopy (FS). The pilot was successful and was followed by a second wave whereby nine healthcare workers received education and training to undertake FS. Backgrounds of those involved in the second wave included healthcare assistants (HCAs), administrative staff, a phlebotomist, a junior doctors’ assistant and a clinical physiologist. This paper provides an overview of the educational programme and the role of the endoscopy practitioner and explores the thoughts and feelings of one HCA who completed the programme.
Writing assignments: how to deconstruct an essay title
Authors: Powell Sarra Saffron
Published: May 2014

This is the first in a four-part series of study skills articles that will help you write better assignments. The series will cover deconstructing titles, effective research skills, reading and critical thinking strategies, and how to write academically.
Long-term mechanical ventilation part 1: ethical dilemmas and decisions
Authors: Hewitt-Taylor Jaqui
Published: May 2014

The increasing use of long-term mechanical ventilation has many benefits, but can also create concerns and dilemmas for those who use it, their families, and staff. This often includes healthcare assistants who provide day-to-day support to people who use long-term ventilation.
Nutrition part 3: malnutrition
Authors: Nazarko Linda
Published: May 2014

Adults who are old and those who have long-term conditions are especially vulnerable to malnutrition. Malnutrition affects health and ill health increases the risk of malnutrition. People who are unwell can become caught in a vicious cycle of ill health, exhaustion and deteriorating health. This article aims to enable you to understand why people become malnourished and how to identify those at risk of malnutrition.
Risk management: the importance of knowledge
Authors: Green Barrie , Tracey Noel
Published: May 2014

Contemporary thinking links the terminology of risk and danger as one concept. The emphasis upon risk avoidance, blame culture and dangerousness creates a range of dilemmas for all staff, but particularly the healthcare assistants (HCAs) who often find themselves in the frontline of risk management without the training or preparation to function effectively. This paper introduces the subject of clinical risk and highlights the role of the HCA in its management.
Regulation: are we any closer?
Authors: Peate Ian
Published: May 2014

The National Nursing Research Unit (NNRU) has published its scoping exercise into the regulation of healthcare support workers for the Nursing and Midwifery Council (NMC) (Griffiths and Robinson, 2010). The report should help inform discussions with key stakeholders about this important issue by providing a wide-ranging, UK-wide evidence base, and help us move towards action on the important issues raised.
Respiratory rate measurement: a comparison of methods
Authors: Smith Ian , Mackay John , Fahrid Nahla , Krucheck Don
Published: May 2014

The value of monitoring respiratory rate as a key vital sign to detect early changes in the health status of critically ill patients has been well documented. However, although pulse oximetry has been a major advance in bedside monitoring, it has not been demonstrated to be an indicator of serious illness. Arterial blood oxygen saturation appears to be poorly understood by hospital staff and lacks specificity as a monitoring tool. Therefore, the primary objective of this study was to demonstrate an equivalence between the respiR8™ respiratory rate monitor and manual counting methods, defined as a difference within ±2 breaths per minute. Secondary objectives of this study were to assess the respiR8™ performance from the end-user perspective, analysing respiR8™ alarm activations, corresponding pulse rate and SpO2 readings (sub-group), and to assess repeatability of both manual and digital readings using a Bland-Altman analysis (describe).
Clinical observations 6/6: nutritional assessment
Authors: Wild Karen , Peate Ian
Published: May 2014

This is the final article in a series of 6 that focuses upon clinical observations. The healthcare assistant (HCA) and assistant practitioner (AP) must ensure they employ effective practices and have the ability to record and report findings in line with local policy. This article explores the why, when, how, what and where of nutritional assessment. A discussion concerning nutrition and the importance of dietary intake is offered, providing the HCA and AP with an understanding of how nutrition is maintained. Methods of nutritional assessment and factors that impact on health and diet are discussed and a conclusion is offered.
Staff views of the introduction of APs into N Bristol NHS Trust
Authors: Crew Sue
Published: May 2014

The article looks at the introduction of the assistant practitioner (AP) role into the established nursing teams within North Bristol NHS Trust (NBT) by means of an evaluation of staff perceptions through their stories.

This research was completed during 2011 and was submitted as a dissertation in partial fulfilment for the degree of MSc Leadership and Management in 2012. The full dissertation is freely available in the Trust library.
Cardiogenic shock: prompt action can reduce deaths
Authors: Peate Ian , Holmes Edward
Published: May 2014

This article provides information concerning a potentially life-threatening condition—cardiogenic shock. Shock is an acute widespread reduction in effective tissue perfusion that causes an imbalance of oxygen supply and demand. Vital organs and tissues fail to be perfused effectively.

The article offers an overview of the anatomy and physiology of the heart. A discussion concerning the pathological changes that occur in conjunction with cardiogenic shock is provided. The signs and symptoms are described and the management of the condition is highlighted.

The role of the healthcare assistant and assistant practitioner (HCA and AP) are briefly addressed. A glossary of terms is provided.
Clinical skills series/6: oral hygiene
Authors: Peate Ian , Gault Christine
Published: May 2014

Healthcare assistants (HCAs) and assistant practitioners (APs) are essential members of the multidisciplinary team and are involved in many ways to ensure that the people they offer care to are provided with high-quality, safe and effective care—which extends to the provision of oral hygiene.

Oral hygiene is seen as a fundamental aspect of care ( Department of Heath, 2010 ). Poor oral care given to vulnerable patients in long-term care settings can have serious consequences, including increased risk of stroke, heart disease and pneumonia.

HCAs and APs are ideally placed to take action to prevent poor oral care by making sure that there are appropriate supplies in place, promoting oral care to all care staff and using an evidence base to offer care to those they look after. This article discusses this important aspect of care and provides guidance to HCAs and APs when helping adults meet their oral hygiene needs.
Good care and management of faecal incontinence (FI)
Authors: Nazarko Linda
Published: May 2014

Faecal incontinence (FI) is a hidden problem that can affect up to 10% of adults. Around one person in 100 regularly experiences this embarrassing condition ( Perry et al, 2002 ). This article explores the reasons why adults can develop faecal incontinence, explains what treatments are available and how intractable faecal incontinence can best be managed.
Helping healthcare assistants make genuine careers in caring
Authors: Glasper Alan
Published: May 2014

Professor Alan Glasper discusses the implications of the independent review of the role of healthcare assistants (HCAs) and support workers in the NHS and social care settings, which was undertaken by Camilla Cavendish, associate editor, Sunday Times
Improving the experience of care for people living with HIV
Authors: Peate Ian
Published: May 2014

Some 30 years have passed since the identification of the human immunodeficiency virus (HIV). During this time, there have been immense strides made in the provision of high-quality and effective care, and there are clear improvements in clinical outcomes and the health and well being of those people living with HIV. People with HIV are living longer.

The health care assistant and assistant practitioner (HCA and AP) have a central role to play as members of the health and social multidisciplinary care team in improving the health and well being of people who are living longer with HIV. Despite the advances in care provision (often against a backdrop of financial constraints), there is more that can be done to help people with HIV.

This article provides an overview of the standards of care for people living with HIV. An awareness of the standards of care can help the HCA and AP offer care that is patient centred and effective.
Educational internship at Portsmouth Hospitals NHS Trust
Authors: Garland Susan , Chrissy Cowan
Published: May 2014

In September 2013, following informal requests for mentoring from various staff members, Portsmouth Hospitals NHS Trust decided to set up a formal internship scheme.

This article introduces the scheme created by the trust’s nursing and midwifery education team. Its aim is to provide successful applicants with a part-time internship opportunity to complete a teaching qualification within a supportive educational environment. This approach provides individual staff members with personal development and broadens the number of people within the trust who can support or ‘buddy’ their colleagues.

BJHCA Board Member, Chrissy Cowan, began her internship in January 2014 and explains why she took up the option and what she hopes to gain from it.
2.8 Safe management of clinical and hazardous waste
Authors: Jones Menna Lloyd
Published: May 2014

Waste is generated in all healthcare environments. Around 10 to 15% of that waste is infectious or hazardous Every healthcare worker who produces waste has the responsibility to ensure that the waste is disposed of in an appropriate and safe manner. As a healthcare assistant (HCA), you will undoubtedly be involved with the disposal of clinical and hazardous waste and spillages. You therefore have a responsibility to ensure that you are competent in the safe disposal of such waste and management of spillages.

This article explains the Government definition of clinical waste and the steps that support workers can take to deal with it appropriately.