bluuebunny/crossref_metadata_2025 huggingface dataset:
Kangaroo care in pre-term or low birth weight babies in a postnatal ward
Authors: Gregson Sarah , Blacker Jonathan
Published: May 2014

Objective:

To compare the efficacy of Kangaroo care (skin-to-skin contact with mother) with standard care (next to the mother in a cot) for premature, low birth weight and babies of diabetic mothers in a transitional care ward setting.

Method:

This was a cohort study undertaken in a transitional care/postnatal ward of a UK district general hospital. The study involved 214 babies (107 in the study group, 107 in the control group) with a gestation 34-36+6 weeks, small for gestational age and babies of diabetic mothers. Babies in the study group had Kangaroo care following birth up to 6 weeks of age. Control group had standard care (in the cot next to the mother). The main outcome measure was the length of hospital stay. The secondary outcome measures were breastfeeding at discharge from hospital and at 6 weeks, admission to neonatal intensive care unit (NICU) and parent satisfaction.

Results:

There was a significant reduction in mean length of stay (4.33 vs. 5.01 days, P = 0.017, 95% CI 3.93-4.73 and 4.58-5.44) in the study group compared to the control. There was also an increase in exclusive breastfeeding rates on discharge from hospital in the study group (72% vs. 55% P = 0.01, OR 2.09, 95% CI 1.18-3.69). There were no differences in feeding outcomes at 6 weeks, or in admission to NICU.

Conclusions:

Kangaroo care is a simple intervention that reduces length of hospital stay and improves breastfeeding rates on discharge from hospital for babies cared for in a transitional care/postnatal ward setting. Parents rate Kangaroo care highly, especially in the first 2 weeks following birth.
Midwifery care for women with Müllerian anomalies
Authors: Bambridge Julie
Published: May 2014

Müllerian or congenital uterine anomalies (MA) are rare and are known to affect 0.5-10% of the general population ( Turhan et al, 2008 ; Tahira, 2010 ; Ludwin et al, 2011 ). They can, however, have a significant effect on pregnancy outcomes with increased rates of miscarriage, placental insufficiency, breech presentation, pre-term birth, intra-uterine growth restriction (IUGR) and stillbirth, which may be recurrent prior to diagnosis ( Lin, 2004 ). Women with MA may therefore require increased input, support and information. The role of the midwife includes providing continuity of care, maintaining a positive relationship with the woman, while ensuring good communication with obstetric, midwifery and medical colleagues. It is essential that the midwife fully understands the effect of the anomaly on the women's perception of pregnancy and strives to balance the medical and social models of care that will optimise continuity, and an individualised approach to the mother's physical, psychological, social and spiritual needs.
Mothers' breastfeeding experiences and implications for professionals
Authors: Guyer Julie , Millward Lynne J , Berger Israel
Published: May 2014

Twenty percent of babies in the UK are receiving breast milk for the recommended 6 months, suggesting that long-term breastfeeding is untenable for many mothers. This article reviews research on breastfeeding experiences and analyses six mothers' experiences of initiating and ceasing, or continuing breastfeeding. Interpretative phenomenological analysis was used to understand how they made sense of their breastfeeding experiences. All had breastfed in the last year, had similar socioeconomic backgrounds, and varied in their breastfeeding durations from up to 1 month, for 1-6 months and more than 6 months. Three major themes emerged: 1) reality of breastfeeding was highly discrepant from expectations, 2) the role of others in sustaining breastfeeding, and 3) feelings of guilt. Breastfeeding promotions that focus on biological benefits of breastfeeding without regard for psychosocial factors create a moral dilemma for mothers. Educational and counselling interventions using a biopsychosocial perspective can help mothers make informed feeding decisions.
Can hormones in breastfeeding protect against postnatal depression?
Authors: Donaldson-Myles Fiona
Published: May 2014

The benefits of breastfeeding are widely accepted; however, one of the likely advantages of breastfeeding is often overlooked: breastfeeding may help protect against postnatal depression. An earlier article ( Donaldson-Myles, 2011 ) reviewed the evidence of the beneficial effects of breastfeeding against postnatal depression. This article now examines the hormonal changes engendered by human suckling and lactation which appear to reduce the incidence of depression. It explores the role of stress and inflammation in depression together with the attenuating effects of the hormones of lactation. Prolactin and oxytocin are shown to have an inhibitory influence on the hypothalamic-pituitary-adrenal axis which is activated at times of stress. In addition, evidence that oxytocin has a central calming effect on the brain is discussed. An understanding of the moderating effects of the lactational hormones on postnatal depression could assist midwives in encouraging vulnerable women to breastfeed and help combat this devastating condition. Using this evidence-based information, midwives can utilize their valuable and limited time to encourage and support breastfeeding in women who are prone to depression to help improve their mental wellbeing.
The role of fathers in breastfeeding: Decision-making and support
Authors: Datta Jessica , Graham Berni , Wellings Kaye
Published: May 2014

Background

In recent years closer attention has been paid to the role of fathers in both the decision about whether to breastfeed and in supporting a breastfeeding mother. This qualitative study explores couples' decision-making regarding infant feeding, parents' views on the father's role in relation to breastfeeding, and examines some dilemmas fathers face when supporting a breastfeeding partner.

Methods

Eighteen men and women using maternity services at the Royal Sussex County Hospital were interviewed by telephone.

Results

Fathers acknowledged that the decision to breastfeed should be made by the mother and a father's role was to endorse his partner's decision and provide practical and emotional support. Those who faced breastfeeding difficulties described the processes involved in deciding whether to continue.

Conclusions

This small study draws upon the views of men and women living in the south-east of England in a city with high rates of breastfeeding initiation. Findings may not be generalizable to the wider population. However, in this setting new parents need information about breastfeeding and support to make informed decisions about duration and further input from health professionals when facing difficulties.
Maternal—fetal attachment and engagement with antenatal advice
Authors: Ross Emily
Published: May 2014

Background:

Following research demonstrating the effect of the intrauterine environment on childhood health and health in later life, women are encouraged to adopt healthy behaviours during pregnancy in order to promote the health of the fetus.

Aim:

This research aimed to explore the influences on women's engagement with healthy practices during pregnancy, particularly the effect of maternal—fetal attachment.

Methods:

This qualitative study used nine semi-structured interviews and one focus group. These were conducted with women who were pregnant or who had recently given birth. Participants were questioned about their attitudes towards and engagement with the health advice they received during pregnancy.

Results:

The bond felt with their baby was an important influence on women's decisions to adopt healthy behaviours during pregnancy. This bond was created in many ways. Previous studies have found an increase in women's adherence to healthy behaviours as levels of maternal–fetal attachment increase. However, this research found that as women became more bonded to the fetus they became more reassured of its wellbeing, and were less anxious about strictly adhering to healthy diets or abstaining from alcohol.

conclusions:

If health advice emphasises the wellbeing of the fetus in efforts to improve maternal health behaviour during pregnancy, women may not see its relevance if their embodied experience and diagnostic tests indicate that the fetus is healthy. The health advice offered to women should be sensitive to their personal experiences of pregnancy.
Birth practices of Nigerian women in the UK
Authors: Dike Priscilla
Published: May 2014

This literature review was carried out in the UK to explore the cultural practices of Nigerian women during pregnancy and childbirth both within and outside their indigenous community, in order to highlight aspects of birth practices that may serve to enhance their health and wellbeing or to constrain these.

Literature was sourced from journals of related disciplines. To encapsulate current knowledge and broaden the scope of the literature review, only articles published within the last 2 decades were selected for this review.

Themes drawn from the literature review sum up core beliefs and practices of Nigerian women in childbirth and uncover existing knowledge on the topic in relation to: beliefs and traditions through the birth continuum, the influence of culture on birth practices and beliefs within and outside their indigenous community, challenges of culture to maternal adaptation and/or transition to motherhood in terms of migration and acculturation, the value of motherhood and children in Nigerian culture, social support or the lack of it, religion and spirituality and the interplay of these in their birth experiences. These themes bear relevance to Nigerian women’s experience of pregnancy, birth and maternity care experience both in their home country and in the UK.
Why VBAC birthplace matters: A literature review
Authors: Rimkoute Anjelika , South Tina
Published: May 2014

The article focuses on the controversy surrounding place of birth for women considering having a vaginal birth after caesarean section (VBAC) out of hospital. It presents a summary of the research and arguments supporting choice of birthplace between midwifery-led and obstetric units. The impact of these opposing environments on birth experience and outcomes is reviewed. A combined VBAC rate in birth centres is between 73.5% and 91% ( Harrington et al, 1997 ; Lieberman et al, 2004 ; David et al, 2009 ). There appears to be no difference in adverse neonatal or maternal outcomes and Apgar scores at 5 and 10 minutes in comparison to a control group. Factors affecting the risk of uterine rupture and contraindications for an out-of-hospital birth are reviewed. Professional and ethical issues highlighted are the duty of the midwife to support women making controversial birth choices and a restriction of women’s and midwives’ autonomy in the context of the medicalised management of birth.
Electronic fetal monitoring during labour and anxiety levels in women taking part in a RCT
Authors: Barber Vicki , Linsell Louise , Locock Louise , Powell Lesley , Shakeshaft Clare , Lean Katie , Colman Jacqueline , Juszczak Ed , Brocklehurst Peter
Published: May 2014

The INFANT study is a randomised controlled trial to determine whether decision-support software for electronic fetal monitoring can reduce the number of babies born with poor outcomes compared to electronic fetal monitoring alone. A mixed methods sub-study was undertaken as part of INFANT to examine the effects of the technologies being used on the anxiety levels of those women randomised: 469 women were asked to measure their anxiety levels using a Visual analogue scale–anxiety (Vas-a) at three time points (two during labour and one postpartum). There was little difference in anxiety scores between the two groups and scores were positively correlated with stage of labour. This study concludes that the addition of decision-support software did not increase overall anxiety during labour. Furthermore, an additional 18 women were interviewed by a qualitative researcher to further assess anxiety in the study participants. From the sample it was concluded that where anxiety occurs it may be more to do with general anxiety about the baby's health, which may be prompted by a range of factors including staff behaviours and verbal communication rather than the addition of decision-support software to electronic fetal monitoring.
Domestic violence: The base of the iceberg
Authors: Lees Susan , Phimister Diane , Broughan Christine , Dignon Andrée , Brown Maureen
Published: May 2014

In 2011, the European Commission funded a 2-year project to raise awareness of domestic violence as part of the Daphne suite of programmes. Coventry University was the lead in the project that worked collaboratively with partners in Spain, France and Bulgaria. The project was entitled ‘The Iceberg Project’, which is a metaphor depicting the fact that much of the violence is hidden below the surface. A key part of the university's role was to conduct a literature review centred on the student population within universities, as young women aged 16–24 years old are the group most likely to experience domestic violence (Flately et al, 2010). Universities and students may play a key role in educating the future generation and eliminating domestic violence. Student midwives are uniquely placed to raise awareness and reduce the prevalence of domestic violence, as well as signpost victims to appropriate sources of support.
Incident reporting
Authors: Wilson Jo
Published: May 2014

Healthcare delivery is a risky business. People view the NHS in the same light as other commercial businesses such as the hotel, retail and airline industries. The White Paper ‘The New NHS: Modern, Dependable’ (Secretary of State for Health, 1997) places statutory responsibilities on managers and clinicians to provide a quality service and to have accountability for clinical governance and performance management. Quality and risk are two sides of the same coin, i.e. if you have good quality you have low risk, and this firmly supports the clinical effectiveness agenda. Healthcare organizations in all sectors of care delivery need to demonstrate their high levels of achievement and commitment to continuous quality improvements. Risk management is a process for identifying, assessing and evaluating risks which have adverse effects on the quality, safety and effectiveness of service delivery, and taking positive action to eliminate or reduce them. Having an open, honest and blame-free organization which is open to improving processes and systems of care is a big step towards having staff who are committed to quality and getting things right. Near-miss, incident and indicator recording and reporting are cornerstones of any quality and risk management system.
Melgisorb: a highly absorbent calcium/sodium alginate dressing
Authors: William Clare
Published: May 2014

Alginates have been used in wound care for many years. In recent years alginate dressings have developed to provide an extremely cost-effective way of managing wounds with a moderate to high level of exudate. The dressing gel has traditionally been either soft or firm on removal, but with new technology softness and fast gelling may now be combined with high integrity in a single product. An example of such a product is Melgisorb from Möinlycke Health Care (the makers of Mepore). Melgisorb is just one dressing in their range of chronic wound care products.
Promoting compliance with antihypertensive medication
Authors: Allen Helen
Published: May 2014

One of the key areas identified for action in ‘The Health of the Nation’ (Department of Health, 1992) is a reduction in the number of deaths from cerebrovascular accident. The major precursor of stroke is elevated blood pressure, and although efficacious medication exists for the control of hypertension, non-compliance in patients with this condition is notoriously high. This article examines ways to successfully address this problem and reduce morbidity. Consideration of psychosocial variables emphasizes that compliance with antihypertensive medication regimens is a multifactorial problem, but one that can be solved. Nurses, mindful of barriers to compliance, can encourage and support the patient in taking the prescribed antihypertensive medication.
Comparing hydrocolloid dressings in management of exuding wounds
Authors: Banks Valerie , Hagelstein Sue , Thomas Nicola , Bale Sue , Harding Keith G
Published: May 2014

Hydrocolloid dressings have been widely used since the late 1970s. This article compares two hydrocolloid dressings — 3M Tegasorb dressing and ConvaTec's Granuflex (E) — and highlights their similarities and differences when used in the clinical situation. Both hydrocolloids were reported to perform favourably by users in most situations. 3M Tegasorb dressing becomes transparent in use and this function was rated highly by users compared to the opaque Granuflex (E). In addition, 3M Tegasorb showed better adherence. One limitation of the study was the small number of patients studied. Weekly assessments yielded 90 data sets in total.
Prison health care: work environment and the nursing role
Authors: Norman Ann , Parrish Alan
Published: May 2014

This article, the first in a new series on prison nursing, gives an overview of the world of prison nursing and the environmental factors that make it so different from other types of nursing. It welcomes the recommendation in the report ‘Patient or Prisoner: A New Strategy for Health Care in Prisons’ (HM Chief Inspector of Prisons for England and Wales, 1996) that the NHS should be responsible for providing health care for prisoners and the recent publication of the report of the Joint Prison Service/NHS Executive Working Group ‘Future Organization of Prison Health Care’ (Department of Health, 1999), which endorses a formal partnership between the NHS and prison service. The article highlights the benefits that this will have for prison nurses who often feel professionally isolated. The role of the nurse working in the prison healthcare environment is outlined. The work of prison nurses differs from the role of nurses working in other healthcare situations as it is controlled by environmental factors associated with regimes, security and the prison culture. However, changes are taking place and a closer link with local services is envisaged. These changes are an excellent opportunity for nurses and nursing to establish a clear role in prisons and to develop further healthcare standards in the prison service.
Importance of handwashing in the prevention of cross-infection
Authors: Parker Lynn J
Published: May 2014

Although the importance of handwashing is routinely acknowledged, a religious application of this practice still does not exist. Discussion in modern medicine on the subject of handwashing always states that it is the single most important factor in preventing hospital-acquired infection. This article continues the series on infection control and practical procedures by looking at the evidence that supports the above statement and discusses various handwashing methods and how to increase compliance to handwashing in the healthcare setting.
System 4: the four-layer bandage system from SSL International
Authors: Marlow Stephanie
Published: May 2014

The System 4 multi-layer system (SSL International) is a compression regime indicated for the treatment of venous leg ulceration. Compression bandaging has become the main treatment for effective healing rates in this type of leg ulcer. System 4 is simple to use and cost-effective.
Use of psychotropic medication in people with a learning disability
Authors: Jenkins Robert
Published: May 2014

The use of psychotropic medication for people with a learning disability is a controversial issue that has received much attention. This article explores some of the issues for learning disability nurses surrounding the use of psychotropic medication. There are concerns regarding the side-effects that antipsychotic medication can produce. Evidence suggests that some healthcare professionals, including learning disability nurses, need to keep themselves regularly updated on issues surrounding the use of these drugs such as efficacy, side-effects and interactions. Learning disability nurses need a clear understanding of the reasons behind the prescription of such powerful medication especially when it is used in the management of challenging behaviour. There are indications that learning disability nurses would support alternative approaches to medication such as the use of behavioural interventions. More healthcare professionals, direct carers and clients should be encouraged to become part of the multidisciplinary drug-review process.
Cost benefits of two dressings in the management of surgical wounds
Authors: Moore Peter J , Foster Lorraine
Published: May 2014

In this prospective randomized controlled trial of the cost benefits of the choice of dressings in acute surgical wounds left to heal by secondary intention, patients had their wounds dressed with either a traditional dressing (ribbon gauze soaked in proflavine) or a modern hydrofibre dressing. Results showed that the hydrofibre dressing, although more expensive than the ribbon gauze, facilitated an earlier discharge from hospital (P = 0.001). The total cost of the patient episode was less in the hydrofibre group (P = 0.01). In an average UK health authority of 300 000 population, 100 bed days a year could be saved releasing an overall potential saving of £55 000. A modern hydrofibre dressing allows more effective use of scarce hospital beds and precious financial resources, while still maintaining high quality patient care. It is important that clinical specialists and purchasers of health care should be aware of this clinical and cost-effective advance in the management of acute surgical wounds.
Indwelling catheters: practical guidelines for catheter blockage
Authors: Doherty Willie , Winder Ann
Published: May 2014

Catheterization is a medical decision and requires a team approach involving, where possible, the patient and carer, as well as those professionals administering care. Catheterization and subsequent effective catheter drainage is associated with many dangers and complications (Lowthian, 1998) and therefore the decision to catheterize someone should not be taken lightly. Catheterization should only be used in intractable incontinence when all other measures have been tried and proven to be ineffective. This article identifies some of the problems associated with the care of patients with indwelling catheters in the community setting, and examines the issues that can cause pain, distress and discomfort to patients. It looks at the various types of solutions to problems associated with catheterization. Case histories are used to illustrate the types of patients who may have been catheterized. It is hoped that nurses can learn from these examples, so that they will not only cope more effectively with these individuals, but also observe their own practice when initiating indwelling catheterization and developing care packages.
Clinical benefits of 3M Tempa • DOT thermometer in paediatric settings
Authors: Macqueen Susan
Published: May 2014

Single-use clinical thermometers provide a safe alternative to the traditional mercury in glass thermometers for routine temperature taking. This article examines the 3M™ Tempa • DOT™ Single-Use Clinical Thermometer and discusses its use in the paediatric setting.
Patient participation in peer support groups after a cardiac event
Authors: Hildingh Cathrine , Fridlund Bengt
Published: May 2014

Peer support groups may be important in long-term rehabilitation after a cardiac event. Questions can be raised about the clients that peer support groups attract. The aim of this study was to compare people who chose to attend peer support groups after a cardiac event with people who declined to attend with regard to health conditions, personal traits, lifestyle and available social support. Patients who sustained a myocardial infarction or were treated with percutaneous transluminal coronary angioplasty or coronary artery bypass surgery (n = 197) responded to a questionnaire. The results showed that there were differences between attenders (n = 64) and non-attenders (n = 133). Attenders reported more health problems than non-attenders, but scored higher on several dimensions of social support. Non-attenders, however, seemed to have a somewhat more relaxed attitude to life than attenders. The homogeneity of the subjects made it difficult to discern which personal and situational factors were of importance for social support seeking in peer support groups. The research indicates that innovative approaches are needed to encourage participation in existing peer support groups.
Acceptability of early discharge with drain in situ after breast surgery
Authors: Chapman Dawn , Purushotham Arnie D
Published: May 2014

The aim of this study was to evaluate a policy of early discharge at 48 hours with suction drains in situ in a cohort of patients undergoing surgery for breast cancer and to compare this with a similar cohort of patients discharged 5 days postoperatively. This was an integrated qualitative/quantitative study using a questionnaire given to both groups providing comparable results by using averages and percentages to describe and synthesize the data. A questionnaire of open and closed questions was given to 19 patients who chose to be discharged at 48 hours with drains in situ, and 16 patients who opted to be discharged at 5 days after drain removal. The study demonstrated that patients regarded early discharge as being safe and were satisfied with their care when they were given a high level of support from hospital and community staff. The results also identified that it was important for patients to make their own decision about either early discharge or standard discharge in order to be satisfied with the outcome of their care.
Partner's perspective of erectile dysfunction: literature review
Authors: Dorey Grace
Published: May 2014

Erectile dysfunction is a problem which men may or may not share with their partners for a variety of reasons. This literature review of 26 articles revealed the partners' perspective of men with erectile dysfunction. Partners fell into four groups: supportive partner/acceptable to patient (the optimum category); supportive partner/unacceptable to patient; non-supportive partner/acceptable to patient; and non-supportive partner/unacceptable to patient. With comprehensive education and counselling by urology nurses, the couples could move into the optimal category. There is increasing recognition that the partner should be involved in the assessment, diagnosis, patient education, counselling and choice of treatment for long-term treatment to be successful, unless the informed patient is unwilling.
Assessment and management of chronic pain in elderly people
Authors: Mitchell Caroline
Published: May 2014

The ageing process can bring with it an increased incidence of conditions which give rise to chronic pain. Persistent musculoskeletal and/or neuropathic pain due to conditions such as back pain, arthritis, osteoporosis and diabetes in elderly people can lead to a marked deterioration in their quality of life. Pain assessment can be complicated by concomitant disorientation, confusion and communication deficits, leading to the undertreatment of pain in this client group. Pain management can be difficult due to the existence of multiple medical problems and the increased incidence of side-effects related to the treatment. This article aims to update nurses on the assessment and management of pain in the older adult, and will provide a broad overview of pain management strategies suitable for elderly patients.
The challenge of evidence-based practice for learning disabilities
Authors: Gates Bob , Atherton Helen
Published: May 2014

There is an ever increasing pressure on professionals within both health and social care settings to demonstrate evidence-based practice. The main aim of this article is to consider as problematic the challenge of evidence-based practice for both health and social care professionals, with particular reference to those working in the field of learning disabilities. The article addresses a number of issues, including the nature of evidence, the different types of evidence that professionals have at their disposal, and issues of reliability and validity concerning the kinds of approaches used to obtain such evidence. The challenges of implementing evidence into practice are also discussed in relation to ideology, organizational implications, and educational issues.
VACUTEX™ capillary action dressing: a multicentre, randomized trial
Authors: Russell Linda , Deeth Michelle , Jones Helen M , Reynolds Tim
Published: May 2014

This article describes a preliminary study comparing the effect of VACUTEX™ capillary action wound dressing vs standard protocol for the treatment of sloughy and necrotic wounds. The study was carried out over a period of 5 months. Randomization was computer generated and batches of trial numbers and dressing allocation were delivered to each of the three study sites, sealed in opaque envelopes to ensure blinding of allocation. A total of 35 patient participants were recruited (17 VACUTEX™, 14 standard protocol, three withdrew, one died). All participants gave their consent to enter the study. All participants were assessed and photographs were taken on days 1, 8, 15, 22 and 29. Nursing assessments of size, site, depth, severity, tissue type of wound and causation were collected, as were demographic factors including mental status, primary/associated medical history, weight, height, and ethnic origin.
Assessment and management of pain in fungating wounds
Authors: Naylor Wayne
Published: May 2014

Pain is a complex phenomenon that affects individuals in different ways. Wound pain is often seen as an inevitable consequence of wound care and many patients may suffer from chronic wound pain. One group of patients that presents a challenge in wound pain management are those with fungating malignant wounds. The effective management of wound pain may be compromised by inappropriate or non-existent pain assessment, the inefficient prescribing of analgesia, and confusion about the appropriate use of dressing products to reduce wound pain. Many healthcare professionals lack knowledge about pain and pain control and hold inappropriate beliefs and attitudes about analgesic medications, in particular relating to opioid drugs. This article aims to address these issues by providing a brief overview of pain physiology followed by strategies for pain assessment and options for the management of pain related to fungating wounds, including pharmacological treatments, wound care techniques and complementary therapies.
Treatment of an infected venous leg ulcer with honey dressings
Authors: Alcaraz Antonia , Kelly Jennifer
Published: May 2014

An infectious diseases unit is potentially an ideal environment in which to carry out research into honey-based dressings. This article looks at the barriers to carrying out case study-based research, and describes the treatment of an elderly gentleman with venous leg ulcers. The patient's wounds improved with the honey-based dressing, but it failed to free the wound of microbes. One possible explanation is that the honey, instead of killing the microbes, actually provided them with a food source.
Parents' support and satisfaction with their child's postoperative care
Authors: Simons Joan
Published: May 2014

It is recognized that parents' presence during their child's hospitalization is of benefit to the parents and the child. However, the level of parental involvement in their child's care may be influenced by many factors, such as the amount of support nurses provide for parents. This article reports on two themes from the findings of a larger study on parental involvement in children's postoperative pain management — parental support and parents' satisfaction with their child's postoperative pain management. The aim of the larger study was to explore both nurses' and parents' perceptions of parental involvement in their child's postoperative pain management. The methods used were both qualitative and quantitative. The qualitative method of phenomenology was used to guide 20 nurse and 20 parent interviews. Quantitative methods involved surveying the nurses and parents on their perceptions of how supportive the nurses were towards the parents. The charts of 20 children were reviewed for pain-related data. This article reports on the issues of parent support from the results of the survey, and on satisfaction relating to their child's postoperative pain management from the parent interviews. The findings demonstrated that nurses perceived that parents were receiving more support from them than that which parents felt they were receiving. Parents were more satisfied with their child's pain management and children received more analgesia when they were cared for by a lower grade nurse.
Nurses' views about returning to practice after a career break
Authors: Durand Mary Alison , Randhawa Gurch
Published: May 2014

Shortages in nursing staff have led to recruitment campaigns targeting nurses who have left the profession. The present study explored reasons why career-break nurses decide for or against a return to practice, as well as perceptions of nursing following return. Semistructured interviews were conducted with 24 nurses who had returned recently to the profession and 28 nurses on a ‘career break’. Findings revealed that those who returned did so when their personal circumstances allowed, and half returned as bank nurses in order to work flexible, family-friendly hours. Some non-returners reported that they could not afford to return because of childcare costs. Although still a caring one, the nurse's role is seen by returners as becoming increasingly technologically and administratively demanding. Flexibility with regard to working practices, increased salaries and demonstrating that it values its staff, were highlighted by interviewees generally as priority issues for the NHS if it wishes to recruit career-break nurses.
Telemedicine: an innovative way of managing patients with leg ulcers
Authors: Samad Ajai , Hayes Sue , Dodds Simon
Published: May 2014

The optimal management of patients with leg ulcers requires a multidisciplinary approach, with contributions from both community and hospital specialists to identify, investigate and treat the underlying cause, provide patient education, assess healing and dress the wounds, and monitor outcome and prevent recurrence. However, current practice is impaired by the limited communication between community and hospital specialists. There are inconsistencies in methods of transferring and updating patient records between the hospital and the community, and this can lead to confusion over the diagnosis and appropriate management. Telemedicine, the electronic exchange of medical information at a distance, would appear to offer a way to establish an efficient and effective communication link between hospital and community specialists involved in the care of patients with leg ulcers. The authors of this article believe that modern information technology and the existing NHSnet information infrastructure could be employed to create such a link via electronic patient records.
The role of the critical care nurse in the delivery of bad news
Authors: Peel Nicholas
Published: May 2014

The NHS Plan and the Code of Professional Conduct direct the nurse to include the family in decisions made about the care of the patient. Well-developed communication is an essential interpersonal skill and a professional means of establishing nurse–patient/family trust. The use of a reliable and valid assessment tool based on Leske's Inventory will enable the nurse to prioritize the needs of each family at a stressful time and in unfamiliar surroundings, whether it is the intimidating critical care setting or not. Key training of critical care nurses in the sensitive area of delivering bad news is lacking. Failure to assess effectively individualized family needs and to plan, implement and evaluate the care given to relatives precludes holistic care. When care is managed to include the family, empowerment of the patient and family will lead to autonomy.
Establishing need for palliative care services for children/young people
Authors: Davies Ruth
Published: May 2014

This article describes how epidemiology may be used effectively to provide hard statistical data upon which to justify and base the development of paediatric palliative nursing services within a defined locality. Through an analysis of mortality data this study identified the number of children and young people with life-limiting (LL) conditions who met the criteria for paediatric palliative care (PPC) in South Glamorgan. Findings from this were then related to the provision of services, including nursing services, required to meet the PPC needs of children and those of their families within such a population. Outcomes identify the need for a multiprofessional/multiagency approach to care provision, including family nursing, respite and terminal care as well as postbereavement support. This study highlights how epidemiology may be used effectively to identify unmet needs and promote better systems of care delivery. Studies such as this strengthen the argument for nurses to cast aside what has been perceived as a hesitancy to use quantitative methods of research (Bonnell, 1999). Epidemiology, as a methodology, may now be deemed as yet another vital weapon in the nurse researcher's armoury aimed at providing evidence-based health care.
Stress responses, pressure ulcer development and adaptation
Authors: Jones Janine
Published: May 2014

This case study explores the possible psychosocial concepts underpinning a spinal cord-injured patient's pressure ulcer development, his response to the treatment offered and subsequent self-discharge. By examining both the physiological and psychological reactions of stress through conceptual models, it was possible to depict that there is a close relationship between autonomic responses and an individual's emotional and appraisal attributes. The effect of stress on the immune system was reviewed, with particular focus placed on the wound-healing process and the inflammatory phase. This identified a probable correlation between emotional stress and pressure ulcer development. An individual's reaction to emotional stressors is frequently associated with his/her unique coping strategies and their interplay with social support mechanisms. This case study will depict both positive and negative coping strategies and how the lack of social support influenced the final outcome. Through the provision of an anonymous patient history, investigation will be made into the effects of stress experienced by a patient. Models of stress and the patient's related physiological and psychological reactions will be discussed. Examination will be made into how the use of social support could have influenced the patient's coping mechanisms.
Healthcare professionals and euthanasia: current law in the UK
Authors: Dimond Bridgit
Published: May 2014

Trevor suffered from motor neurone disease and was concerned about the late stages of the illness. He had heard reports of people being unable to swallow or move and being in considerable pain and he wanted to ensure that he would die a dignified, pain-free and peaceful death. He therefore asked his son, a diabetic, to set aside insulin for him so that when he wished to end his life his son would help him die. His son was prepared to do that for him, but was concerned at the possibility of his being prosecuted. What is the law?.
Patient-professional partnership in spinal cord injury rehabilitation
Authors: Collis Pellatt Glynis
Published: May 2014

There has been considerable pressure from both patients and professionals for greater patient involvement in the delivery of health services in recent years, particularly in the domain of rehabilitation. However, it has been suggested that involvement by patients is limited in rehabilitation. Accordingly, this study aimed to explore and describe patients' and professionals' experiences of patient participation in team decision-making processes. This article presents findings from a larger ethnographic study, which employed interviews and participant observation to collect data. This article focuses on the results from semistructured interviews, which were conducted with 30 healthcare professionals and 20 patients in a spinal cord injury unit in the UK. Findings suggest that the experience of team membership and decision-making is shaped by professional paternalism. Patients and professionals perceive that they are involved in a partnership where patients make decisions. However, different levels of paternalism in the professional–patient relationship within team decision-making processes emerged from the data. These have been categorized as ‘open paternalism’ where power and control lies with professionals; ‘they tell me what they are doing’ where patients are informed of decisions; ‘they can always say no’ where patients can agree or disagree; ‘making the right choice’ where patients are steered towards the choice professionals consider as the ‘right’ choice; and ‘active participation’ where patients choose the course of action. It is suggested that professionals should examine their own practice and attempt to develop ways of working that empower patients to become equal members of the rehabilitation team.
Supporting parents in managing drugs for children with cystic fibrosis
Authors: Slatter Amanda , Francis Sally-Anne , Smith Felicity , Bush Andrew
Published: May 2014

A semistructured interview guide was used to interview 17 parents of children with cystic fibrosis identified through a shared care patient database at a London hospital to examine parents' medication-related roles and problems. Parents described their responsibilities in the home and the problems experienced, including adherence to regimens, involvement in decision-making, and relationships with the hospital teams and other healthcare professionals. The findings confirmed medication management as an integral part of the informal caring role. Many practical problems of ensuring the availability and administration of medication on a regular basis were described. Information gaps and problems with medication adherence increased the stress of providing effective care. The involvement of healthcare professionals across primary, secondary and tertiary care sectors in supporting parents in all aspects of medication management, including the development of strategies for transferring the responsibility for medication to their children, must be improved.
Professional holistic care of the person with a stoma: online learning
Authors: Hollinworth Helen , Howlett Sheila , Tallett Jane , Pettitt Sue , Cooper Debbie , Skingley Sarah , Power Sally , Woolgar Alison , Fendley Chris
Published: May 2014

Stoma care nurse specialists are valued for their diverse expertise, but it is essential that all practitioners who regularly care for people with stomas have the opportunity to develop professionally and influence this important area of practice. The vision of a clinical and educational team from Suffolk and south Norfolk led to the development of innovative web-based learning material. The aim is to inspire nurses to engage actively with people who have a stoma. ‘Professional care of the person with a stoma’ is about caring for the whole person, physically and emotionally, from the period before surgery, to their continuing care in the community. An overview of four aspects of stoma care is presented here as a way of sharing with a wider audience the expert practice harnessed during the development of this web-based module.
An infection control link nurse network in the care home setting
Authors: Roberts Carol , Casey David
Published: May 2014

Link nurse groups or networks are used to enhance practice at clinical level (Cooper, 2001), improve the collaboration and education of nursing staff (MacArthur, 1998) and, therefore, have an effect on patient care. The use of link nurse networks is widespread and applied to a range of nursing specialties, particularly in acute settings. Reference in the literature to link nurse networks in nursing homes is very limited, despite their existence. This article examines the advantages and disadvantages of link nurse networks and the link nurse role as described in the literature. In addition, comparisons are made with an established infection control link nurse network in North Wales nursing homes. The article describes the assessment of the North Wales network using an audit cycle. The efficacy of link nurse networks is rarely considered; however, the process of audit can enable the evaluation of the link nurse network in relation to staff education, monitoring of infection control practice and dissemination of information.
A case study using larval therapy in the community setting
Authors: MacDougall K Margaret , Rodgers Fiona RT
Published: May 2014

This article discusses the use of larval therapy by district nurses in wound bed preparation in the community. A case study is presented of a patient with a persistently necrotic and painful anterior tibial wound post-fasciotomy. The case study offers an insight into the practicalities involved in the use of larvae as effective and safe debriders of tissue for wound bed preparation. It is concluded that larval therapy is an under-used and misunderstood resource when considering effective wound care and this treatment should be actively considered as an alternative therapy in wound care. There is a need for both qualitative and quantitative research in this field, enabling a more thorough discussion to be entered into by all practitioners with an interest in this subject.
Hand hygiene: promoting compliance among nurses and health workers
Authors: AS Rickard Norman
Published: May 2014

Around 10% of hospital patients acquire a healthcare-associated infection and it has been estimated that around one-third of these could be prevented. This article discusses the causal link between hand hygiene and infection and the reasons why healthcare workers (HCWs) fail to comply with hand-hygiene policies. The action of hand hygiene is discussed in terms of the removal of transient microorganisms and the agents used. Reasons for non-compliance and some measures for achieving compliance, such as education and patient empowerment, are discussed alongside the difficulties that these present. In order to move forward, it is suggested that the problem has to be managed through cultural change, making it easier for HCWs to comply by improving hand-cleansing facilities and materials and providing feedback to personnel on local infection rates so that high-priority areas can be targeted. This may be facilitated by locally based action research.
An audit of the patient's experience of arterial blood gas testing
Authors: Crawford Anne
Published: May 2014

Arterial puncture is the most common method used to obtain a sample for the measurement of arterial blood gases (ABGs) and is essential to guide the prescription of long-term oxygen therapy (LTOT) in patients with chronic hypoxic lung disease. However, this procedure is often reported by patients as a painful and unpleasant experience, which to date has not been explored. This audit specifically examines the subjective views of a small group of patients (n=41) who are receiving LTOT who have experienced repeated ABGs. Results demonstrated that 49% (n=20) were poorly informed regarding what the procedure involved, almost half the patients 49% (n=20) recalled pain levels of 5 and above on a visual analogue scale and 66% (n=27) were totally unaware that the test could make a considerable difference to their treatment. While highlighting the deficits in current practice locally, this audit concludes that the respiratory nurse specialist is in an ideal position to implement changes to improve the patient's experience of chronic disease management.