bluuebunny/crossref_metadata_2025 huggingface dataset:
Venous thromboprophylaxis in acutely ill patients: nursing role
Authors: Wilmott Rosalind , Alikhan Raza
Published: May 2014

Venous thromboembolism (VTE) is a serious medical problem and is one of the most important preventable causes of mortality and morbidity in hospitalized patients. This article reviews the prevention of VTE with thromboprophylaxis in acutely ill general medical patients. We review recent studies which show that general medical patients are at moderate risk of VTE and that low-molecular-weight heparin reduces this risk. Nurses have a key role to play in changing clinical practice by increasing awareness of the risk of VTE in medical patients, helping in the process of risk assessment and ensuring appropriate prophylaxis.
Teaching the stoma care routine to a patient with low vision
Authors: Benjamin Helen Claire
Published: May 2014

Teaching the patient with a newly-formed stoma, but who also has low vision, to manage his/her stoma independently can be a difficult task. This case study shows how a nurse taught a patient with low vision to become independent in relation to his newly-formed stoma, with a view to being discharged home successfully. At the time the stoma care nurse used her past experience and commonsense in achieving this aim. After the event the stoma care nurse researched the literature and discovered that there are accessories/devices available to assist patients with low vision to manage their stoma and help improve their vision. On reflection, the stoma care nurse felt she did not have sufficient time preoperatively with the patient, which prevented her from being able to change the course of action. She has now improved her knowledge, which will assist her in the future if she has to care for another patient with low vision who has had a newly-formed stoma.
Cutinova® Hydro: a modern alternative to hydrocolloids
Authors: Law Jaki
Published: May 2014

Since the 1960s, moist wound healing has been accepted as the scientific approach to wound care. The White Paper ‘Making a Difference’ (Department of Health (DoH), 1999) stated that nursing practice should be supported by research and that current evidence should be utilized to improve information used to support care and treatment decisions. Wound care products, both the traditional and the new, are under increasing scrutiny as the physiology of the wound healing process is understood with more clarity, assisting the clinician to reappraise current practice in the light of new information. The following study considers such physiological responses when reporting the effects of Cutinova® Hydro (Smith & Nephew) in treating exuding wounds.
Urgotul®: a novel non-adherent lipidocolloid dressing
Authors: Meaume S , Senet P , Dumas R , Carsin H , Pannier M , Bohbot S
Published: May 2014

Urgotul® belongs to a new class of non-adherent dressings: the lipidocolloid dressings. It is composed of an open weave polyester mesh impregnated with hydrocolloid polymers dispersed within petrolatum. The first clinical trial data are presented. Efficacy and safety were evaluated in a multicentre non-comparative trial involving 92 patients treated to healing or up to 4 weeks. Adult outpatients with acute wounds (n = 34), leg ulcers (n = 24), other chronic wounds (n = 14) or with second-degree burns (n = 20) were included. Results showed 32.4% (n = 11) of the acute wounds, 12.5% (n = 3) of the leg ulcers and 14.3% (n = 2) of the other chronic wounds completely healed before 4 weeks. Surface areas decreased on average by 76.4%, 63.5% and 44.2% at study endpoint respectively. For burns, 19 patients healed (95%) within 519 days. A total of 771 dressing changes were performed during the course of the study. Dressing application was considered as easy or very easy in 90% or more of the changes and there was no difficulty in removing the dressing in about 95% of the cases. Safety was good with five reports of a transitory local adverse event, probably dressing-related, being observed. Two patients (2.2%) prematurely stopped treatment because of moderate periwound erythema. Urgotul® is a highly promising new dressing which is currently undergoing further, comparative, clinical evaluations.
Dietary needs for bone health and the prevention of osteoporosis
Authors: Love Christine
Published: May 2014

Osteoporosis is identified as a painful, disabling and disfiguring health deficit that is entirely preventable given early detection and reversal of the causes — one of which is deficiency of nutrients required for bone health. The notable examples of nutrients where deficiency is directly related to the onset of osteoporosis are identified as calcium and vitamin D. The reasons why deficiency occurs are analysed in this article and high-risk situations for deficiency identified and discussed. The use of phytooestrogens in dietary prevention of osteoporosis is explored to include analysis of foods containing phytooestrogens, the quantities required, and product variability. Given the increasing role of phytooestrogens in dietary prevention of osteoporosis, discussion in this section looks at the need for food labelling, including phytooestrogen content, so that consumers can make reasoned choices as to the quantities they require and the dietary sources from which this will be obtained.
Infection control and maintaining hygiene and cleanliness
Authors: Dimond Bridgit
Published: May 2014

Sarah is a staff nurse working on a surgical ward. She is aware that the ward is not being cleaned properly and therefore is concerned at the possibility of hospital-acquired infection. What action should she take? The level of infection and, in particular, hospital-acquired infections (HAIs), are of considerable concern. This article considers the recommendations of the National Audit Office report, the Department of Health's (DoH's) NHS hospital clean-up campaign and the appointment of matrons.
Managing and improving healthcare delivery in 2003
Authors: Tingle John
Published: May 2014

The year 2002 has drawn to a close and therefore it may be useful to examine whether the NHS is learning from the errors of its past.
Suspension must not be managers' first port of call
Authors: Birchenall PD , Parrish OBE Alan A
Published: May 2014

There is a common theme among health service managers, management consultants and management theorists that people are the most important resource in any organization. For some managers it is a phrase that, having returned from courses or conferences, they conveniently ignore. In a recent article, Castledine (2003) points out that organizations and institutions influence our lives in various ways. This is a view that is endorsed by Redbridge (2003).
Nurse who was not competent and who overlooked key tasks
Authors: Castledine George
Published: May 2014

When Sister Winters took over as ward manager of a busy medical ward in a large hospital she was told it needed reforming and bringing up to date as there had been rumours and complaints about the quality of nursing care. This led Sister Winters into planning a strategy of working closely with all her permanent staff nurses to see how well they performed. She invited staff to write down any procedures or aspects of nursing care they felt they needed more training in, and encouraged them to the prioritize tasks.
Nurse who did not keep accurate fluid balance records and was rude
Authors: Castledine George
Published: May 2014

Monitoring a patient's fluid balance is a serious business which on many general wards is carried out in a haphazard and inaccurate way. Too many patients are placed on fluid balance charts who do not really need their intake and output monitoring closely. This leads to careless practice and sends out a message that fluid monitoring is not as important as it should be.
Does screening for loss of lung function help smokers give up?
Authors: Wells Sally , de Lusignan Simon
Published: May 2014

One-fifth of smokers show accelerated decline in lung function. These are the patients that go on to develop chronic obstructive pulmonary disease (COPD), an illness characterized by cough, production of sputum, shortness of breath and premature death (Sethi and Rochester, 2000). If this group of smokers stopped smoking, their decline would slow and they might avoid developing COPD. This pilot study aimed to discover whether those with accelerated decline in lung function would quit if presented with the facts about their situation. Known smokers in their 50s were screened for signs of accelerated respiratory decline. Those with an accelerated decline in lung function were identified and given tailored smoking cessation advice. Of 141 eligible patients, 22 responded and six gave up smoking and remained non-smokers 1 year later. The results of this pilot suggest that screening smokers for accelerated respiratory decline by practice nurses is feasible and acceptable to those patients that respond. Further research is needed to discover whether such an intervention would be cost-effective.
The introduction of nurse prescribing in the community: 1
Authors: Dimond Bridgit
Published: May 2014

A group of district nurses run a children's clinic. The district nurses who have prescribing powers are able, where appropriate, to give the mothers a prescription for any necessary medicinal products. Mavis decided that one child required a preparation for head lice and asked the mother if the child was asthmatic. The mother said no and the nurse wrote a prescription. Mavis said that she had been unable to refer to the child's records as they were not available at this clinic. She subsequently learnt that because of an allergic reaction, the child had suffered considerable harm. Is she liable?
The introduction of nurse prescribing 2: final Crown report
Authors: Dimond Bridgit
Published: May 2014

A clinical nurse specialist in accident and emergency prescribed the pain killer paracetamol for a patient suffering from a minor injury. She was unaware that the patient was allergic to this medicine. The patient suffered serious liver damage and the relatives are urging her to sue. What is the liability of the clinical nurse specialist?.
Registered nurse who failed to attend to the needs of patients
Authors: Castledine George
Published: May 2014

When Beryl Brooks first went to work as a registered nurse at Ashington Nursing Home, she was warmly welcomed by her colleagues as there had been some acute staffing problems. Her arrival meant two senior trained staff could be on duty, one in charge of each floor of the home.
Palliative care philosophy in care homes: lessons from New Zealand
Authors: Nolan Mike , Featherston Jan , Nolan Janet
Published: May 2014

Increasing numbers of people are dying in care homes yet little is known about the nature and quality of their deaths. The limited research available suggests that there is a need to promote a philosophy of palliative care that is not confined to the terminal phase of life. However, adopting such an approach appears to be inhibited by a lack of understanding, education and training, as well as continuing reluctance to discuss issues of death and dying in an open and honest way. Drawing on data from a large convenience sample of caregivers in New Zealand this article argues for a reappraisal of the way in which care homes view death and dying and advocates the more widespread adoption of a palliative care philosophy.
The causes of anaphylaxis and its management in adults
Authors: Ferns Terry , Chojnaka Irena
Published: May 2014

Anaphylaxis is a potentially life-threatening condition which nurses may encounter while practising in any sphere of nursing. This article reviews the management of adults presenting with severe anaphylaxis in a general hospital setting. It summarizes data obtained from studies on the incidence of anaphylaxis, explains their significance, and defines the terms used when describing the pathophysiology of the condition. This is followed by an examination of the pathophysiology surrounding anaphylaxis with a summary of common causative agents. An overview of the management of patients with anaphylaxis is presented, together with a summary of the literature relating to the legal and ethical issues that nurses may face when encountering patients presenting with or experiencing anaphylaxis.
Web Watch
Authors: * *
Published: May 2014

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

Nursing education has undergone major changes. Its relocation into therealm of higher education is now well established. Reorientation to this reality has been painful and has elicited divisiveness from some, and has required a good deal of re-education for many. There are those within and outside the profession who still find the subject inflammatory.
Matron who restrained a patient with bandages in a wheelchair
Authors: Castledine George
Published: May 2014

Harry had always been independent and determined to maintain his autonomy, despite his ill-health. He suffered from Parkinson's disease, diabetes mellitus, glaucoma and angina. Over the past few months his general condition had deteriorated and he had been admitted to the local general hospital.
ProfiCare®: an alternating pressure-relieving mattress
Authors: Collins Fiona
Published: May 2014

Risk assessment tools should only act as a guide to patient status rather than definitive diagnosis. Emphasis must be placed on not using the Waterlow score in isolation but in conjunction with clinical judgment. We must therefore attempt to minimize opportunities for disagreement over pressure ulcer risk scores through the selection of appropriate support surfaces based on a thorough consideration of costs of pressure ulcers for the patient, institutions and healthcare professionals. This product focus advocates that ProfiCare® replacement mattresses are an option as they are designed for use on a hospital bed frame and provide alternating and static patient support surfaces.
Mental health nursing students' rationales for self-disclosure: 2
Authors: Ashmore Russell , Banks David
Published: May 2014

This is the second of two articles that consider the findings of a study exploring mental health nursing students' reasons for their use and non-use of self-disclosure in their relationships with patients. The first article (Vol 12(20): 1220–7) described the background to the deployment of this skill within therapeutic approaches, the paucity of literature discussing its use within nursing, the methods employed in this study and the findings for mental health nursing students' reasons for using the skill. This second article focuses on students' reasons for not deploying this skill, which are discussed in the following categories: ‘crossing the line’, ‘unhelpful’, ‘name, rank and serial number’ and ‘students’ vulnerability'. A discussion of the findings from both articles and their implications is offered.
Injury in the workplace: Criminal Injury Compensation Authority
Authors: Dimond Bridgit
Published: May 2014

Bob was a staff nurse in the accident and emergency department and was used to dealing with drunk people at weekends. One Friday night, however, he was caring for a patient who had been knocked down by a car. The man's friends were extremely drunk and attempted to interfere with their friend's treatment. Bob asked them to leave, but they refused. He warned them that he would be calling the police but one of them lunged at Bob, who fell backwards against a trolley causing a severe back injury. He was off work for several weeks and was warned that he might never fully recover. How can he obtain compensation?
Correspondence
Authors: Woods Karen , Powell Rebecca , Richardson Margaret
Published: May 2014

I was interested to read your editorial ‘People should not have to resort to assisted suicide’ (Vol 12(3): 136) in which you commented on the recent case of Reginald Crew who was suffering from motor neurone disease and went to Switzerland where an association called Dignitas helped him to die.
Smoking and the right to expect a smoke-free environment
Authors: Dimond Bridgit
Published: May 2014

A community nurse went to an elderly man's home every day to give him insulin injections and to attend to dressings for his leg ulcer. She complained that he smoked incessantly, that the house was filled with smoke and that after her visit her chest tightened up and she frequently suffered from an asthma attack. She wondered if she could refuse to visit this particular patient.
Developing a spiritual approach to health care
Authors: Castledine George
Published: May 2014

There is strong evidence that people are starting to demand more from their workplace. In health care, it is especially important to care for those who are working in stressful environments and with demanding and difficult patients. Health care is much more than just achieving Government targets or the prevention and treatment of disease. Nurses want to feel that the experience of nursing is one that also brings self-satisfaction and meaning to their lives.
Nurses' willingness to manage the pain of specific groups of patients
Authors: Brockopp Dorothy Y , Ryan Patty , Warden Sherry
Published: May 2014

Effective pain management remains a challenge for the nursing profession. While nurses' knowledge of appropriate pain strategies has improved considerably, additional research needs to be conducted into the influence of factors other than knowledge on the management of pain. This study examined the willingness of nurses (n=157) and nursing students (n=265) to spend time and energy managing the pain of different groups of patients, when told that all patients had the same degree of pain. The willingness of nurses to spend time and energy in managing patients' pain was used as a proxy for preconceived notions relative to particular groups of patients. A pattern emerged that suggested that nurses' and nursing students' willingness to spend time and energy managing patients' pain is influenced by their perceptions of different groups of patients.
Forgotten importance of giving a bed bath
Authors: Castledine George
Published: May 2014

There is a decline in the quality of bathing and the attention given to patients' general toilet needs while in hospital. This essential aspect of nursing care, which was once seen as one of the most important aspects of a nurse's duties, is now being downgraded or delegated to support workers. The reason for this is either a shortage of qualified nurses, or that registered nurses are now more concerned and preoccupied with paperwork or other more technical tasks and medical procedures.
Secondary prevention for coronary heart disease: a qualitative study
Authors: Macintosh Mike J , Lacey E Anne , Ford Angela
Published: May 2014

The many responsibilities of primary care, cardiac rehabilitation and secondary prevention of coronary heart disease is a growing concern. Demanding standards have been given to primary care in the National Service Framework for Coronary Heart Disease. This article reports an evaluation of an intervention to support primary care service providers in this responsibility. A part-time specialist nurse and a part-time exercise worker were appointed to work in a group of 11 GP practices in a primary care trust in a city in the north of England. The evaluation component reported here is a qualitative study of the perceptions of health professionals on secondary prevention of coronary heart disease. Interviews were conducted with 18 primary care staff from practices in both intervention (n=11) and control (n=11) groups. The evaluation revealed support for the development of nurse-led clinics, increased confidence and skills development among practice nurses, but some concern about competing demands on practice nurses' time. Primary healthcare professionals found their resources stretched by competing demands on their time from government initiatives.
Law relating to the classification and regulation of controlled drugs
Authors: Diamond Bridgit
Published: May 2014

Mary, a newly qualified staff nurse, was asked by the night sister to draw up a syringe of morphine for a patient who was in severe pain. She had understood that she should not be doing this on her own, but the night sister said that they were too short of staff to provide another person.
Evaluating selection and efficacy of pressure-relieving equipment
Authors: Chaloner Donna , Stevens Jenny
Published: May 2014

The drive towards evidence-based practice has highlighted the lack of randomized controlled trials that compare interventions such as pressure-relieving medical devices. This may influence practitioners, particularly purchasing practitioners, to consider other types of evidence when appraising literature to determine clinical practice and support recommendations and local guidelines. This article will illustrate the development of an audit tool used to evaluate nurses' knowledge and skills in patient assessment, selection and installation of appropriate pressure-relieving equipment. The tool also assists in assessing clinical effectiveness and user satisfaction of equipment. This article focuses on a small audit of the Karomed Ltd Transair 1500 (also known as the 3·Comm) mattress replacement system.
Pressure ulcers and a lesson from the car industry
Authors: Butcher Martyn
Published: May 2014

I am one of those individuals who find television advertising fascinating. Every day we are bombarded with images of the good, the bad and the desirable (which we either accept or refute depending on our own agenda, background or susceptibility). However, one advert has recently got me thinking, not about the motorcar in question, but about what we need to consider when managing pressure ulcers.
Tissue viability research must be encouraged
Authors: Gray David
Published: May 2014

As we approach Wounds UK 2003 (11th and 12th November, Harrogate) it seems timely to focus on the contribution researchers make to the field of tissue viability. The conference will feature 35 free papers and over 70 posters. By far and away the largest group contributing to these presentations are nurses. There are also a large number of papers from a small number of research centres. We are lucky that the UK has such an active research community and it is hoped that this community continues to grow in not only numbers but also quality. Both of these facts can be seen as either positive or negative depending on the stance you adopt.
Law relating to pregnancy, stillbirths and miscarriages and disposal
Authors: Dimond Bridgit
Published: May 2014

Brenda was 5 months' pregnant when she miscarried. She was seriously ill but when she recovered she asked for the foetal remains to be made available to be buried in her local churchyard. She subsequently discovered that they had been incinerated and she wished to sue the hospital.
Preventing cellulitis in older people with persistent lower limb oedema
Authors: Stalbow Julie
Published: May 2014

Persistent lower limb oedema is an underestimated problem in the elderly population. Oedematous tissue predisposes the individual to the development of bacterial infections. Accurate assessment of the underlying aetiology and application of compression hosiery could prevent cellulitis and reduce the risk of recurrent episodes. Awareness of the complications of leg oedema needs to be raised in the general population. Healthcare professionals require education to enable the provision of safe, effective treatment to reduce morbidity relating to chronic oedema and cellulitis. The National Service Framework for Older People and the British Lymphology Society's Framework for Education could facilitate the development of national service provision to meet the needs of the population with chronic oedema.
Exploring issues of parental consent to research: a case-study approach
Authors: Peters Judy , Charles-Edwards Imelda , Franck Linda S
Published: May 2014

In this article, a novice nurse researcher relates her personal experience of encountering a challenging situation while taking consent from the parents of a critically ill child. This critical incident raises issues for the researcher of ensuring validity of the consent process and ensuring recruitment of an unbiased sample when issues of language and culture could impede communication. The process of reflection allowed the novice researcher to gain greater insight into her responsibilities as a research nurse in relation to recruiting patients and to reflect on how she would integrate this into her future practice, thus enhancing her confidence in her role.
The correct terms for the Catholic faith
Authors: Kalve Peter
Published: May 2014

As a Catholic theologian, I feel it appropriate to comment on Bridgit Dimond's recent article ‘Disposal and preparation of the body: different religious practices’ (BJNVol 13(9): 547–49), and her response to correspondence to that article (BJNVol 13(13): 781). I was pleased to see an attempt at a balanced article on these matters. The nature and type of article that Professor Dimond has written is bound to be limited in what it can say.That is not to criticize but to recognize the realities. However, it is this precise brevity of scope that puts the onus on Professor Dimond to be accurate in the language she uses. Brevity demands accuracy. I would like to raise three points.
From trade to profession: from appentice to graduate
Authors: Fulbrook Suzanne
Published: May 2014

In her article in The Times, Julia Magnet blamed much of today's troubles in nursing on the changes brought to the education of nurses. A move from the bedside — a practical passing on of skills from nurse to nurse — to the more formal teaching in a university (Magnet, 2003). She is not alone — many nurses trained under the former method would agree with her.
Loved ones of seriously ill patients need information
Authors: Ridley Saxon
Published: May 2014

Last year over 78000 people were treated in critical care units across the UK ( www.nice.org.uk ). Statistically, this means virtually everyone you meet will know someone who has been in critical care. It can be very frightening for friends and family to be told a loved one has been admitted to an intensive care unit (ICU). Relatives often feel confused and anguished; naturally, they have lots of questions about why their loved one is critically ill and what is happening to them in the ICU.
The introduction of a ‘trial without catheter' model in primary care
Authors: Warrilow Mary , Williams Dawn , Guest Jayne
Published: May 2014

Action research was used to compare and evaluate the current nursing practice of urinary catheter removal. The aim of this study was to plan, implement and evaluate a trial without catheter (TWOC) model in primary care and compare it with the clinical procedure being performed in the secondary care setting. Two sample groups were used; the first sample consisted of 10 patients who had undergone a TWOC in hospital, and the second consisted of 10 patients who had a TWOC in the community. An interview with the urology nurse specialist was also undertaken to gain further qualitative data. Statistics were analysed using an unpaired t-test. Results showed that 80% of hospital patients and all community patients stated that given the choice they would prefer to have their TWOC at home. Infection rates were monitored and 40% of hospital TWOC patients developed a urine infection, whereas no infection was reported in the community group. From this small study, it was evident that there were major benefits to providing a TWOC service within the community setting.
JOBST® Opaque compression hosiery in the management of venous disease
Authors: Pah-Lavan Zahra , Hampton Sylvie
Published: May 2014

Prevention of leg ulceration is a simple process involving assessment, accurate measurement of the leg and application of appropriate compression hosiery along with appropriate care of the skin. Persuasion of at-risk individuals to be aware of and follow prevention options needs to be incorporated in the ongoing health promotion activities of the practitioner (Price and Harding, 1996). This product focus examines the potential contributions of the new JOBST® Opaque gradient compression hosiery (with the innovative JOBST® soft care yarn) in prevention and management of venous disease and deep vein thrombosis, without sacrificing comfort and style in order to promote patient concordance.
Occupational exposure of staff to HIV and prophylaxis therapy
Authors: Peate Ian
Published: May 2014

Often the provision of post-exposure prophylaxis (PEP) is after exposure to persons with an undetermined human immunodeficiency virus (HIV) status. Cases of occupationally acquired HIV infection have been documented. The risk of contracting HIV from percutaneous exposure is small and PEP can significantly reduce the rate of occupational transmission. The Department of Health recommends that PEP be considered whenever there is significant exposure to high-risk body fluids, e.g. blood or other high-risk body fluids such as synovial or cerebrospinal fluid. It is important that a risk assessment is conducted to ascertain if the exposure is deemed significant. If it is, in an ideal situation, PEP should be commenced immediately, preferably within 1 hour; however, starting PEP up to 2 weeks after exposure may still be beneficial. All NHS and other healthcare settings, including the independent/private sector, should ensure that they have policies and procedures in place to ensure that their staff are aware of the actions to be taken if they are at risk of occupational exposure to HIV.
Nurse who put patients at risk by performing poor nursing practices
Authors: Castledine George
Published: May 2014

Jane was employed as a qualified practice nurse at a large GP surgery in a rural area of the West Midlands of England. She was joining a very supportive team of six very experienced qualified nurses who all worked well together and maintained their continuing professional development. For the first few weeks of the job she was carefully introduced to the practice and all the staff. Then following this period she worked with a reduced caseload so that she could settle into her work routine and be assessed for further help and support.
The introduction of nurse-initiated thrombolysis in coronary care
Authors: Smallwood Andrew , Pidgeon John , Kemp Hayley
Published: May 2014

Nurse-initiated thrombolysis has emerged as an organizational strategy to improve the delivery of thrombolytic agents to patients suspected of having an acute myocardial infarction. This article will outline the evolution of nurse-initiated thrombolysis on the coronary care unit in the authors' trust and present data on the critical decision-making skills of those nurses who have expanded their practice. Patients that were assessed and whose thrombolysis was initiated by a nurse designated to deliver this treatment, had ‘door-to-needle’ times consistent with the current targets of the National Service Framework for Coronary Heart Disease (Department of Health (DoH), 2000). A cardiologist acting as a ‘gold standard’ reviewed the assessments of the first 50 patients seen by nurses able to deliver thrombolysis, finding each treatment decision appropriate. This gives support to the notion that appropriately trained and experienced nurses can assess and make treatment decisions in this acute care situation.
Senior nurse who physically and verbally abused elderly residents
Authors: Castledine George
Published: May 2014

Sunnyhill was considered by the local homes inspection agency to be on the borderline when it came up for its formal inspection. It was concerned at some of the staffing ratios which showed very variable cover by trained nursing staff. Also, drug administration was not as tight as the official policy and procedures demanded, but on the day of the inspection it was carried out in the correct manner by the matron of the home.
Preventing hip fractures in care homes 2: role of the specialist nurse
Authors: Davies Sue , Doherty Donna , Glover Jean , Johnson Tracy
Published: May 2014

This article is the second of a two-part series based upon a research project to evaluate the impact of a specialist nurse role in reducing the incidence of hip fracture within care homes. The first article (Vol 13(21): 1242–48) described the background and methods of the study, and presented the findings relating to resident and staff experiences of using hip protectors as a preventive measure within the homes. This article focuses on staff experiences of the nurse specialist role as a mechanism for raising awareness of hip fracture prevention strategies and implementing evidence-based practice in this area. Findings suggest that specialist nurses have the potential to encourage evidence-based practice within care homes, while also improving staff morale and job satisfaction.
Guidance on the law concerning hospital postmortems in the UK
Authors: Dimond Bridgit
Published: May 2014

Fred Harvey died 3months after contracting a wasting disease which puzzled both his GP and hospital doctor. The consultant physician wished to carry out a postmortem on Fred and asked permission of Fred's wife Muriel. Muriel was a member of a religious sect of strict brethren who believed in the ultimate resurrection of the body. She therefore refused to allow Fred to be cut up. The consultant considered that he could not complete the death certificate until a postmortem had been carried out to ascertain exactly what the cause was of Fred's death. In addition, although he did not tell Muriel this, he wished to examine Fred for his own research and teaching purposes and, in particular, remove the liver and carry out research on it. What is the law?
A review of needle-protective devices to prevent sharps injuries
Authors: Trim Joanna
Published: May 2014

The risk of occupational transmission of bloodborne pathogens via sharp devices remains a significant hazard to both healthcare and ancillary workers. Previously, education, training, universal precautions and hepatitis B vaccination have been implemented in an attempt to reduce the risk. However, the most recent preventive strategy is needle-protective devices. These have been developed from conventional products but incorporate a safety mechanism that, when activated, covers the needletip and thus assists in the prevention of needlestick injuries and potential seroconversion to bloodborne pathogens. To date, a number of studies have been undertaken to evaluate these products, the majority of which show these devices to be safe and reliable in addition to potentially reducing associated needlestick injuries. However, to encourage the introduction of these devices in the UK, further studies are needed to either support or refute initial findings and to encourage the evaluation and subsequent implementation of needle-protective devices.
Accountability and medicinal products 1: criminal law
Authors: Dimond Bridgit
Published: May 2014

A patient was suffering from leukaemia and was receiving chemotherapy by intravenous transfusion. Unfortunately, a junior doctor, in error, administered the drug by epidural. The patient subsequently died.
What lessons can we learn from conflict resolution?
Authors: Field Harry , Nolan Peter
Published: May 2014

In the last 20 years, 50 of the poorest countries in the world have been involved in wars. In 30 of these, more than 10% of the population has been displaced and approximately 90% of casualties have been civilians. So what helps traumatized people in situations of violence and slaughter to continue with their lives?. In June 2003, a conference in Malta brought together psychiatrists, anthropologists, writers, artists, nurses and clergy to look at conflict resolution. Horrific images of war were put before the delegates and terrible experiences described. Yet speakers asserted that people are far more resilient than health professionals assume. People survive unspeakable horrors with or without counselling and it was even argued that counselling often fails to take into account the culture of the people and their existing support structures.
Staff nurse who failed to provide adequate nursing care for patients
Authors: Castledine George
Published: May 2014

Failure to provide essential nursing care is becoming a worrying trend in specialist hospital care. In the following case a senior nurse called Jo deliberately ignored certain aspects of care while on night duty because she felt that it was not her responsibility to do certain tasks or check that they had been carried out.
Management of scrotal swelling after pelvic and acetabular fractures
Authors: Raman Raghu , Senior Carol , Segura Pablo , Giannoudis Peter V
Published: May 2014

Complex pelvic and acetabular fractures are usually associated with high-energy trauma and often present with substantial perineal soft tissue swelling. This is the result of the significant haemorrhage that develops into the retroperitoneal space, which dissects along fascial planes to extend into the scrotum. Other factors that could contribute to the progression of the soft tissue swelling include the extensive approaches used for surgical stabilization of the fractures, the prolonged traction using a perineal post and the early typical catabolic responses after major trauma. This article describes a successful protocol for the management of scrotal swelling associated with complex pelvic and acetabular fractures. Rapid reduction of the swelling in the scrotal region prevents the onset of perineal wound slough. It also minimizes the risk of infection in case of skin breakdown by isolation from the perianal region. Furthermore, it precludes friction of the scrotum with the skin of the thigh, thus allowing adequate pain relief and faster rehabilitation.
The law and the certification, verification and registration of death
Authors: Dimond Bridgit
Published: May 2014

Daisy was a registered nurse who worked in a community hospital. One night, Gwen, who was 85 years old, died and Daisy phoned the GP who was responsible for providing a service to the hospital. She was told that the GP did not come out at night for a death but would come in the morning. Daisy wanted the patient moved from the four-bedded ward to the mortuary, but was told that the procedures did not permit that until a doctor had certified the death. Daisy felt that it was unsettling to the other patients who knew that Gwen had died. What is the law?
Early postoperative feeding and abdominal gynaecological surgery
Authors: Wu Lihua , Griffiths Peter
Published: May 2014

Since the 1990s, the traditional postoperative feeding protocol has been challenged for patients who have undergone major abdominal gynaecological surgery and value of extended delays in commencing oral intake has been questioned. This review aims to determine whether early rather than delayed postoperative feeding following major abdominal gynaecological surgery has an impact upon recovery as measured by length of hospital stay. The Cochrane Library, Embase, CINAHL and Medline were searched for randomized controlled trials (RCTs) which compared early postoperative oral intake with delayed (traditional) postoperative oral intake for patients who had undergone major abdominal gynaecological surgery. Three RCTs were identified and available for consideration. Although study quality was variable, they suggest that early postoperative feeding appears to be safe and well tolerated after most abdominal gynaecological surgery and leads to a considerable reduction in hospital stay of approximately 1 day. However, patients' preference and costs remain unclear. Therefore, further well-designed studies are needed to identify the comprehensive effectiveness of early postoperative feeding protocol.
Nurse who physically abused her patients
Authors: Castledine George
Published: May 2014

On 1 February 1999, a report was sent to the local police in Derbyshire that a nurse, Donna Roulston, had been mistreating patients in her care at the local community hospital. The police set up a meeting with the executives from the Derbyshire Community Health Services NHS Trust and it was agreed that the police would investigate allegations of physical abuse on patients. These allegations included three separate cases of ill-treatment of patients.
Guidance for first-line treatment of anogenital gonorrhoea infection
Authors: Tyson Mandy
Published: May 2014

Gonorrhoea is currently the second most common bacterial sexually transmitted infection in England and Wales (Public Health Laboratory Service, 2002). Early initiation of treatment is important in the reduction of the onward transmission of infection and contributes to the overall control of the spread of gonorrhoea. A central tenet of this is the use of effective antimicrobial treatment. Both global and local surveillance programmes have successfully generated robust data, identifying the prevalence of antimicrobial resistance when using fluoroquinolones, formerly a first-line treatment for genital infection with Neisseria gonorrhoeae. As a result of this evidence base, the first-line treatment recommendations in England and Wales were changed. It is now recommended that anogenital gonorrhoea is treated with third generation cephalosporins, with either a 400mg single oral dose of cefixime, or a single intramuscular dose of ceftriaxone 250mg. This change in 2004 in first-line treatment exemplifies the application and delivery of evidence-based treatment and care.
Renal replacement therapy choices for pre-dialysis renal patients
Authors: Tweed Alison E , Ceaser Karen
Published: May 2014

With the numbers of patients developing end-stage renal failure predicted to increase over the coming years, more patients than ever will be expected to choose their future form of renal replacement treatment. This study explored the decision-making processes of pre-dialysis patients to elucidate how these choices were made. Nine pre-dialysis patients were interviewed, transcripts of which were analysed using interpretative phenomenological analysis. Four main themes relating to the decision-making process emerged: maintaining one's integrity, forced adaptation, utilizing information, and support and experiencing illness. While making a decision was an individualized process, contextualized within participants' illness experiences, these core themes emerged for the whole group, irrespective of the chosen treatment modality. For renal services, there is a need to tailor information provided to pre-dialysis patients and to become cognizant of the contexts in which they live and operate.
Maternity services are failing women in vulnerable groups
Authors: Tingle John , Dunmore Laura
Published: May 2014

The process of childbirth can be both joyful and stressful, and most people have an uneventful birth. But, when problems do occur, expensive litigation claims can result. In 2002/2003, birth-related brain damage (including cerebral palsy) accounted for 60% of all annual expenditure on medical litigation (Department of Health, 2003).
Rights to information access under the Data Protection Act
Authors: Dimond Bridgit
Published: May 2014

A patient has a legal right to access personal information held by health professionals on the basis of statutory provisions, such as the Data Protection Act 1998 and the regulations made under that Act, the Access to Health Reports Act 1988 (which is considered in a later article), and also on the basis of the common law, i.e. judge made or case law. Neither legal rights, however, give the patient an absolute right, but are qualified.
Management and treatment options for epilepsy
Authors: Lawal Muili
Published: May 2014

Epilepsy is a major chronic condition of the nervous system affecting almost 380000 people in England and occasionally results in death of the patient. Although epilepsy and its treatment are complex, there is evidence to support a significant gap in epilepsy care, ranging from a lack of adequate record keeping of seizure occurrence to poor referral systems. This article provides a broad introduction to the condition, discusses the incidence, disease process, diagnosis, classification and the various ways, both conventional and otherwise, in which it can be managed. By understanding the above, it will assist healthcare practitioners to improve their knowledge about management of a client with epilepsy entrusted to their care.
Practical management of obesity in primary care
Authors: Hilll Jill
Published: May 2014

The UK population is rapidly becoming obese. Recent reports published by the National Audit Office (2001) and the House of Commons Health Select Committee (2004) have highlighted this and reveal a worrying trend. For example, reduced levels of physical activity and an increased consumption of calorific-rich food have led to an increase in the prevalence of obesity of nearly 400% in England over the past 25years (House of Commons Health Select Committee, 2004). The burden of obesity and obesity-related disease on the NHS is considerable, with direct costs of approximately £0.5billion per annum and an annual indirect cost of around £2billion (National Audit Office, 2001).
Angels and swingers, matrons and sinners: nursing stereotypes
Authors: Ferns Terry , Chojnacka Irena
Published: May 2014

Media sexual stereotyping of the nursing profession is a well-recognized phenomenon; however the sexual stereotyping of the image of the nurse by the sex/pornography industry is a much less publicized or discussed phenomenon within the nursing profession. This paper aims to examine the presentation of the sexual stereotyping of nurses by newspapers and the sex/pornography industry. Both national and local newspapers in the UK frequently use derrogatory terminology to depict the sexual stereotyping of nurses. Images and sexual stereotyping of nursing by the sex industry is also noted. The media was found to emphasize both positive and negative nursing stereotypes and in comparison with other occupations and professions sexual stereotyping was prevalent. The utilization of nursing imagery is also significantly visible across a wide range of pornographic and sex industry material.
Case of the deputy ward manager who broke patient confidentiality
Authors: Castledine George
Published: May 2014

Mrs A was a well known figure in her local community. She had not only been the local headmistress, but had led the town council and had been awarded an honour in the Queen's birthday honours. There was no doubt that she was a much loved person whose family strove to enable her to continue living her life as independently as possible. Now, at the age of 85years, the effects of her chronic illness were starting to take their toll and Mrs A was admitted to a medical assessment ward to determine her future care and treatment.
The essence of continuing education in nursing
Authors: Castledine George
Published: May 2014

A few years ago nurses were rushing like lemmings to take up courses in higher education. Now, with the problems of staffing and tighter financial controls, continuing education opportunities are drying up.
Evolution and healthcare impact of a 21st Century avian flu pandemic
Authors: Davies Kevin , Higginson Ray
Published: May 2014

The risk of an outbreak of avian flu is greater now than at any time since 1968. This article will explore the history of influenza and will discuss the evolution and healthcare impact of a 21st Century avian flu pandemic. It highlights the need for healthcare professionals to be adequately prepared for such a pandemic and discusses the responses and infection control precautions required for dealing with avian flu patients.