bluuebunny/crossref_metadata_2025 huggingface dataset:
Improving patient care and quality of life after laryngectomy/glossectomy
Authors: Dobbins Maureen , Gunson John , Bale Sue , Neary Mary , Brown Marcus
Published: May 2014

Patients undergoing total laryngectomy/glossectomy are left without a voice at least temporarily in the early postoperative stage, since their larynx and/or tongue has been removed. Those patients rendered permanently speechless usually acquire a form of mechanical speech through electronic devices. However, the life-changing nature of this surgery should not be under-rated as effectively these people have lost their normal voice. It can be argued that this patient group is also without a voice in a political sense — theirs seems to be a forgotten cancer, as other forms of cancer appear to attract greater attention for research priorities and funding. In some ways this research attempts to redress the balance through exploring the patient experience postoperatively, in particular the issues related to communication for this patient group. The results also highlight the emotional trauma experienced by patients and the mechanisms healthcare staff employ to support these patients. This research is multidisciplinary, involving patients and all those health workers that come into contact with them on the ward. The patient experience forms a major part of this article, allowing their stories to form much of the content. The results draw attention to deficiencies in service delivery that, as a direct result of this research, have been and are being addressed so that patients' care is improved and their quality of life is restored. Such change has been driven by patient comment such as: ‘But then when you wake up after that operation that’s the pits when you are laying there and you think “I'm dead”. And then when you wake up properly that's the bit I always say you wish you were dead. That's when you wish you had died.'
The therapeutic relationship: dead or merely impeded by technology?
Authors: Foster Tom , Hawkins Jen
Published: May 2014

The ways in which current nurse education is delivered, combined with rapid increases in technological advances in health care, are havinga major impact on the delivery of care to patients. This article focuses on one aspect of that care: the establishment, development and maintenance of the therapeutic relationship. The authors argue that the changes in education delivery and the rapid introduction of technologies are contributing to the possible demise of the contemporary nurse–patient relationship and, therefore, the loss of that essence of nursing which is essential to the patients' well-being and the nurses' professional satisfaction. The article explores the requisite knowledge and skills competences essential for the formation of the therapeutic relationship and asks whether these are being impeded by simulated educational activities and the advent of ubiquitous computing. The authors acknowledge the difficulties associated with the assessment of an effective therapeutic relationship and suggest a possible framework in which a performance of understanding of the formation of a therapeutic relationship can be established.
Work stress differentials between psychiatric and general nurses
Authors: Hughes Helen , Umeh Kanayo
Published: May 2014

Reducing occupational stress among nursing staff is a public health priority in many western countries. This study assessed stress differentials between psychiatric nurses (PNs) and general nurses (GNs), and the moderating function of social support. It was expected that PNs would report different (higher) stress levels than GNs given PNs' lower levels of social support. A questionnaire was completed and returned by 73 nurses at several public hospitals in England. Multivariate analysis of variance showed that social support moderated stress differentials between PNs and GNs, albeit not as anticipated; the latter group reported significantly higher and lower stress levels when social support was low and high, respectively. This interaction was applicable to both the quality and quantity of social support. Overall, the benefits of social support seemed to accrue primarily to GNs. Implications of these findings for the development of stress-reduction interventions are considered.
The carcinogenic and protective effects of food
Authors: Banning Maggi
Published: May 2014

It has been estimated that 70% of all cancers are caused by the food that we consume and smoking tobacco (Wogan et al, 2004). Currently, food health advice focuses on maintaining a diet which is low in fat and calories, rather than concentrating on the cooking methods used and the amount of meat that is consumed. More time should be spent educating individuals on the importance of cooking in different ways and eating a varied diet which includes cruciferous vegetables, such as broccoli. Nurses can be influential in the provision of health education advice to patients on the types of cooking methods that can be used to reduce the risk of developing forms of cancer and also the types of food that offer protection against cancer.
Mental health records
Authors: Dimond Bridgit
Published: May 2014

Records relating to the detention and treatment of mentally disordered persons are one of the few occasions on which there are statutory provisions over what must be recorded and in what circumstances, and how corrections can be made. In the event of a failure to comply with the statutory provisions relating to detention, the patient would not be lawfully detained and could seek his/her release. Where a patient is admitted informally to a psychiatric hospital, there are no statutory provisions but the general principles discussed in an earlier article relating to record keeping should be observed.
The duty of nurses to meet patients' spiritual and/or religious needs
Authors: Ledger Sylvia Dianne
Published: May 2014

As part of giving holistic care, nurses have a duty to meet the spiritual, religious and cultural needs of patients. These aspects of care are clearly identified in the Nursing and Midwifery Council's standards for nurses. According to the latest Census, 76.8% of people claim to have a religion. It is recognized that while people may not have a religious affiliation, they may have spiritual needs. The article considers the concepts of spirituality and religion and the significance of meeting these needs from the patient's perspective. Research-based evidence demonstrates that patient's spiritual and/or religious needs are not always addressed by nurses. Barriers to giving spiritual/religious care are identified and spiritual assessment tools are considered.
An evaluation of the Waterlow pressure ulcer risk-assessment tool
Authors: Thompson Deirdre
Published: May 2014

The National Institute for Clinical Excellence (NICE, 2001) stated that in order to achieve clinical governance strategies, risk management in the form of pressure ulcer risk assessment will contribute to improved quality of patient care. Risk-assessment tools must display high-predictive values, be highly sensitive and specific, reliable, and easy and convenient to use. Despite their extensively documented poor performance, pressure ulcer risk-assessment scales play a primary role in the prevention and management of pressure ulcers. The tools attempt to determine patients' risk status by quantifying a range of the most commonly recognized risk factors. Although there are over 40 different assessment tools, the Waterlow pressure ulcer risk-assessment tool is the tool that is most widely used in the UK. This article aims to review studies relating to the reliability, content validity, predictive validity, concurrent validity and the construct validity of the Waterlow pressure ulcer risk-assessment tool.
Providing the nurse with a guide to tracheostomy care and management
Authors: Russell Claudia
Published: May 2014

To care for a patient with a tracheostomy requires a clear understanding of each patient's need for the tracheostomy and the type of tube that is required. The impact of a tracheostomy on the respiratory system includes thorough knowledge of respiration, methods of humidification and also suctioning techniques. In addition to this a tracheostomy may impact on swallowing, communication and body image. Appreciation of these effects will guide the nurse and the wider multidisciplinary team in future needs and care. Tracheostomy care and management is more and more necessary in both the intensive care setting and the general ward. It is, therefore, ever more important that trained nurses are equipped with the appropriate skills, knowledge and support to meet the unique needs of each patient safely and competently. This article aims to discuss the indications for a tracheostomy and also the care and management commonly carried out, with the purpose of increasing knowledge and interest of the care of a patient with a tracheostomy.
Films or fabrics: is it time to re-appraise postoperative dressings?
Authors: Aindow Dana , Butcher Martyn
Published: May 2014

Post-operative wounds healing by primary intention are often seen as the simplest areas of modern wound care. However, have we overlooked the problems that can exist and are we really looking at postoperative dressing selection with the same vigour we attach to other areas of wound care? This article outlines the development of modern post operative dressings, both fabric and film-based and raises the question ‘if postoperative wound infection is a problem should we consider more effective barrier dressings?’
Caring for people with carotid artery rupture
Authors: Frawley Theresa , Begley Cecily M
Published: May 2014

In the second of three articles, the authors discuss the care of people with carotid artery rupture. Carotid artery rupture is a potentially fatal condition that requires swift action on the part of the nurse who is present. The size of the rupture and the prognosis for the individual patient determines whether or not active resuscitation is undertaken. The multi-professional team should decide, in advance of an impending rupture, on the optimum plan of care. Calm, careful explanations should be given to patients and relatives and the decision regarding resuscitation should be recorded in the patient's notes. In the event of unforeseen circumstances where a rupture occurs, an active nursing care plan should be instituted and care taken to keep relatives well informed. The patient's airway should be kept clear through the use of suctioning, inflation of tracheostomy tube cuff and correct positioning. Sedative drugs and palliative care may subsequently be necessary. Support and help should be given to all who witness or are involved in the care of these patients.
Dysphagia in the elderly - a management challenge for nurses
Authors: Morris Heather
Published: May 2014

Dysphagia (swallowing difficulties) is relatively common in the general population, but the prevalence increases with age and poses particular problems in the older patient, potentially compromising nutritional status, complicating the administration of solid medications, increasing the risk of aspiration pneumonia and undermining the quality of life. The repercussions of dysphagia are not only physical but also emotional, affecting patient morale and leading to feelings of social isolation. There are various causes, including carcinoma, stroke and advanced Alzheimer's disease. The diverse range of causes may manifest in a number of different ways, but should always act as a warning sign, which requires further investigation. Management is multidisciplinary, depending on the underlying cause, extent of dysphagia and likely prognosis. This article examines the incidence, causes and management of dysphagia, based on a review of recent literature. The focus is on the nurse's role in the management of this challenging disorder with particular emphasis on the care of the elderly patient.
The process of conducting a physical assessment: a nursing perspective
Authors: Baid Heather
Published: May 2014

Physical assessment is a new responsibility for many nurses in the UK who are expanding their parameters of advanced clinical practice. A physical assessment framework can be used by both community and acute care nurses as a guide to the process of conducting a physical assessment. The framework presented here consists of the following sequence of steps: identifying the purpose of the assessment; taking a health history; choosing a comprehensive or focused approach; and examining the patient using the sequence of inspection, palpation, percussion and auscultation. The next step, interpretation of the clinical findings, which results in either the recognition of abnormality or identification of a differential diagnosis, then becomes the basis for clinical decision making. This paper describes a comprehensive, head-to-toe assessment as one example of the application of this physical assessment framework in clinical practice.
Review and discussion of the body's normal microorganisms
Authors: Coutts Alison Margaret
Published: May 2014

Nurses need to be constantly vigilant in their hygiene practices, yet not ignore the role of normal microbes in the maintenance of health: we have more microorganisms living on us and in us than any other type of cell, and they have a role in preventing colonisation by harmful pathogens, and also in regulating the immune system. This article reviews the types of microorganisms normally found in and on individuals, and how these can contribute to health.
Occupational back pain in Iranian nurses: an epidemiological study
Authors: Mohseni-Bandpei Mohammad A , Fakhri Moulod , Bargheri-Nesami Masumeh , Ahmad-Shirvani Marjan , Khalilian Ali Reza , Shayesteh-Azar Masoud
Published: May 2014

The aim of this study was to identify the prevalence and risk factors for low back pain (LBP) in nursing personnel and to analyze how individual and occupational characteristics contribute to the risk of LBP. Following ethical approval, 1226 nurses were randomly recruited from 13 general hospitals in northern Iran. Different questionnaires were designed to cover personal and professional data, the prevalence, and associations of risk factors with LBP. Results indicated that prevalence of LBP in nurses was over 50%. Lifting was the most common mechanism for LBP (30.4%). Prolonged standing and rest were found to be the significant aggravating and relieving factors (57.6% and 59.2%, respectively). Absence from work because of LBP in the month before the questionnaire was completed was reported by 33.7% of the sample. The results demonstrate that the magnitude of LBP among nursing personnel appears to be high and therefore more resources should be allocated to prevent such an injury occuring in the nursing profession.
Nutritional support for children with epidermolysis bullosa
Authors: Haynes Lesley
Published: May 2014

Epidermolysis bullosa (EB) comprises a rare group of genetically-determined skin blistering disorders characterized by extreme fragility of the skin and mucous membranes, with recurrent blister formation. The cornerstones of management are control of infection, wound management, pain relief, promotion of optimal nutritional status and mobility, surgical intervention and provision of the best possible quality of life. There is currently no cure for EB and, throughout life, those with the more severe types are at risk of significant nutritional compromise which impacts negatively on health and overall quality of life. Nutritional support is an important facet of holistic care and the dietetic challenges can be considerable. This paper describes some of the issues involved in optimizing the nutritional status of children with this disorder.
Caring for female patients: the experiences of male nurses
Authors: Keogh Brian , Gleeson Madeline
Published: May 2014

This article presents the results of two small qualitative studies, which examined the experiences of six male registered psychiatric nurses (RPN) and five male registered general nurses (RGN) when caring for patients of the opposite sex. Semi-structured interviews were used to collect the data. The focus of the interviews was an attempt to describe the male nurses' experiences of caring for women with a particular emphasis on interventions that involved physical touch. Themes were generated from both studies and the common themes are presented here. Male nurses in this study were often apprehensive about using physical touch and they used coping strategies in response to their fears of being accused of using touch inappropriately. Several factors also influenced the male nurses when using physical touch as an intervention. These findings suggest that learning about caring for female patients needs to be included in the undergraduate curriculum and that further research on the experience of men as nurses is required.
Making effective clinical decisions: a framework for nurse practitioners
Authors: Pritchard Michael John
Published: May 2014

Much has been written and researched about the decision-making process. Many agree it is one of the most difficult processes a health professional has to undertake. It is also one of the most important parts of nursing practice. There is increasing evidence that formal decision techniques applied sensibly can improve decision-making (Aitkin, 2003). Nurse practitioners must strive to find ways to improve and enhance their decision-making abilities. This article explores one such framework for decision-making that can be used by both novice and experienced nurses.
Role of the continence nurse in health promotion
Authors: Kelly Anne Marie , Byrne Gobnait
Published: May 2014

Incontinence is a distressing and unpleasant symptom, which impacts on a person's physical, social and psychological wellbeing. Nurses, like other healthcare professionals, have a role in health promotion. Continence nurses can identify causes, create treatment plans and empower patients with incontinence to be involved in all aspects of their care. The five approaches to health promotion: medical, behavioural, educational, public policy and empowerment, are a useful framework to discuss the role of the nurse in the promotion of continence.
Intravenous enzyme replacement therapy: better in home or hospital?
Authors: Milligan Alan , Hughes Derralynn , Goodwin Sian , Richfield Linda , Mehta Atul
Published: May 2014

This article evaluates satisfaction with enzyme replacement therapy (ERT) at home and at hospital in adult patients with Fabry and Gaucher diseases. A questionnaire was developed and sent to 34 patients with Fabry disease who were receiving ERT with agalsidase alfa (Replagal™) and to 49 patients with type I Gaucher disease who were receiving ERT with glucocerebrosidase (Cerezyme®). Of the 45 returned questionnaires, 20 were from patients with Fabry disease and 25 from patients with Gaucher disease. Hospital treatment visits were reported as stressful by 18 patients (40%), whereas only 4 (9%) patients reported that home therapy was stressful. Both groups of patients adjusted well to receiving home-based therapy. Nearly all of the patients with Fabry disease (19 patients, 95%) and Gaucher disease (21 patients, 84%) preferred home-based therapy. Treatment in the home was reported as more comfortable, less stressful, more effective and had less impact on family life. Only 4 (9%) patients chose to continue receiving infusions in hospital. The majority of patients with Fabry disease and Gaucher disease found home-based therapy to be more convenient and less stressful than hospital-based therapy.
Nursing research: perspectives on critical thinking
Authors: Banning Maggi
Published: May 2014

Critical thinking is an important component of professional practice. It is the hallmark of the competent nursing practitioner and yet, there is no consensus on its definition, teaching nor learning strategies of critical thinking skills in nursing students. Although critical thinking appears to be desirable at all levels of nursing practice, evidence to support its educational development in nurses appears to be limited. If educators are to prepare nurses to become leaders in their profession, the educational development of these essential skills in nurses needs to be addressed.
An overview of atopic eczema in children: a significant disease
Authors: Gill Steve
Published: May 2014

Atopic eczema is a significant disease, being the most common skin disorder in children, affecting 12–15% of all school-age children (Emerson et al, 1998). It is an inflammatory skin condition, which is genetic in origin but is triggered by many factors, such as detergents, emotional distress or dust mites (Buxton, 1998) and often starts in the first year of life. It is characterised by dry and itchy skin. This often breaks down and becomes infected, partly as a result of the close relationship of atopic eczema and the organism Staphylococcus aureus, which is found on the skin of most children with atopic eczema (Goodyear, 1993).
Doppler ultrasound - basics revisited
Authors: Eagle Mary
Published: May 2014

Palpation of pedal pulses alone is known to be an unreliable indicator for the presence of arterial disease. Using portable Doppler ultrasound to measure the resting ankle brachial pressure index is superior to palpation of peripheral pulses as an assessment of the adequacy of the arterial supply in the lower limb. Revisiting basics, this article aims to aid the clinician to understand and perform hand-held Doppler ultrasound effectively while involving the client or patient in the process. The author describes the basics of Doppler ultrasound, how to select correct equipment for the process, and interpretation of results to further enhance clinicians' knowledge.
The impact of preoperative education on postoperative pain. Part 2
Authors: O Oshodi Titilayo
Published: May 2014

The second of this two-part article examines the impact of preoperative education on postoperative anxiety, pain and recovery. The first part (Oshodi, 2007) explored the general concept of preoperative education. Surgery can be physically and psychologically stressful for patients. It is hypothesized that education before surgery reduces anxiety and enhances postoperative outcomes. This article critically reviews some of the published research in this field since 1994 through a rigorous methodology to evaluate the impact of preoperative education on postoperative outcomes. Despite inconsistencies in the evidence, the studies all point to the fact that preoperative education is beneficial to adult surgical patients. Based on the evidence presented, implications for nursing are discussed and recommendations for practice are made.
Testicular self-examination: the person with learning disabilities
Authors: Peate Ian , Maloret Paul
Published: May 2014

People with learning disabilities are at just as much risk as the general population are of contracting cancer. Mainstream men’s healthcare needs are often neglected and this is also true for men who have learning disabilities. Testicular self-examination (TSE) is seen as an important activity that men should be taught to detect any early changes that may be signs of physiological significance. While testicular cancer is rare, its incidence is rising. In the majority of cases of testicular cancer, over 90% are curable (Cancer Research UK, 2002). TSE, for the purposes of this article, is seen as an activity that can be carried out independently (by the man himself) or with the assistance of another person (for example, carer or partner). This article discusses the importance of TSE and, in particular, with men who have a learning disability.
An audit of oxygen therapy on a respiratory ward
Authors: Hickey Steven
Published: May 2014

Oxygen therapy can be a life-saving intervention, which is widely available and commonly prescribed by medical staff. Patients often receive oxygen therapy in hospital but, like any other drug, oxygen can be dangerous when given in the wrong concentration.

Aims: To review the current literature. To examine current prescribing practice plus methods of oxygen delivery on a respiratory ward.

Method: A prospective audit was conducted on patients receiving oxygen therapy over a 4-week period. The ward was audited pre- and post-education sessions. Education was on oxygen prescribing and oxygen therapy.

Results: The literature revealed that oxygen was often poorly prescribed by doctors and at times poorly administered by nurses. Of the 55 patients audited pre-education, only 5% of patients had a prescription. This increased to 20% post-education (P=0.042). The initial audit uncovered 14 issues surrounding oxygen delivery. This fell to one post-education (P<0.001). Reassuringly, all patients had arterial oxygen saturation recorded.

Conclusion: Current rates of oxygen prescribing remain unsatisfactory despite doctors being made aware of the audit findings. Education on oxygen therapy improved the delivery of oxygen therapyto patients on a respiratory ward.
The safe and responsible disposal of unused controlled drugs
Authors: Ahmed Iftikhar , Majeed Amer
Published: May 2014

There are well-defined legal requirements for the safe storage, handling and disposal of controlled drugs (CDs): The Misuse of Drugs Act 1971, and Safer Management of Controlled Drugs (Department of Health, 2007). Clinical staff involved in the prescription and administration of CDs to patients are responsible and accountable for the appropriate disposal of these drugs because of the risk of substance abuse. A review of current practice, as followed by staff involved in the use and disposal of CDs, has been evaluated in a multi-centre audit. This audit showed that a wide variation in attitude towards disposal of CDs exists among medical and non-medical staff, and that the sample hospitals are falling short of meeting proposed standards.
Cognitive behavioural therapy group work with voice hearers. Part 1
Authors: McLeod Terry , Morris Mervyn , Birchwood Max , Dovey Alan
Published: May 2014

This study presents a small, randomized control trial of cognitive behavioural interventions within a group setting for the treatment of auditory hallucinations. In a sample of 20 voice hearers, 10 were randomly allocated to an eight-session cognitive behavioural therapy group, and 10 underwent psychiatric ‘treatment as usual’. Baseline assessments were undertaken. Measures of control, power, frequency, and symptoms of distress and anxiety, were recorded on assessment and on completion of the group. The groups achieved a significant reduction in frequency of auditory hallucinations and in the beliefs about the power of the voice. Satisfaction measures also suggested that the group participants valued the group and benefited from the structured sessions. Universality, the recognition that other people experience very similar problems, was one of the most beneficial factors of the intervention. This study suggests that group cognitive behavioural therapy was helpful in the treatment of auditory hallucinations.
Tasks and routines in 21st century nursing: student nurses’ perceptions
Authors: Pearcey Patricia
Published: May 2014

The aim of this study was to explore final year nursing students’ views about their clinical experiences. This was the second of three studies using a grounded theory approach overall with theoretical sampling of final year student nurses being chosen as a result of the initial study’s findings. The sample was of a volunteer nature. The data collection tool was an open-ended questionnaire, with themes arising from the first study helping to form the questions. It was anticipated that more clinically experienced students would confirm, refute and perhaps provide ‘new’ information about the reality of clinical nursing when compared with the sample of neophyte nurses from the first study. Data were analysed through initial coding of responses and then compared and contrasted to the data of study one. Findings included categories of views about the nurses’ roles and tasks, clinical priorities of qualified nurses, holistic care, and care plans. The conclusion suggest that despite nursing theory proclaiming the advent of ‘new’ nursing with hallmarks of holistic care and movement away from tasks and routines, the student nurses did not find this to be the case. Indeed, tasks and routines are what seemed to structure the work of nurses, with little evidence of holistic, patient centred care occurring clinically.
Compliance and infection control guidelines: a complex phenomenon
Authors: Cole Mark
Published: May 2014

Healthcare-acquired infection has become a global health phenomenon affecting approximately 8.7% of the world’s population. Despite a plethora of evidence-based guidelines, policies and procedures, knowledge of these can be poor, and when this is the case, suboptimum care may follow. Historically, enhancement strategies have focused on the provision of education by making the tacit assumption that an increase in knowledge will result in an improvement in compliance. However, compliance is a multi-dimensional, abstract, complex concept that is difficult to define. Decision-making is rarely objective and the capacity of personal experience to outweigh scientific evidence is a hallmark of the post-modern times in which we live. It is well established in social psychology research that when faced with complex encounters, individuals turn to simple reasoning rules called ‘heuristics’, to make decisions. These heuristics are potentially dangerous as they can introduce flawed probability judgements in relation to compliance behaviour. If the raison-d’être of infection control nursing is to attain compliance with the best available evidence, organizations need to reject a reductionist, cause-and-effect view of compliance and acknowledge that compliance and infection control practice is a complex social construct.
Travel health. Part 1: preparing the tropical traveler
Authors: Carroll Bernadette , Daniel Amanda , Behrens Ron H
Published: May 2014

The health threats of modern day travel change as population, wealth and tourism increase across the world. A series of three articles have been written to describe the spectrum of health issues associated with travel. Pre-travel health advice has become more focused on risk assessment and educating the traveller about infectious disease and the more frequent non-infectious hazards associated with travel, while ensuring they are not unnecessarily exposed to injury from vaccines and drugs. In part one, the role of the health advisor and the needs of the traveller are examined. The importance of risk assessment during a consultation is described and factors that influence recommendations and prescribing are explored. As most travel-associated morbidity and mortality is non-vaccine preventable, the focus of the pre-travel consultation should be on educating the traveller and influencing behaviour change. The second article in this series deals with the highest risk group of travellers – residents who visit friends and relatives. It highlights their specific problems and special needs and how to influence their risk of disease by addressing their health beliefs and their cultural dimension of risk. The third article explores the common, and not so common, clinical problems found in returned travellers. Nurses have to deal with a large range of clinical problems and diagnostic dilemmas when attending to the returned traveller. The review provides a perspective on the frequency and severity of problems and how nurses should manage travel associated disease.
Evidence-based care: enhancing the rigour of a qualitative study
Authors: McBrien Barry
Published: May 2014

Qualitative research methodology is a suitable approach for clinical inquiry into nursing practice, leading to theory development and advancement in clinical practice. Rigour is necessary to enhance the consistency and quality of qualitative research. It is the framework for demonstrating credibility and integrity of the qualitative research process. Methodological decisions regarding rigour can have implications for the quality, integrity and interpretability of the findings. Rigour, therefore, is a principle that should be present during all stages of the research study, from its inception to the writing of the final report. For qualitative researchers, reaching the desired goal and meeting the requirements of rigour become particularly problematic due to the considerable debate about what it means to do valid research in the field of qualitative inquiry. This article outlines methods that can be used to maintain rigour in a qualitative study, including member-checking, peer debriefing, audit trail and reflexivity.
Causes and management of indwelling urinary catheter-related pain
Authors: Wilson Mary
Published: May 2014

Urinary catheters can be introduced into the urinary bladder either per urethra or via the suprapubic route; this article examines indications and contraindications to these routes. Catheter pain is subdivided into pain experienced as the catheter is passed, while in situ, and on removal. Relating to pain felt on insertion, risks associated with local anaesthetic/antiseptic gel and the occurrence of paraphimosis are discussed. Once in situ, the type of material used to manufacture the catheter, pressure on the urethra caused by a large Charrière size catheter, or from drainage bag traction, leading to discomfort and possible tissue damage are examined and solutions suggested. Catheter-associated meatal trauma in men and urethral post-menopausal discomfort in women are addressed; likewise, catheter cramp due to bladder spasm or catheter blockage, and interventions are recommended. Encrustation and ‘cuffing’ may cause pain during catheter removal and again, advice is given. Lastly, the possibility of pain due to fear/non-acceptance of the catheter is raised. In conclusion, once identified, the cause of catheter pain is often treatable, but should not be regarded negatively or ignored, as it warns of potentially harmful conditions and allows intervention before permanent damage can occur
Epidermolysis bullosa. Part 1: causes, presentation and complications
Authors: Pillay Elizabeth
Published: May 2014

This article is the first in a series of three focusing on the causes, clinical presentation, complications and care of adult patients affected by epidermolysis bullosa (EB), a group of rare genetic skin fragility disorders. Although the condition is rare, in some cases it presents extreme challenges both to those affected and those involved in the care of the EB patient; therefore, these articles may have relevance for other long-term disorders. While there is a wealth of information regarding the ‘science’ of EB there is dearth of information regarding the care of the adult EB patient, and this series of articles will endeavour to fill that gap. This article focuses mainly on those patients affected with the most severe form of EB found in the adult group, recessive dystrophic epidermolysis bullosa; with the part two looking at the care of the adult with EB from the nursing perspective, including wound management, and the experiences of a specialist EB psychotherapist being presented in the final article of the series. Readers will thus have an opportunity to gain an overall view of this difficult condition.
Sporicidal activity of two disinfectants against Clostridium difficile spores
Authors: Wheeldon LJ , Worthington T , Hilton AC , Lambert PA , Elliott TSJ
Published: May 2014

The sporicidal activity of an odour-free peracetic acid-based disinfectant (Wofasteril®) and a widely-used dichloroisocyanurate preparation (Chlor-clean®) was assessed against spores of the hypervirulent strain of Clostridium difficile (ribotype 027), in the presence and absence of organic matter. In environmentally clean conditions, dichloroisocyanurate achieved a >3 log10 reduction in 3 minutes, but a minimum contact time of 9 minutes was required to reduce the viable spore load to below detection levels. Peracetic acid achieved a >3 log10 reduction in 30 minutes and was overall significantly less effective (P<0.05). However, in the presence of organic matter – which reflects the true clinical environment – there was no significant difference between the sporicidal activity of dichloroisocyanurate and peracetic acid over a 60-minute period (P=0.188). Given the greater occupational health hazards generally associated with chlorine-releasing agents, odour-free peracetic acid-based disinfectants may offer a suitable alternative for environmental disinfection.
Medihoney™: a complete wound bed preparation product
Authors: Acton Claire
Published: May 2014

In recent years, honey has emerged as a versatile product that can be applied to many different types of wound to achieve a variety of outcomes, depending on the requirements of the clinician and patient. However, there is still some confusion about how specific honeys work, their antibacterial potency, and what effects this has on wounds treated with honey products. This article reviews the need for ongoing use of honey in wound care. It focuses on Medihoney™, a medically certified honey licensed for professional wound care, and presents an update of the clinical data supporting its use.
Mepitel: a non-adherent wound dressing with Safetac technology
Authors: White Richard , Morris Clare
Published: May 2014

Objective:Wound pain and tissue trauma are two main considerations of wound management, and appropriate dressing selection plays an important role in both. Traditional dressings may adhere to wounds resulting in significant pain and trauma to new tissue upon removal. The development of primary wound contact materials has provided a unique approach to solving this problem. This article aims to aid clinicians in identifying wound types on which Mepitel®, a primary wound contact dressing with Safetac® soft silicone adhesive technology, can be used by summarizing the published clinical literature relating to its use. Method: Searches of bibliographic databases and internet sites were supplemented with manual searches of journals of relevance to wound management for clinical data relating to the use of Mepitel. Results: The literature search identified a number of articles, presenting data generated from randomized controlled trials, non-randomized controlled trials and case study evaluations of Mepitel on a wide range of wound types and skin injuries. Conclusion: The results of the clinical evaluations demonstrate that Mepitel is associated with atraumatic and virtually pain-free dressing changes. The dressing with Safetac can be used cost-effectively in the treatment of a wide range of wound types and skin injuries.
Promoting a culture of curiosity within nursing practice
Authors: Kedge Stephen , Appleby Ben
Published: May 2014

The professional status of nursing requires that nurses have access to and can understand a knowledge base at the correct academic level. Over the last 15 years there has been an explosion in the amount of best practice evidence available to nurses. There has also been an increasing emphasis on independent life-long learning and an expectation that nurses should be able to teach themselves. This article argues that a culture of curiosity is a key requirement of these demands. It examines the origins and nature of curiosity and proposes teaching techniques that can be used in higher education institutions and in clinical practice to promote a culture of curiosity in nursing The professional status of nursing requires that nurses have access to and can understand a knowledge base at the correct academic level. Over the last 15 years there has been an explosion in the amount of best practice evidence available to nurses. There has also been an increasing emphasis on independent life-long learning and an expectation that nurses should be able to teach themselves. This article argues that a culture of curiosity is a key requirement of these demands. It examines the origins and nature of curiosity and proposes teaching techniques that can be used in higher education institutions and in clinical practice to promote a culture of curiosity in nursing
Improved oxygen prescribing using a nurse-facilitated reminder
Authors: Medford Andrew , Bowen Jennie
Published: May 2014

Poor oxygen prescribing and administration is well documented despite junior doctor education and oxygen prescription charts. This prescribing behaviour can be harmful to patients. This study examines whether oxygen prescribing and the appropriateness of oxygen therapy would be increased by medical admissions unit (MAU) nurse education and a nurse-mediated reminder strategy to junior medical staff. A quality improvement study was carried out involving a prospective single centre audit, educational intervention to MAU nurses, and implementation of a nurse-facilitated oxygen prescribing reminder strategy with prospective re-audit. The study took place in a 26-bed MAU in a 678-bed teaching hospital with a lung centre serving a population of 540,000. Fifty-one patients were involved in the initial and re-audits and two nurses were involved in the audit team. A team of 10 acute medical nurses were involved in facilitating the appropriate administration and prescription of oxygen by liaison with junior medical staff. Oxygen prescription and appropriateness of oxygen therapy were measured. Results showed an improvement in oxygen prescribing from 0% to 49% (p < 0.0001). Nonsignificant improvements in appropriate oxygen prescription (pre- versus post-intervention) overall (70.6% versus 76.5%, p = 0.65); more marked reduction in type 1 respiratory failure errors (18.4% versus 3.8%, p = 0.13) and less marked reduction in type 2 respiratory failure errors (61.3% versus 44.0%, p = 0.49). In conclusion, significant and quick improvements in oxygen prescribing behaviour are achievable through a nurse-facilitated reminder strategy with reduction in inappropriate oxygen prescribing. These strategies are relevant to other ward settings and aspects of patient care.
COSMOS – a study comparing peripheral intravenous systems
Authors: González López Juan Luis , del Palacio Encarnación Fernández , Martí Carmen Benedicto , Corral Javier Olivares , Portal Pilar Herrera , Vilela Ana Arribi
Published: May 2014

In many areas of the world, safety peripheral intravenous systems have come into widespread use. The Madrid region was the first in Spain to adopt such an approach. These systems, though initially introduced to protect users from sharps injuries, have now evolved to include patient protection features as well. Patient protection, simply stated, means closing the system to pathogen entry. The authors’ purpose was to investigate, in a prospective and randomized study, the clinical performance of a closed safe intravenous system versus an open system (COSMOS – Compact Closed System versus Mounted Open System). COSMOS is designed to provide definitive answers, from a nursing perspective, to many topics related to peripheral venous catheterization, which have important implications in intravenous therapy and which have not been validated scientifically. Furthermore, it forms pioneering research in that it is the first clinical trial on medical devices in a legislated environment carried out entirely by nurses and whose promoter and principal investigator is a nurse. The objectives of COSMOS are to compare the effectiveness (as defined by time of survival without complications) and rates of catheter-related complications, such as phlebitis, pain, extravasation, blockage and catheterrelated infections. It also looks at rates of catheter colonization, the ease of handling of both systems and overall costs. This article outlines the authors’ approach, both in preparing hospital units for such an evaluation as well as in the choice of parameters and their method of study. Further articles will detail the results and findings of the study.
Sharps management and the disposal of clinical waste
Authors: Blenkharn J Ian
Published: May 2014

Dangerous errors in clinical waste management continue to occur and inappropriate items find their way into clinical waste sacks that are not designed to hold sharp or heavy items, or fluids. Although great attention is given to the safe use of sharps, needles still find their way into waste sacks instead of a sharps bin. Sharps injuries among ancillary and support staff, and waste handlers working in the disposal sector, can occur at a rate greater than for health-care staff. Blood and body fluid exposures from carelessly packaged clinical waste are similarly common, with almost 100% of waste handlers having blood splashes on their clothing within four hours of starting a shift. Blood splashes are also common on the outside surfaces of sharps bins and on the frames supporting clinical waste sacks. Using forensic techniques, blood residues invisible to the naked eye can be detected on all surfaces of most sharps bins and on the bench top, walls and floor where the bins were positioned. Care is required when disposing of clinical waste, to protect and maintain the immediate environment from contamination, and to ensure the safety of those who come into contact with waste as it passes along the disposal chain.
Patient confidentiality and mental health: part 1
Authors: McHale Jean
Published: May 2014

Confidentiality has long been considered as particularly important in health-care practice in general and in mental health-care in particular. This is the first of two papers which explores the nature of the obligation of health-care confidentiality in law and it implications for those concerned with mental health care services. It explores how the obligation of confidentiality arises and whom it is owed to.
Can ELISpot replace the tuberculin skin test for latent tuberculosis?
Authors: Greveson Kay
Published: May 2014

Background: Screening and treatment of latent tuberculosis infection (LTBI) prior to anti-tumour necrosis factor alpha (anti-TNFalpha) therapy has been shown to decrease the incidence of active tuberculosis (TB) by more than 80%, and is recommended by the British Thoracic Society. In the absence of a gold standard test for LTBI, conventional screening currently involves taking a clinical history of risk factors, a chest X-ray and a tuberculin skin test (TST) which can be difficult to interpret in immunosuppressed patients. Alternative cellular immune-based screening tests have been developed to detect Mycobacterium tuberculosis. Aim: To examine, evaluate and summarize the quality of evidence on the use of interferon gamma release assay (the ELISpot test) in the diagnosis of latent tuberculosis prior to initiation of anti-TNF-alpha and examine the agreement with the tuberculin skin test. Methods: Ovid MEDLINE, EMBASE and the Cochrane library were searched using search terms that included tuberculosis, each of the current anti- TNF-alpha biological agents, TST and interferon-gamma release assay. Terms were searched using MeSH (medical subject headings) terms and/or free text where relevant. Results: Discordance between tuberculin skin test and ELISpot is greater in individuals who have had the bacillus Calmette-Guérin (BCG) vaccination and are taking corticosteroids. ELISpot technique using CFP-10 and ESAT-6 antigens is more sensitive than TST in detecting M. tuberculosis infection in patients taking corticosteroids. ELISpot avoids cross-reaction with BCG, making it a more specific test in this group of patients. Agreement between the tests was found to be fair (72.8% kappa value=0.38). Conclusion: Tuberculosis resulting from reactivation of latent tuberculosis following treatment with anti-TNF is a continuing problem. Screening reduces the risk but does not eliminate it. Further studies are needed into the cost-effectiveness and sensitivity of ELISpot and the tuberculin skin test in routine clinical practice.