bluuebunny/crossref_metadata_2025 huggingface dataset:
The use of amelogenin protein in the treatment of hard-to-heal wounds
Authors: Chadwick Paul , Acton Claire
Published: May 2014

The management of hard-to-heal or chronic wounds places a high economic burden on healthcare services. This problem is exacerbated by the increasing age of the general population, an increasing diabetes population and a high prevalence of such wounds in the elderly, patients with diabetes and those with venous insufficiency. Standard treatments for such wounds, such as compression therapy in venous leg ulcers, debridement and wound care for diabetic foot ulcers, can still -leave a significant population with non-healing wounds, resulting in extended hospital stays and reduced quality of life. The use of amelogenin (Xelma®>, Mölnlycke Health Care) for the treatment of a variety of chronic wounds has been assessed in both case studies and larger clinical trials with encouraging findings. This article examines the findings of studies relating to amelogenin in the treatment of hard-to-heal wounds.
In-vitro test for comparing the efficacy of wound rinsing solutions
Authors: Kaehn Kurt , Eberlein Thomas
Published: May 2014

Wound coatings can severely delay chronic wound healing by inducing ischaemia and degradation of viable tissue and increasing susceptibility to infection. It is, therefore, essential to cleanse wounds gently and thoroughly to remove the detrimental coatings. In this study, an in-vitro model that mimics wound coatings (human plasma dried onto adhesive glass slides) was used to compare the efficacy of four sterile solutions used to cleanse wounds: saline and Ringer’s (both salt solutions), a betaine surfactant-containing wound rinsing solution (Prontosan®> B. Braun) and an antiseptic solution (Octenisept®> Schülke & Mayr). Both salt solutions and the wound rinsing solution were found to remove protein from the test wound coatings, whereas the test coatings became fixed and insoluble when immersed in antiseptic solution.
Wound-related pain: key sources and triggers
Authors: Vuolo Julie Caroline
Published: May 2014

Wound-related pain is a common phenomenon for many patients and in recent years there has been a growing awareness of the impact it has on both wound healing and quality of life. Research in the field of wound pain and the patient experience, the development of new products and the issue of expert consensus statements have all contributed to an improvement in our understanding of wound-related pain issues and our ability to effectively manage them. However, there are a multitude of intrinsic sources of wound-related pain which can be triggered or exacerbated by numerous external factors, making management both complex and challenging at times. In this article, key sources and triggers of wound-related pain are discussed, along with practical strategies for effective, patient-focused management to help health-care practitioners reduce both the incidence and impact of wound-related pain.
Prevention and treatment of pressure ulcers
Authors: Riordan Jennifer , Voegeli David
Published: May 2014

The prevention and treatment of pressure ulcers continues to present a challenge across acute and long-term care settings, and costs the NHS up to £2.64 billion annually. As well as causing a reduced quality of life for sufferers, they can prove to be fatal. The complexity of the exact causes of skin breakdown and accurate risk assessment has proved problematic to fully understanding this common nursing problem, yet despite limited evidence clear guidelines on best practice exist, suggesting that prevention strategies should encompass interventions in three areas: risk assessment; relief of pressure, and education. Evidence exists that where these strategies are adopted at an organizational level, and strong leadership provided, the outcomes can be remarkable. This article outlines effective prevention and risk-reduction strategies, together with interventions that can promote healing.
‘Transition: Moving on Well’ — from paediatric to adult health care
Authors: Pywell Alison
Published: May 2014

Adolescence involves great social and psychosocial change, and young people with long-term health problems are inevitably at significant risk if they disengage with health services at this crucial time. Good transition services to facilitate the transfer from paediatric to adult health care are therefore essential to the wellbeing of these young adults. Transition: Moving on Wellis a policy produced jointly by the Department for Children, Schools and Families and the Department of Health (2008) as part of the Every Child Matters programme. The policy stresses the importance of an early start to transition planning, the vital role played by coordinators, specific areas that should be discussed and the need for collaboration with young people and their families. The main drawback of the policy is that it necessitates higher levels of funding and staffing than are available; evidence from literature suggests that these resourcing shortfalls mean that charities still provide many of the transition services that should be coordinated by healthcare services. The result is that many young people receive no transition support until shortly before the transfer to adult services, meaning that the opportunity for them to engage with such services can be irretrievably lost.
A partnership approach to learning about accountability
Authors: Plant Nigel , Pitt Richard , Troke Ben
Published: May 2014

Clinicians and healthcare providers are frequently reminded that they are ‘accountable’ practitioners – but what is the definition of accountability, and how does it apply in a practical and legal context? To clarify these issues, the University of Nottingham School of Nursing has formed a partnership with Browne Jacobson Solicitors. Together they have developed a 7-stage training programme for nursing students which covers the key aspects of accountability, including ethical concepts, the law of negligence, and scenario-based training on being called as a witness in an investigation. This article introduces the implications of accountability and describes the structure and syllabus of the programme, including participants’ feedback on the benefits of the experience
Urinary incontinence in women: quality of life and help-seeking
Authors: Howard Faith , Steggall Martin
Published: May 2014

y incontinence on its own is not considered life-threatening, yet it has been shown to negatively affect a patient’s wellbeing. While it is considered a common problem, with approximately 3 million women in the UK affected, the number of those women seeking help is much lower. This article will explore the relationship between urinary incontinence, quality of life (QoL), and barriers to help-seeking behaviour. Developing an understanding of this patient group will highlight implications for nursing practice. A number of factors appear to contribute to how women experience urinary incontinence, and how it impacts on QoL. While not all of these can be fully explored, the predominant factors appear to be: severity of urinary incontinence; type of urinary incontinence; age; and the actual QoL score itself. QoL ‘scores’ are significant when women decide whether or not to seek help for urinary incontinence. Seeking help often depends on beliefs and an nderstanding of how the condition can be treated. Health promotion, the training of health professionals, and further research are required to improve the understanding of women’s experiences, and to develop appropriate services with which to manage this condition
Caring for cancer patients on non-specialist wards
Authors: Gill Finola , Duffy Anita
Published: May 2014

As cancer is the leading cause of death worldwide, every nurse will be required to care for patients with the condition at some point in his/her career. However, non-specialized oncology nurses are often ill-prepared to nurse patients suffering from cancer. This literature review aims to provide an overview of current trends and developments in cancer care nursing in an attempt to identify the range of previous research pertaining to caring for patients with cancer on non-specialist wards. The review finds that non-specialized cancer nurses report a lack of education and training with regard to cancer care and cancer treatments, which acts as a barrier to providing quality nursing care. Emotional and communication issues with patients and their families can also cause non-specialist nurses significant distress. International research has shown that specialist oncology nurses make a considerable difference to physical and psychosocial patient care. It is therefore paramount that non-speciality nurses’ educational needs are met to develop clinical competence and to provide supportive holistic care for both patients and their families
Keeping breast cancer survivors lymphoedema-free
Authors: A. Fleysher Larisa
Published: May 2014

With the increasing number of breast cancer survivors, post-treatment interventions to improve quality of life are gaining priority. Current breast cancer treatment modalities put patients at risk of developing upper-extremity lymphoedema. Upper-extremity lymphoedema is a common and overlooked complication of breast cancer treatment. Health professionals play an important role in identifying breast cancer and promptly referring these patients for further interventions. After successful completion of breast cancer treatment, these patients continue to have regular evaluations by their oncologists; and, provided there are no signs and symptoms of breast cancer, primary and community care health professionals will continue to play an essential role in the management of this unique patient group. As breast cancer treatment places these patients at a lifetime risk of developing upper-extremity lymphoedema, radiation oncologists, surgical and medical oncologists, and primary care practitioners must be knowledgeable and educate these patients about risk reduction behaviours. Prevention, prompt identification, and treatment of lymphoedema are the goals for achieving positive and cost-effective patient outcomes. This article aims to provide health professionals with specific educational tools with regard to the prevention, recognition, and management of upper-extremity lymphoedema; these tools should be used to change the ongoing trends in the management of breast cancer survivors’ follow-up care
A brief insight into how nurses perceive patients who self-harm
Authors: Laura Emerson Amy
Published: May 2014

This article considers the perception of people who self harm by nurses. ‘Self-harm’ is commonly known as self-inflicting harm, and this discussion includes a basic introduction to selfharm, and recommendations for interventions that can mitigate the stigmatization of self-harmers entering the health system. It is evident from the literature that many nurses require further information and training on self-harm, largely because self-harmers do not fit with the everyday norms of society. Other conditions, such as eating disorders, are better understood, and while there is stigma, this is less than that levelled against self-harmers
Self-helplessness in arthritis: an important but overlooked index
Authors: Palmer Deborah , El Miedany Yasser
Published: May 2014

The recent introduction of patient-reported outcome measures (PROMs) assessment into rheumatology practice has changed the way patients suffering from inflammatory arthritis are assessed. This article describes a cross-sectional study of 102 rheumatoid arthritis (RA) patients that was undertaken to evaluate the construct of helplessness in patients with RA, its correlation with other disease activity parameters, and its sensitivity to change following biologic therapy. The study also set out to explore the possibility of including a self?helplessness measurement, using the modified Rheumatology Attitude Index (mRAI), as part of the holistic patient assessment in standard clinical practice. Assessment of self-helplessness was shown to be significantly correlated with both psychological as well as functional status measures. The mRAI index is a highly useful and predictive tool for clinical use that is responsive to change in the patients’ clinical condition. As part of the PROMs questionnaire, this scale can be applied in a manner similar to other indicators of disease activity status, and is as easy to administer and interpret in standard clinical practice
Medullary sponge kidney: causes and treatments
Authors: Pritchard Michael John
Published: May 2014

Medullary sponge kidney is a little known and little understood disease. A patient with a medullary sponge kidney may undergo decades of suffering in the form of infections and pain before any diagnosis is even made. When a diagnosis is made, it is more than likely to be an incidental finding from a test for another problem. However, on diagnosis there are a number of options available to treat this condition. These include non-invasive treatments such as drug therapy, diet or extracorporeal shock wave lithotripsy, to invasive therapies such as percutaneous nephrolithotomy, ureteroscopy and more advanced surgery. The aim of this article is to highlight this little known condition, outline the effects, and discuss the treatment options available to patients
The role of the community stroke rehabilitation nurse
Authors: McGinnes Alison , Easton Sarah , Williams Jane , Neville Janet
Published: May 2014

There is strong evidence for early supported discharge (ESD) following stroke, but there is no evidence on how these services should be organized or the best models of care. ESD teams rarely include a community stroke rehabilitation nurse. A service development project was undertaken in Portsmouth Hospitals NHS Trust’s community stroke rehabilitation team to identify and explore the unique contributions of community stroke rehabilitation nurses in an established ESD team. When the team was set up, the nurses had inpatient stroke rehabilitation skills, but no community experience. This novel approach, which involved taking specialist hospital nurses into the community, meant there was a steep learning curve and, unfortunately, there were no role models to support their development. During these early days, it became apparent that intensive stroke rehabilitation within an interdisciplinary ESD team required effective and timely nursing intervention, the development of skills to support interdisciplinary working and a greater understanding of the roles of all team members. Locally and nationally, questions were being asked pertaining to the nurses’ role, which precipitated this project. Through a series of journal club sessions, the interdisciplinary team reviewed the evidence base of the nurse role in stroke rehabilitation. The team were able to evaluate findings against current practice. The project confirmed that the community stroke rehabilitation nurse provides a unique and fundamental role to the team that strengthens the model of interdisciplinary teamworking
Can mental healthcare nurses improve sleep quality for inpatients?
Authors: Niet Gerrit de , Tiemens Bea , Hutschemaekers Giel
Published: May 2014

This article describes a pilot study that was carried out to in order to gain an indication as to whether mental healthcare nurses can apply evidence-based interventions for sleep problems effectively in inpatient mental health care. The study had a pre-test/post-test design and a comparison group was used. The study was performed on three psychiatric admission wards, located in three different towns in one province of The Netherlands. The participants were inpatients (18–60 years old) admitted owing to severe mental health problems like psychotic, mood or anxiety disorders. Of the newly admitted patients, 62.8% perceived having a sleep problem. Two brief, evidence-based interventions were introduced on two of the wards: the first with stimulus control (SC) as active component; the second with music-assisted relaxation (MAR). A third ward, with no interventions other than usual care, served as a point of comparison. Sleep quality was monitored using the Richards-Campbell Sleep Questionnaire (RCSQ). The change score means of the treatment groups were compared with the mean score of the comparison group by means of a t-test. Estimates of effect were calculated. The results of this study showed that MAR produced a statistically significant improvement of sleep quality and showed a large effect size. The total RCSQ score did not improve significantly. SC failed to produce statistically significant improvement of sleep quality, nor of the RCSQ total score. This pilot study provided a strong indication that mental health nurses can apply MAR effectively. No such indication was found for stimulus control.
Caring for those with mental health conditions on a children’s ward
Authors: Buckley Sinéad
Published: May 2014

Background: 20% of young people experience mental health distress (e.g. depression, suicide, and psychological disturbances of varying intensity). Failure to provide timely, effective and appropriate interventions to young people experiencing mental health difficulties can have profound and lasting consequences. Nurses practising in paediatric settings should be prepared to nurse young people with mental health problems. Methods: The study methodology was an exploratory mixed methods approach, with both descriptive statistics and qualitative findings. This study was undertaken with registered nurses from two children’s medical/surgical units in the Republic of Ireland. A questionnaire entitled ‘Nurses’ Experiences of Nursing Young People with Mental Health Problems in the Paediatric Ward Setting’ was used for data collection. SPSS 11.0 and content analysis were used for data analysis. A convenience sample was used, with a response rate of 56%.Results: 68% of nurses had inadequate educational preparation for nursing young people with mental health problems; 81% of nurses believed that in-house educational courses did not facilitate care for mental health issues in young people. Anorexia nervosa, depression and suicidal tendencies were the three most common problems identified in this study. Overall, 67% of nurses were dissatisfied with having to nurse young people with mental health problems on a general paediatric ward. Conclusions: 87% of nurses highlighted that young people with mental health problems should be nursed by mental health nurses in separate adolescent units. Recommendations are made for further developments in the nursing care of young people with mental health problems.
Predisposing factors leading to depression in the British Army
Authors: Finnegan Lt Col Alan , Finnegan Sara , McGee Professor Paula , Srinivasan Lt Col (retired) Mike , Simpson Colonel Robin
Published: May 2014

Few studies have explored the predisposing factors leading to depression within the British Army, and this qualitative investigation provides a novel approach to advance knowledge in this poorly researched area. Information was provided by army mental health (MH) clinicians, with results aligned to theoretical groupings under the headings of: occupational stressors; macho culture, stigma and bullying; unhappy young soldier; relationships and gender. These issues were influenced by peacetime and operational settings; the support offered by the Army Medical Services and unit command. The results indicate that Army personnel are exposed to multi-factorial stressors that are incremental/ accumulative in nature. Soldiers can cope with extreme pressures, often in hostile environments, but often cannot cope with a failing relationship. Officers were worried about the occupational implications of reporting ill, and the negative impact on their career, and might seek support from private civilian agencies, which have potentially dangerous ramifications as they may still deploy. GPs refer female soldiers more frequently for a mental health assessment because women express their emotions more openly then men. Young disillusioned soldiers who want to leave the Army form the main group of personnel accessing mental health support, although often they are not clinically depressed.
Facilitating pre-registration nurse learning: a mentor approach
Authors: Warren Diana
Published: May 2014

The aim of this literature review is to highlight the need for effective learning and teaching facilitation in the clinical workplace, so that nurses are fit to practise on entry to the Nursing and Midwifery Council (NMC) register. The article focuses on the importance of the relationship between mentors and student nurses, and summarizes recommendations from the literature on this subject
Improving nurse documentation and record keeping in stoma care
Authors: Law Lesley , Akroyd Karen , Burke Linda
Published: May 2014

Evidence suggests that nurse documentation is often inconsistent and lacks a coherent and standardized approach. This article reports on research into the use of nurse documentation on a stoma care ward in a large London hospital, and explores the factors that may affect the process of record keeping by nursing staff. This study uses stoma care as a case study to explore the role of documentation on the ward, focusing on how this can be improved. It is based on quantitative and qualitative methods. The medical notes of 56 patients were analysed and in addition, focus groups with a number of nurses were undertaken. Quantitative findings indicate that although 80% of patients had a chart filed in their medical notes, only a small portion of the form was completed by nursing staff. Focus group findings indicate that this is because forms lacked standardization and because the language used was often ambiguous. Staff also felt that such documentation was not viewed by other nurses and so, was not effective in improving patient care. As a result of this study, significant improvements have been made to documentation used on the stoma care ward. This is an important exploration of record keeping within nursing in the context of the Nursing and Midwifery Council’s emphasis on the importance of documentation in achieving effective patient outcomes.
Critical thinking is crucial
Authors: Castledine George
Published: May 2014

There has been growing concern among many employers of registered nurses that new recruits lack the ability to think critically and broadly about their work.
Nurse prescribing: does more responsibility mean more litigation?
Authors: McHale Jean
Published: May 2014

This paper examines the current legal regulation of nurse prescribing. It considers the background to, and current position in relation to patient group directions, and independent and supplementary prescribing. It explores the prospect for enhanced liability which may result from such expansion in role. It considers some of the dilemmas which may result, and some of the practical safeguards which need to be in place to reduce the possibility of future litigation.
Medical futility in children’s nursing: making end-of-life decisions
Authors: Brien Irene O , Duffy Anita , Shea Ellen O
Published: May 2014

Caring for infants at end of life is challenging and distressing for parents and healthcare professionals, especially in relation to making decisions regarding withholding or withdrawal of treatment. The concept of medical futility must be considered under these circumstances. Parents and healthcare professionals should be involved together in making these difficult decisions. However, for some parents, emotions and guilt often are unbearable and, understandably, parents can be reluctant to make a decision. Despite the recognition of parental autonomy, if parents disagree with a decision made by medical staff, the case will be referred to and solved by the courts. The courts’ decisions are often based on the best interest of the child. In this article, the authors discuss the concepts of ‘parental autonomy’ and ‘the child’s best interests’ when determining medical futility for infants or neonates. The role of the nurse when caring for the dying child and their family is multifaceted. While nurses do not have a legitimate role in decision making at the end of life, it is often nurses who, through their advocacy role, inform doctors about parents’ wishes and it is often nurses who support parents during this difficult time. Furthermore, nurses caring for dying children should be familiar to the family, experienced in end-of-life care and comfortable talking to parents about death and dying and treatment choices. Children’s nurses therefore require advanced communication skills and an essential understanding of the ethical and legal knowledge relating to medical futility in end-of-life children’s nursing.
Observations in acute care: evidence -based approach to patient safety
Authors: Preston Rosemary M , Flynn Deborah J
Published: May 2014

Both the National Patient Safety Agency and National Institute for Clinical Excellence have recommended that nurses must competently carry out observations, accurately interpret the data and make appropriate decisions on that data if unnecessary deaths are to be avoided. This review explores patient safety through a review of nurses’ knowledge, skills and practices of recording observations in acute clinical settings (TPR, BP, blood glucose levels, blood oxygen saturation levels and neurological function). Findings from different research studies indicate the respiratory rate in particular is a sensitive indicator of clinical deterioration, but is the one observation that is poorly performed in acute care. The review also highlights the advantages and disadvantages of using electronic recording devices and using early warning systems that have been designed to identify patients at risk of deterioration. In addition to this, the review explores what nurses need to know about physiological compensatory mechanisms in order to facilitate accurate detection and reporting of clinical deterioration in acute care. Some recommendations for improving nurses’ competence in doing the observations are considered. These recommend nurses should attend the ALERT course (acute life threatening events recognition and treatment), within the first eighteen months post qualifying if working in acute care. It is also recommended that further development of simulation exercises in both pre and post registration courses may help to foster ‘what is best practice’ for doing the observations in acute care.
Evaluating a super absorbent dressing (Flivasorb) in highly exuding wounds
Authors: Verral Debby , Coulborn Anna , Bree-Aslan Cathie
Published: May 2014

This article reports an observational evaluation of 19 patients with highly exuding wounds. Flivasorb was used as a super absorbent dressing that could remove the harmful exudate fluid and promote a healthy wound bed. The outcomes demonstrated that Flivasorb is successfully absorbs large amounts of fluid, reduces the number of dressing changes required and therefore, reduces the cost of the patient’s care.
A critical analysis of the NSF for Older People standard 6: falls
Authors: Kennedy Angelina
Published: May 2014

As practitioners, we need to have an awareness and recognition of how policy affects our professional practice. The NHS has undergone major policy changes in recent years, many of them affecting older people. These include national policies and guidance intended to prevent and reduce falls in the older adult. The prevention and management of falls among older people is a priority in the Government’s public health strategy, which aims to reduce falls by at least one fifth by the year 2010. Standard 6 of the National Service Framework for Older People was developed to reduce the number of falls in older adults and to ensure effective treatment and rehabilitation of those who have fallen. However, a recent national audit has highlighted inadequacies and deficiencies in fall prevention services. Falls in older adults have a significant impact not only on the individual but also on the NHS. Nurses have an active role to play in assessing older people who have fallen. They are also pivotal in implementing falls-prevention programmes and in influencing policy that will change practice. If falls prevention policies are to be effective, it is imperative that effective training systems are in place and healthcare professionals are trained and equipped to deliver the quality of care needed to help reduce falls in the older adult.
Standards for pre-registration nursing education: your view counts
Authors: Karstadt Lyn
Published: May 2014

Lyn Karstadt examines the latest consultation on graduate practice, and urges nurses and student nurses to speak out and help shape the future structure their profession
Promoting curiosity through the enhancement of competence
Authors: Kedge Stephen , Appleby Ben
Published: May 2014

Because of the political and professional expectation that nurses engage in independent lifelong learning, nurses have to be able to teach themselves. Furthermore, their learning needs to be at the correct educational level. A culture of curiosity is therefore a key requirement of modern nursing. This article analyses a theory that cyclically links curiosity to competency and argues that curiosity thrives in an environment that maximizes competency. The nature and dimensions of competency are discussed. The article examines the importance of competence in nursing practice. It discusses what the principles of best practice are in relation to using competency to maximise curiosity in the clinical learning environment.
A review of patient safety errors in cancer diagnosis
Authors: Tingle John
Published: May 2014

This article reports on the National Patient Safety Agency’s recent review of incidents that have resulted in harm to patients and even in death, in patients on a cancer diagnosis pathway. Errors include: failure to report results of investigations in good time; poor communication between health professionals and departments as well as poor communication with patients; cancellation of investigations due to failure to confirm availability of specialist staff or equipment; and errors in clinical assessment. The report makes five recommendations for improvements in patient care
A team approach to identify and manage risk in infusion therapy
Authors: Lee Paul T
Published: May 2014

Infusion therapy has developed significantly in recent years, and many infusion devices and systems are now in use in clinical practice. Errors associated with administering intravenous infusions can cause serious harm to patients, and a lack of standardization of infusion devices, among other factors, can increase the risk of these occurring. Following an audit investigating infusions in one acute NHS trust, a multidisciplinary group was formed to address the need for device replacement and standardization. This article describes this process and the implementation of the group’s 5-year plan. This plan was implemented between 2004 and 2009, and significantly reduced organizational risk, harm to patients and exposure to unnecessary clinical risk. A variety of purchasing models were used including administration set/consumable deals, cash injections and capital replacement programmes. The organization successfully reduced the variety of infusion device from over 31 device types to just eight types during this period
Managing wound pain during application and removal of dressings
Authors: Fletcher Jacqueline
Published: May 2014

Wound pain is a common experience in patients with acute and chronic wounds, and also post healing in some cases, with scars (Stavrou et al, 2009). This pain can cause patients considerable suffering and distress, and patients identify that wound pain is an important part of their experience, for example during dressing removal, wound cleansing or debridement. They frequently identify pain management as their most important priority, over and above achieving wound healing. Pain-free dressing removal was also ranked the most highly desired characteristic of a dressing in a survey of 3918 clinicians across 11 countries (Moffatt et al, 2002).
Validity of the Waterlow scale and risk of pressure injury in acute care
Authors: Webster Professor Joan , Gavin Nicole , Nicholas Catherine , Coleman Kerrie , Gardner Glenn
Published: May 2014

Aim: To assess the validity of the Waterlow screening tool in a cohort of internal medicine patients and to identify factors contributing to pressure injury. Method:A longitudinal cohort study design was used. A total of 274 patients (mean age 65.3 years) admitted through the emergency department or outpatient clinics of a tertiary hospital in Brisbane, Australia, and expected to remain in hospital for at least 3 days were screened on admission using the Waterlow screening tool. Their pressure ulcer status was monitored and recorded every second day. The main outcome measure was pressure ulcer incidence. Results: Fifteen participants (5.5%) had an existing pressure ulcer and a further 12 (4.4%) developed a pressure ulcer during their hospital stay. Sensitivity of the Waterlow scale was 0.67 (95% confidence interval [CI]: 0.35–0.88), specificity was 0.79 (95% CI: 0.73–0.85), positive predictive value was 0.13 (95% CI: 0.07–0.24) and negative predictive value was 0.98 (95% CI: 0.94–0.99). Conclusion: This study provides further evidence of the poor predictive validity of the Waterlow scale. A suitably powered, randomized controlled trial is urgently needed to provide definitive evidence about the usefulness of the Waterlow scale compared with other screening tools and with clinical judgment.
Development of an ultrasound-guided PICC insertion service
Authors: Nicholson Jackie
Published: May 2014

Use of the peripherally inserted central catheter (PICC) has gained popularity over the past 30 years in the USA and over the past 15 years in the UK. The PICC was initially used for specific purposes, such as the delivery of parenteral nutrition and chemotherapy, but its use has expanded both within the acute hospital and community settings. This article describes an ultrasound-guided PICC insertion service that has been set up in a district general hospital to expand the service within the oncology department and to begin a service for non-oncology patients. As expected, patients who have benefited from the development of this service include those requiring parenteral nutrition, chemotherapy and intravenous therapy in the community. However, retrospective audit has shown that the largest group of patients to benefit from the ultrasound-guided PICC insertion service was those with difficult venous access for a variety of reasons. Some of these reasons are discussed, along with an overview of the benefits the service has provided to other groups of patients, and associated benefits to the hospital trust.
Embedding the quality agenda into tissue viability and wound care
Authors: Ousey Karen , White Richard
Published: May 2014

The vision for the NHS over the next 5 years is to go from ‘good to great’, with the government’s 5-year plan mapping the journey for the NHS while focusing on improving quality and productivity, using innovation and prevention to drive and connect them. The Department of Health’s 2010 report Frontline Care. Report of the Prime Minister’s Commission on the Future of Nursing and Midwifery in Englandidentified the need to develop national nursing indicators that measure nurse quality and their impact on patient outcomes and satisfaction. This article explores the impact that the quality agenda will have on tissue viability and wound care, and discusses the development of effective and achievable metrics. The importance of the multidisciplinary team working together to develop metrics and achieve quality outcomes for patients is further identified and discussed.
Effective evidence-based intermittent self-catheterization: an update
Authors: Nazarko Linda
Published: May 2014

Intermittent self-catheterization (ISC) has been used to relieve voiding problems for 4000 years. Although the materials used have changed since the ancient Egyptians used papyrus reeds and the Chinese the stalks of alum, ISC continues to play an important role in managing bladder dysfunction. ISC has the potential to reduce infection risks and transform the lives of people with bladder dysfunction (Woodward and Rew, 2003; Nazarko, 2010). This article aims to provide a brief update on ISC
Towards IV drug standardization in critical care
Authors: Keeling Peter , Scales Katie , Keeling Susan , Borthwick Mark
Published: May 2014

Local infusion practice within critical care has evolved over time, and one example of this is the wide variation in concentrations of drug infusions within critical care. While there are many similarities between critical care units, there are also many differences. Often drug infusions are used outside their product licence and, because of the diversity in practice, manufacturers are unlikely to license multiple preparations of even the most commonly used infusions. Critical care nurses spend many hours every day preparing and administering intravenous infusions. Much time could be saved if the infusions were available as a ready-to-use solution. This would also reduce the risk of errors that occur during the preparation and administration of medication infusions. This article describes a national project to achieve consensus on the strengths of drug infusions used within UK critical care units. Having agreed on standard solutions, it is hoped that manufacturers will seek licences for commonly used infusions and work towards mass production of these products. Off the shelf, ready-to-use infusions of commonly used medications could become a reality.
The Valued People Project: users' views on learning disability nursing
Authors: Gates Bob
Published: May 2014

A well-educated and trained workforce is undoubtedly crucial to the development of quality care for people with learning disabilities. Notwithstanding this, and unsure as to the need to continue to commission educational programmes for one part of this workforce—pre-registration learning disability nursing—South Central Strategic Health Authority commissioned the Valued People Project to undertake a detailed strategic review of educational commissioning, along with a review of the specialist learning disability health workforce more generally. This project has recently been completed, and provides a unique evidence-based expert evaluation of the future strategic direction of education commissioning and leadership for workforce issues in specialist learning disability services, as well as the wider NHS workforce. This is the first in a series of articles that reports on one aspect of the project: the focus group work undertaken with parents and relatives of people with learning disabilities, and people with learning disabilities themselves, as to the need and type of health workforce needed to support them in the future. The article concludes by identifying the key messages of importance from parents and people with learning disabilities concerning the future specialist and wider NHS workforce.
Balloon gastrostomy tubes for long-term feeding in the community
Authors: Ojo Omorogieva
Published: May 2014

Aim:

Dysphagic patients with functional guts often receive nutritional and hydration support through enteral feeding tubes. These include percutaneous endoscopic gastrostomy (PEG) and radiologically inserted gastrostomy (RIG) tubes. The balloon gastrostomy tube (BGT) as a primary tube of choice in tube-fed patients, including head and neck cancer patients, offers a new approach to enteral tube feeding in the community. There are complications associated with the use of enteral feeding tubes. This study compared the complication rates and the costs of PEG tubes and BGTs in patients on long-term enteral feeding in the community and looked at the possible use of BGTs as an alternative to PEG tubes.

Methods:

The records of all 15 BGT-fed patients on the caseload and 15 randomly selected PEG tube-fed patients were reviewed. The study was based on two consecutive visits to these patients. Tube and stoma complications were clinically scored in order of increasing severity (0–10) and statistically tested. The prevalence of stoma and tube complications was expressed in percentages.

Results:

There was no significant difference (P>0.05) in the overall clinical scores between BGT-fed and PEG tube-fed patients at both initial and final visits. However, with regard to specific complications—infected sites, tube dislodgement, overgranulation, and infection with overgranulation—significant differences were observed between the two groups of patients at the initial and final visits. In addition, the total costs of inserting and managing BGTs were significantly higher than those for PEG tubes.

Conclusions:

Although BGTs may be used as analternative to PEG tubes in patients on long-term enteral feeding in the community, the higher cost of using BGTs over PEG tubes should be considered when selecting feeding tubes for these patients.
Attitudes to sexuality of patients with learning disabilities: a review
Authors: Futcher Sarah
Published: May 2014

Objective:

A critical review of the literature to determine the attitudes of staff and families towards the sexuality of adults who have learning disabilities.

Design:

An evidence-based practice literature search of all published studies conducted since 2000. This included a comprehensive review of books, electronic databases, grey literature and hand-searching. Four key studies were identified and subjected to critical analysis.

Method of critique:

The four key studies yielded were critically analysed using a framework developed by Parahoo (2006) . This critiquing tool identifies seven key areas: title, abstract, literature review, methodology, data analysis and results, discussion and interpretation, and conclusions and recommendations.

Results:

All four studies uniquely addressed similar issues in practice; there are areas of bias and concerns about the reliability of some of the studies critiqued. Similar themes were identified, suggesting that the results could be replicated in further studies. Education for staff was a key theme throughout the studies.

Conclusions:

Education for staff is vital to ensure that a consistent approach is taken to support adults who have learning disabilities to express their sexuality. In order to facilitate the changes required in practice, leadership, education and a support network are required. Recommendations from this review include training on leadership and on the sexuality of adults with learning disabilities for all staff.
Simulated practice — a panacea for health education?
Authors: Valler-Jones Tracey , Meechan Ronnie , Jones Helen
Published: May 2014

A variety of approaches to teaching and learning are required to encompass the complexity of nursing. Simulated practice involves computer-based simulated environments, human patient simulation and role play, enabling multiple learning objectives to be taught in arealistic clinical environment without harming patients. The Nursing and Midwifery Council recognizes the use of simulated practice and has enabled higher education pre-registration nurse programme providers to incorporate a maximum of 300 hours of simulated practiceas part of the 2300-hour practice hours component. However, not all students respond positively to simulated activity, which should be used to augment clinical practice and not replace it. It is important to ensure the quality of the simulation enables the educational experience to be positive for students.
Communicating news of a patient's death to relatives
Authors: Reid Megan , McDowell Joan , Hoskins Robert
Published: May 2014

Breaking the news of the death of a patient to their relatives is one of the most difficult and dreaded aspects of nursing. While it is not an aspect of the job that nurses relish, it is key that nursing staff have full understanding of their role during this time to allow them to communicate this difficult news in a sensitive manner. This article will examine the role of the nurse in communicating the news of a patient's death to their next of kin and relatives. Staff education and training to deal with the bereaved will be assessed, as will the nurse's perceptions of their role. The impact of the nurse's presence on the bereaved will be looked at, and finally the role of the nurse in bereavement follow up will conclude this article.
Clinical challenges of preventing incontinence-associated dermatitis
Authors: Beeckman Dimitri , Woodward Sue , Rajpaul Kumal , Vanderwee Katrien
Published: May 2014

Incontinence-associated dermatitis (IAD) is a common skin disorder in patients with faecal and/or urinary incontinence. The past decade has seen a huge growth in publications focusing on the complexity and inconsistency of the clinical observation of IAD and the differentiation between IAD and pressure ulcers. IAD and superficial pressure ulcers cause confusion in clinical practice when trying to determine the true nature and underlying pathology of the lesion. It is a daily challenge for health professionals in hospitals, nursing homes and community care to maintain a healthy skin in patients with incontinence. The aim of this article is to provide a brief update on recent developments regarding the differentiation between pressure ulcers and IAD and the prevention of IAD. Recommendations for clinical practice and research are provided.
Supporting self and others: from staff nurse to nurse consultant. Part 5: Clinical supervision
Authors: Fowler John
Published: May 2014

This series of articles explores various ways of supporting staff who work in the fast moving and ever changing health service. In previous articles, John Fowler an experienced nursing lecturer, author and consultant examined the importance of developing a supportive working culture and the role of preceptorship and mentoring. This article examines the use of clinical supervision within nursing.
Assessing glycaemic control: self-monitoring of blood glucose
Authors: Wilson Danny D , McAllister Gillian , West Adele
Published: May 2014

Diabetes Mellitus is a chronic, lifelong metabolic disorder characterized by an elevated blood glucose level resulting from an absolute or relative shortage of insulin. Self-monitoring of blood glucose (SMBG) has escalated over the years following the outcomes of evidence demonstrating a strong correlation between tight blood glucose control and the significant reduction of diabetes-related complications. While glycosylated haemoglobin (HbA1c) measures mean glycaemic exposure during the preceding 2-3 months, it does not provide day-to-day changes in glucose levels. SMBG represents an important adjunct to HbA1c because it distinguishes among fasting, preprandial (before a meal) and postprandial (after a meal) hyperglycaemia and provides immediate feedback about the effect of food choices, activity and medication on glycaemic control. The successful outcome of glycaemic control cannot be effectively achieved without the input of the nurse. The nurse's role is to identify people with diabetes who are most likely to benefit from SMBG and provide them with appropriate education, problem solving skills and ongoing support.
The Liverpool Care Pathway: does it improve quality of dying?
Authors: Duffy Anita , Payne Sheila , Timmins Fiona
Published: May 2014

The Liverpool Care Pathway (LCP) for the dying patient is an integrated care pathway that was developed to assist non-specialist palliative care staff care for dying patients in acute clinical areas. The LCP has generated numerous debates among health professionals regarding its strengths and weaknesses. The complexity of patient needs at the end-of-life cannot be underestimated and the LCP provides the foundations of quality evidence-based care patients require, particularly in the final phase of dying. Nevertheless, not all health professionals are in agreement as to the advantages of using integrated care pathways in clinical practice. Despite the attention that has surrounded the LCP there is limited evidence to suggest that it improves end-of-life care. This article examines the evidence in relation to the LCP as a tool to improve palliative care for dying patients and their families in non-specialized palliative care practice