bluuebunny/crossref_metadata_2025_split huggingface dataset:
Communication Skills and Ethics
Authors: Mehta Gautam , Iqbal Bilal , Bowman Deborah 
Published: November 2020

AbstractCapacity is at the heart of ethical decision making. Capacity to make choices about healthcare will rarely, if ever, be assessed without the benefit of input from a clinician. Often it is assumed that a psychiatrist should be involved where there are doubts about capacity, but the criteria for assessing capacity are relatively straightforward and it is a core skill in which all doctors should be competent, calling psychiatrists only in situations of doubt or complexity. Capacity is a legal rather than a medical concept, i.e. its definition is drawn from the law. As such, no doctor should engage in an assessment of a patient’s capacity without understanding the relevant legal processes. As capacity is a legal concept, the standard of proof that is used in assessing capacity is that which is applicable to civil law in general, i.e. on the balance of probabilities rather than beyond reasonable doubt. • The legal test used in assessing capacity to make decisions and choices about healthcare was first established in the case of Re: C (Adult: Refusal of Treatment). Since October 2007, the Mental Capacity Act 2005 and its accompanying Code of Practice is the source for guidance on capacity. The principles in Box 3 underpin the legislation and are particularly important to note: • The task in this scenario is to assess capacity, but clearly to do so effectively a candidate will need to employ appropriate communication skills to explore whether the patient is able to meet the criteria of capacity (see section “Key concepts”), namely: ♦ the patient’s comprehension of information ♦ the patient’s ability to retain that information ♦ whether the patient can weigh information in the balance to reach a considered decision; and ♦ communicate the decision. • Candidates should begin with an appropriate introduction telling the patient their full name and role and checking the patient’s identity and preferred form of address. • The patient should be invited to tell the doctor why he is attending and what he expects to happen at the consultation.
Urinalysis
Authors: Lovegrove Jane 
Published: November 2020

Abstract
Urinalysis simply means analysis of urine. It is an easily performed investigation that can detect a wide variety of abnormalities within a few minutes at low cost. Urinalysis is an investigation which all nurses should be competent to perform and is identified by the NMC (2007) as being an example of an essential skill nurse students should be competent to perform before entering their branch programme. Urinalysis may be performed in a wide variety of clinical settings. It should be performed on every patient entering the acute care setting. Additionally, the National Confidential Enquiry into Patient Outcome and Death (NCEPOD (2009), stresses the need for urinalysis to be performed on all emergency admissions to an acute hospital. It may also be performed in outpatient and general practice clinics, and community areas. To obtain the most accurate information from the test, students need to know how to obtain and assess a sample of urine and be aware of factors that may influence the reliability of the investigation. Urine may be tested in three different ways. ● Macroscopic urinalysis, ● Microscopic urinalysis, ● Chemical analysis. Macroscopic and chemical analysis are the investigations performed in the clinical setting which may be tested by OSCE. Microscopic investigation requires samples to be sent to a laboratory. Macroscopic analysis is the analysis of the urine by the naked eye. Chemical analysis may be performed by use of a plastic diagnostic reagent strip or ‘dipstick’ which contains small pads of chemicals which react to substances that may be found in urine. For purposes of testing urine at random, clients are asked to urinate into a clean but not sterile dry container with no precautions regarding contamination. In females in particular this may result in samples being contaminated by vaginal fluids, such as blood or mucus. Due to the risk of contamination a mid-stream specimen of urine may be required if an abnormality is found in a random sample. A mid-stream specimen requires cleaning of the external urethral meatus prior to urination, passing the first half of the bladder contents into the lavatory, and passing the second part of the urine flow into a sterile container.
Understanding Bone Conditions
Authors: Sutcliffe Anne , Swift Cameron 
Published: November 2020

Abstract
The aim of this chapter is to provide nurses with the knowledge to be able to assess, manage, and care for people with bone conditions in an evidence-based and person-centred way. Bone conditions (a major category of musculoskeletal conditions) cover a wide spectrum of diseases, some of which may be considered mild and self-limiting, while others may have a significant impact upon the individual’s quality of life and ability to function. It is estimated that up to 30% of all GP consultations are about musculoskeletal complaints; many are age-associated, and population ageing will continue to increase this demand (Oliver, 2009). The chapter will focus on osteoporosis, hip fracture (perhaps the most serious and costly consequence of osteoporosis or osteopaenia), Paget’s disease, and osteoarthritis, respectively. The chapter will provide a broad overview of these common conditions, enabling a proactive approach to patient care within a multidisciplinary context, whether in the primary or secondary care setting. The nursing management of the symptoms and common health problems associated with bone conditions can be found in several Part 2 chapters, and these are highlighted throughout the chapter. Osteoporosis has been defined as:...A progressive systemic skeletal disease characterised by low bone mass and micro-architectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture. (WHO, 1994)…The World Health Organization (WHO) has recommended a clinical definition of osteoporosis based on a bone mineral density (BMD) measurement of the spine or hip, expressed in standard deviation (SD) units called T scores. Using this definition, an individual is classified as having osteoporosis if his or her T score is ≤–2.5 SD at the spine or hip (WHO, 1994). It is estimated that osteoporosis occurs in approximately 3 million people in the UK, resulting in more than 230,000 fractures per annum, the most frequent being hip, vertebral body, and forearm fractures. In total, 75,000 hip fractures occur annually (British Orthopaedic Association, 2007), with the average age of incidence being 84 and 83 in men and women, respectively (National Hip Fracture Database, 2010).
Understanding Renal Disorders
Authors: Ugboma Debra , Willis Helen 
Published: November 2020

Abstract
The aim of this chapter is to provide nurses with the knowledge to be able to assess, manage, and care for people with the renal disorders chronic kidney disease (CKD) and acute kidney injury (AKI) in an evidence-based and person-centred way. In recent years, AKI has replaced the term ‘acute renal failure’. The chapter will provide a comprehensive overview of the causes, risk factors, and impact of CKD and AKI, before exploring best practice to deliver care, as well as to prevent further progression of these conditions. Nursing assessments and priorities are highlighted throughout, and further nursing management of some of the symptoms and common health problems associated with CKD and AKI can be found in Chapters 6, 9, 15, and 19, respectively. Chronic kidney disease (CKD) is the gradual and usually permanent loss of some kidney function over time (Department of Health, 2007). In CKD, the damage and decline in renal function usually occurs over years, and in early stages can go undetected (Department of Health, 2005a). CKD has rapidly moved up the healthcare agenda in recent years, primarily because of the links with cardiovascular risk, and with a shift in focus away from the treatment of established renal failure towards the detection and prevention of CKD in primary care (O’Donohue, 2009). Glomerular filtration rate (GFR) is an indicator of renal function and is the rate at which blood flows through, and is ‘filtered’ by, the kidney; a normal GFR is approximately 125 ml/min. CKD is classified into five stages according to an estimated glomerular filtration rate (eGFR) and, in the milder stages, further evidence of renal damage such as proteinuria and haematuria. This classification holds regardless of the underlying cause of kidney damage. The understanding of GFR is pivotal to caring for patients with renal disorders. Monitoring, management, and referral of the patient in the earlier stages of CKD became much clearer following the publication of the National Clinical Guidelines for the Management of Adults with Chronic Kidney Disease in Primary and Secondary Care (NICE, 2008a). Many people with stage 3 CKD, unless they have proteinuria, diabetes, or other comorbidity such as cardiovascular disease, have a good prognosis and can be managed in primary care (Andrews, 2008).
Managing End-of-Life Care
Authors: Albarran John W , Hills Marika 
Published: November 2020

Abstract
This chapter addresses the fundamental nursing role of managing end-of-life care. Death is as fundamental a part of life as living, and while caring for a dying patient and their family is demanding, complex, and emotionally exhausting, it can also be a gratifying and privileged experience for nurses. Specifically, nurses have a centre-stage role in leading and informing care delivery at the end of life. Care will typically embrace assessing the needs of the patient and family, providing symptom relief and comfort care, and providing cultural and spiritual support. Additionally, caring functions should also extend following death to caring for the deceased in a dignified manner and supporting the newly bereaved, demonstrating genuine concern, compassion, and effective communication skills (Hills and Albarran, 2010a; Maben et al., 2010). To examine the key themes and challenges of practice, it is important to understand the political, professional and societal influences, and contextual nature of death and dying in the UK. At present, there is neither a clear nor universally accepted definition of end-of-life care, but it is generally understood to be the care of a person who is identified as having failing health and who is in a progressive state of decline (Shipman et al., 2008). Establishing the last phase of a patient’s life can be a difficult and complex process, and this might occur:…● after the diagnosis of a life-limiting condition; ● during the transition or deterioration of a chronic disease illness; ● when there is an increasing frailty combined with greater dependence on care provision, particularly in the older adult; ● following a sudden infective episode, cardiac event, or a life-threatening accident….The last phase of end-of-life care is referred to as the dying phase. Consideration of the end-of-life care needs of people with chronic terminal conditions should begin at diagnosis, and must embrace after-death care and family support. Over the past century, progress and advancement in disease management, together with improvements in living standards, have resulted in changes to the national death profile, with currently two-thirds of the 0.5 million annual deaths in the UK occurring in people over 75 years of age.
Managing Hydration
Authors: Ugboma Debra , Cowen Michelle 
Published: November 2020

Abstract
This chapter addresses the fundamental nursing role of managing hydration. Water is a basic nutrient and is essential to sustaining human life. In the developed world, we often take for granted the basic commodity of clean and plentiful water, but in other parts of the world water can have a profound effect on human health, in both the reduction and the transmission of disease (World Health Organization, 2011). For health, body water and electrolytes must be maintained within a limited range of tolerances. For nurses working in acute or primary care settings anywhere in the world, it is important to have a clear understanding of fluid and electrolyte homeostasis to assess haemodynamic status, to anticipate and recognize deterioration in status, and to implement appropriate corrective interventions. Developing knowledge and associated skills around this topic will be facilitated by reflecting upon your clinical experiences as a student or as a qualified nurse, and your ability to link theory and practice. Your basic foundation of knowledge should include an understanding of how fluid is gained and lost from the body, the distribution of water between different compartments within the body, the processes by which fluid and electrolytes move between the intracellular and extracellular environments (Pocock and Richards, 2009; Cowen and Ugboma, 2011), and knowledge of the different types of intravenous replacement fluid (Endacott et al., 2009: 249舑73). Equally important is an insight into the use of criteria such as clinical/outcome indicators and benchmarking, what to use on what occasions, and how to use such tools to your best advantage. Armed with this knowledge, you will be well equipped to assess each patient’s needs and to make clinical decisions about the most appropriate evidence-based nursing interventions to be used. The state of water balance within the body is principally maintained by the osmoreceptors in the hypothalamus. These are best described as ‘sensors’ that detect the osmolarity (concentration) of the blood to stimulate or suppress the thirst mechanism, as well as regulate the amount of antidiuretic hormone (ADH) released by the posterior pituitary gland. When a person is becoming dehydrated, the thirst centre will be stimulated and usually he or she will seek fluid to rehydrate him or herself.
Managing Hygiene
Authors: Voegeli David 
Published: November 2020

Abstract
This chapter addresses the fundamental nursing role in managing hygiene. The ability to maintain personal and oral hygiene forms some of the activities of living that everyone undertakes every day, but which are often taken for granted until a deterioration in a person’s physical or mental state, such as illness or ageing, prevents individuals from meeting these needs independently. Being able to assess the need for nursing intervention accurately, and to deliver appropriate evidence-based care, requires considerable skill. It draws on many of the core competencies of professional nursing, such as observation, communication, and clinical decision-making. Therefore it is inappropriate that, in a majority of care settings, these activities are often delegated by the registered nurse to those with the least experience. It is important to remember that, registered nurses retain professional accountability for the quality and effectiveness of the interventions provided or delegated to the patients under their care. Increasingly, this fundamental aspect of care is viewed as an overall indicator of the quality of the care provided. Assisting individuals to maintain their personal hygiene needs promotes comfort, safety, well-being, and dignity, and also plays an important part in the prevention of infection. It is also an important aspect of many religions, such as the ritual washing performed by Muslims before prayer. Indeed Young (1991) suggested that cleanliness is a basic human right rather than a luxury. There has been criticism over the past decade that aspects of nursing care relating to the maintenance of patient hygiene have become neglected, and the Healthcare Commission (2007) reported that 30% of complaints received against UK hospitals related to issues of personal care and dignity, including:…● patients being left in soiled clothing or bedding; ● hygiene needs not being met (patients not being washed or mouthcare given); ● hair and nails not being cared for….In response to these criticisms, both the Nursing and Midwifery Council (NMC) and the Department of Health (DH) worked to improve the quality of personal care provided by nurses.
Managing Medicines
Authors: Baileff Anne , Davis Jan 
Published: November 2020

Abstract
The management of medicines is a fundamental component of contemporary nursing care and a pervasive form of therapeutic intervention in healthcare (Medicines Partnership, 2002). In this chapter, we will focus on the skills and underpinning knowledge that you need to enable you to undertake an in-depth assessment of an individual’s use of medication, and how you can work in partnership with him or her to optimize safe, effective use, regardless of care setting. We will not address factors associated with the scheduled administration of medicines undertaken (for example, during the traditional ward drug round), although the principles articulated in this chapter are transferable. Likewise, the principles of good medicine management are also applicable to all of the chapters in this book on core conditions and health needs. Medicines are used to promote health, and to prevent, control, and treat disease. However, they are potent substances. All have side effects, and many interact adversely, not only with other medicines, but also with common fruit, vegetables, and food products. Ethnicity, race, age, weight, and gender can also affect an individual’s response to a specific medicine. Public access to medicines has increased hugely in the past decade, and prescriptive authority is no longer the sole right of medical practitioners. Nurses, pharmacists, physiotherapists, podiatrists, optometrists, and radiographers are now all able to prescribe a wide range of drugs. Patient group directions enable nurses and other health professionals to supply and administer drugs to patients without referral to a doctor, and medicines are increasingly available without prescription to purchase over the counter from a number of retail outlets and over the Internet. At the outset, it is clearly important to understand what we mean by ‘medicines management’; you will then appreciate the extent of your responsibilities and the skills that you need for competent practice. Medicines management is a complex subject and there have been several attempts to define it. The Audit Commission (2001: 5) defines it as:…the entire way that medicines are selected, procured, delivered, prescribed, administered and reviewed to optimise the contribution that medicines make to producing informed and desired outcomes of patient care….
Jaw cysts and odontogenic tumours
Authors: Robinson Max , Hunter Keith , Pemberton Michael , Sloan Philip 
Published: November 2020

Abstract
Odontogenic cysts and tumours arise from inclusion of tooth-forming epithelium and mesenchyme in the jaw bones during development. Cysts also arise from non-odontogenic epithelium trapped during fusions or from vestigial structures. In addition, bone cysts that can arise at other skeletal sites may also occur in the jaws. Odontogenic cysts and tumours may be classified according to their putative developmental origins and biology. The classification of jaw cysts is shown in Fig. 6.1. Odontomes are hamartomatous develop­mental lesions of the tooth-forming tissues. Odontogenic tumours are uncommon and are usually benign. Ameloblastoma is the most com­mon odontogenic tumour and is described in detail. The other odon­togenic tumours are rare and only the principal features are presented. Very rare congenital lesions of possible odontogenic origin are men­tioned in the final section. A cyst may be defined as pathological cavity lined by epithelium with fluid or semi-fluid contents. However, clinically, the term encompasses a broader range of benign fluid-filled lesions, some of which do not possess an epithelial lining. The preferred definition is, therefore, ‘a pathological cavity having fluid or semi-fluid contents that has not been created by the accumulation of pus’. Cysts are commonly encountered in clinical dentistry and are generally detected on radiographs or as expansions of the jaws. Most cysts have a radiolucent appearance and are well circumscribed, often with a corticated outline. At least 90% of jaw cysts are of odontogenic origin. The clinico-pathological features of jaw cysts are summarized in Table 6.1. The incidence of the four most common jaw cysts are provided in Table 6.2. The epithelial lining of odontogenic cysts originates from residues of the tooth-forming organ. • Epithelial rests of Serres are remnants of the dental lamina and are thought to give rise to the odontogenic keratocyst, lateral periodon­tal, and gingival cysts. • Reduced enamel epithelium is derived from the enamel organ and covers the fully formed crown of the unerupted tooth. The dentiger­ous (follicular) and eruption cysts originate from this tissue, as do the mandibular buccal and paradental cysts. • Epithelial rests of Malassez form by fragmentation of Hertwig’s epi­thelial root sheath that maps out the developing tooth root. Radicular cysts originate from these residues.
Refashioning Paradise on Earth: Mughal Governance in Kashmir
Authors: Zutshi Chitralekha 
Published: November 2020

Abstract
This article unravels the complex political, economic, and narrative relationship between the Mughal Empire and its Kashmir province. Contrary to scholarly and popular opinion regarding the devastating and exploitative nature of Mughal rule on Kashmir, in which Kashmiris had little say, the article illustrates that Kashmiris at various levels of society worked with the Mughals to bring the empire and Kashmir closer together through matrimonial, administrative, trade, and literary links. At the same time, Kashmiris resisted the Mughal incorporation of Kashmir into the imperial imagination—through the celebration of its natural beauty, complemented by the building activities of the Mughal rulers on its landscape—as paradise on earth. By drawing on local and more universal historical and literary ideas, Kashmir’s narrative tradition went beyond the confines of the Mughal imagination to reclaim Kashmir’s individuality and autonomy within the empire.
Mughal Authority: The View from Below
Authors: Hasan Farhat 
Published: November 2020

Abstract
This chapter views Mughal authority from below, in terms of the entangled relations between the state and social forces. It looks at the state as an activity, ceaselessly reproducing itself in and through complex layers of relations with the local power relations. Looking at the state from the vantage point of the localities, it argues that the state was largely undifferentiated from the networks of social relations. State–society relations were molded by the use of pen and paper, but scribal literacy was intertwined with oral tradition and performative practices. Literacy was not just an instrument of state control, but was also appropriated by social actors to participate in the rule structure. The ordinary subjects negotiated with the state, and incessantly modified the system of rule through such devices as petitions, complaints, handbills, etc. that were routinely presented at the local qazi’s courts.
Joshua in Reception History
Authors: Farber Zev I. 
Published: November 2020

Abstract
In the Bible, Joshua fulfills many roles. He is Moses’s understudy and successor, conqueror of the land, a miracle worker who stops the sun, and a prophet who knows God’s will and the Torah of Moses. But his character did not cease to evolve with the closing of the biblical canon. Instead, Joshua’s image was adapted and recast depending on who was writing about him and what that author or community needed him to represent. Thus, we see some traditions emphasizing Joshua the warrior, and others Joshua the religious leader. Some emphasize his prophetic abilities, and others his mastery of Torah. In some texts he is the consummate rabbi, in others a typological forerunner of Jesus. The use of Joshua continues into modern times, where he has been used as an archetype for the Israeli soldier and even for the first African-American president.