bluuebunny/crossref_metadata_2025_split huggingface dataset:
Median sternotomy scars: formation and impact on patient quality of life
Authors: Papaspyros SC , Patel RK , Polyzois K , Javagula KC , Jeffrey RR 
Published: May 2014

More than 30 000 people undergo heart surgery in the UK each year. A significant source of long-term morbidity following sternotomy is the tendency to form abnormal scars. Living with scars can be challenging in a social environment that values physical attractiveness. The physiology of wound healing is a complex, dynamic process that results in restoration of anatomical continuity and function. However, where the reparative processes are disrupted, wound healing can be impaired resulting in two pathological extremes: deficient healing leading to chronic wounds or excessive healing leading to hypertrophic or keloid scars. Current post-sternotomy precautions are, at best, supported by indirect evidence and have several limitations. Psychosocial distress is directly related to patient-perceived scar severity and unrelated to clinicians’ ‘objective’ rating. The potential impact of sternal scar formation should be discussed with patients pre-operatively and appropriate support (social skills training, cognitive behavioural therapy) should be offered during recovery.
New training and qualifications in electrocardiography
Authors: Richley David 
Published: May 2014

The electrocardiogram (ECG) is the most commonly performed cardiac investigation in the world. It has been estimated that in Europe alone, up to 300 million ECGs may be recorded annually ( World Health Organisation, 1981 ). The test is fundamental to many cardiac diagnoses, and it is recorded in a wide range of healthcare settings. Despite the clinical importance and ubiquity of the ECG, until very recently there has not been any nationally recognised qualification in the UK to certify competence either in carrying out the procedure or interpreting the result. The only professional group who have had to undergo formal training and assessment in ECG recording and interpretation in order qualify are cardiac physiologists, yet once they are qualified cardiac physiologists record very few ECGs, devoting their time instead to more specialist procedures such as echocardiography and the follow-up of implanted devices. Most ECGs are probably recorded by healthcare practitioners who have not undergone formal training and assessment in practical electrocardiography and who do not hold a recognised qualification in the technique.
UK survey of patient cardiac rehabilitation attendance
Authors: Dressler Corinna , Lewin Robert J 
Published: May 2014

Aim: In the UK, cardiac rehabilitation programmes differ in set-up and service provision is variable. No aggregate information is available on how programmes identify and invite patients. This study aimed to determine how patients are identified and invited to attend cardiac rehabilitation programmes. Methods: A nine-item electronic survey was e-mailed to 354 publicly-listed UK cardiac rehabilitation coordinators. The survey included questions on the phases of cardiac rehabilitation on offer, how patients are identified, how they are invited, how non-attenders are followed up and which groups are least likely to attend. Results: In total, 190 cardiac rehabilitation coordinators participated in the survey (53% response rate). The attendance rate was 83.5% for phase 1 and 66.3% for phase 3. Suitable patients were identified through referrals from hospital (82.6%), by the cardiologist/hospital physician (53.6%) and from going around wards (59%). In hospital invitation (70.5%), telephone (70%) and written invitations/reminders (50.5%) were the most frequently used modes of inviting patients. Most programmes used three (n=110) or more (n=127) methods of patient contact. People at work and older women were less likely to attend cardiac rehabilitation. Conclusions: Variations in patient identification and invitation methods indicate that liaison and knowledge exchange could help optimise services. The importance of context-sensitive policies is highlighted.
Help for bereaved children: a preventative approach
Authors: Davies Christine 
Published: May 2014

This paper describes the work undertaken with children and adolescents who have lost a significant person in their lives through death. The author works with the paediatric nurse member of a palliative care team running groups for children and adolescents who have been bereaved. The aim of the project is to invite the child/adolescent as soon as possible after bereavement to participate in groups with others who are grieving. This groups allow participants to express their feelings through art, play and discussion in a safe and confidential environment. It is hoped by using a preventative approach such as this, that the incidence of some of the results of unresolved childhood grief, such as failed relationships, depression and ill-health in adult life can be minimised.
Teenage smoking
Authors: DeBell Diane , Wales Helen 
Published: May 2014

Health education and promotion in secondary schools is generally under-resourced because of competing pressures on teachers to deliver the core national curriculum. School nurses are well placed to work with teachers in providing such programmes in the school setting. However, for their role to be effective there is a need to ensure that they are informed by research-based knowledge of how young people make decisions about their own health. This research in Norfolk examined decision making about tobacco use amongst 13-18 year olds and contextualised young peoples’ attitudes to smoking within a study of attitudes to health risk behaviours generally. Findings indicate a complex set of biopsychosocial factors which interact over a long maturation period and challenge the presumptions adults make about why young people do – or do not – decide to smoke tobacco.
Allergen avoidance in asthma management
Authors: Buck Sallie 
Published: May 2014

Allergy is increasing and it is a common cause of asthma (Burr 1993) – particularly within modern Western society. Traditionally, the emphasis on management of asthma has been heavily biased towards pharmacology and yet much research has shown that allergen avoidance in allergic asthma can reduce symptoms. Although avoidance strategies have no side effects they can be onerous and involve some initial financial expense. It is therefore prudent that when advice is given on allergen avoidance, a positive skin prick test result is obtained to corroborate the history. This paper discusses potential allergen triggers to asthma, the important role skin prick testing plays within a structured diagnosis and implications for both patients and staff in the community.
Postnatal mental health: co-operation in community care
Authors: Hardy Bill , Parke Sian 
Published: May 2014

Postnatal mental health problems – particularly postnatal depression – affect approximately 15 per cent of women in the United Kingdom (UK). In smaller numbers puerperal psychosis affects one or two women per 1000 births and usually requires the support of the specialist psychiatric services. This paper explores the roles of health visitors, midwives and community psychiatric nurses in the context of postnatal mental health. Different types of postnatal mental health issues are highlighted, and varying approaches to working with women who suffer with these problems are discussed. The focus on interventions in the primary care setting offers a starting point for community practitioners to demarcate their roles and promote their skills for effective outcomes for clients and their families. This paper concludes with a brief discussion about how community practitioners can collaborate in providing services for women with postnatal mental health problems.
Hospital at home: the use of a new series
Authors: Wilson Andrew , Wynn Alison , Bergström Jessie 
Published: May 2014

Hospital at Home (HH) schemes can provide an alternative to acute hospital admission. However they create extra work for GPs, and might be used as an additional rather than alternative source of care. The introduction of a Hospital at Home scheme in Leicester enabled these issues to be examined. Case mix, service inputs, discharge destination and re-admission rates were monitored during the first 15 months of its operation. Also, hospital avoidance, GP workload and the scheme’s acceptability were estimated. Routinely collected data about patients admitted during that period was used. In a sub-sample of patients, the general practitioner was asked to complete a postal questionnaire about admission avoidance and work load.
Compulsory removal from home under the National Assistance Act 1948
Authors: Griffith Richard 
Published: May 2014

District nurse Mary Thomas has had concerns about one of her older patients for some time. The lady, Miss Oates, is in her 80s and she lives alone in a bungalow with 30 cats. Her physical frailty is such that she is unable to care properly for herself or her cats. She has refused all offers of help from the social services authorities and only allows the district nurse in to dress an ulcer on her leg. The bungalow is filthy and stinks of urine. There is no heating or electricity. There is cat excrement and uneaten pet food everywhere. Today Sister Thomas has found her patient lying at the foot of her bed after falling the night before. She refuses to be helped into bed and seems determined to stay on the floor. Despite the urging of the district nurse and GP the patient has consistently refused to leave her bungalow. Both sister Thomas and the GP accept that the patient has no signs of a mental disorder or of mental incapacity, nevertheless they both consider that care and attention in a care home, even for a short period to allow her bungalow to be cleaned, would be of great benefit and wonder if the law could be used to compel Miss Oates to move to a care home.
Assessing the impact of health policies on COPD
Authors: Berjon-Aparicio Sonia 
Published: May 2014

COPD is a leading but under-recognized cause of morbidity and mortality worldwide. It is currently the fourth leading cause of death in the world. and the fifth commonest cause of death in England and Wales, accounting for nearly 28,000 deaths each year. Methods: The author analyses systematically the national policies around chronic obstructive pulmonary disease such us the long term conditions NSF, the expert patient program, policies around smoking cessation and NICE and BTS recommendations on COPD. Finding/Conclusion: The analysis of current national policies on chronic obstructive pulmonary disease leads to a discussion to justify the need for a National Service Framework on this chronic disease. The current and future impact on local implementation is also analysed.
Termination of pregnancy: a case for a change in the law
Authors: Griffith Richard , Tengnah Cassam 
Published: May 2014

In recent months there has been renewed public and parliamentary debate on whether the abortion law in the United Kingdom should be reformed. Parliament has debated the issue on three occasions and now the House of Commons Select Committee on Science and Technology are calling for evidence in support of their inquiry into reform of the Abortion Act 1967. The inquiry gives district nurses the opportunity to inform the debate and ensure that their voices are heard given that topics for reform include nurse-led abortions and home abortions. In this article Richard Griffith and Cassam Tengnah review the development of the law relating to abortion and highlight the areas of reform to be considered by the select committee.
Motivational interviewing with clients with chronic leg ulceration
Authors: Morris Tania , White Geoff 
Published: May 2014

In order to meet the holistic needs of the client with chronic illness, the nurse is required to adopt many different approaches to care. This article will explore one client-centred counselling approach that can be used by community practitioners to address behavioural change and improve concordance. The techniques are illustrated with an example of where motivational interviewing has been used to great success—in the ‘Look After Your Legs’ (LAYL) programme undertaken by West Gloucestershire primary care trust. Interventions such as motivational interviewing have the potential to empower clients and so enhance care delivery.
The clinical management of women with primary breast cancer
Authors: Rogers Carolyn 
Published: May 2014

Breast cancer is the most common cancer in the UK. Incidence is increasing but mortality is decreasing meaning people are surviving for longer with the disease. This will undoubtedly have an impact on health professionals working in a primary care setting. This article presents an overview of the diagnosis and current clinical management of women with primary breast cancer. It emphasizes that individualized patient care is based on many biological and pathological characteristics and is becoming increasingly the way forward in personalizing treatment for breast cancer.
Principles of good evidence giving
Authors: Griffith Richard , Tengnah Cassam 
Published: May 2014

With increased regulation and litigation in the health-care sector, appearing in court is becoming an almost routine part of a district nurse’s role. A review of local newspapers shows that in the last 4weeks alone district nurses around the UK have given evidence in no fewer than ten different cases that have involved the coroners’ court, county court and magistrates’ court. The prospect of appearing in court or giving evidence at fitness to practice hearings remains a daunting one. The process is still largely adversarial and cross examination is a hostile experience. This article highlights the principles of good evidence.
Health and safety at work: a guide for district nurses
Authors: Griffith Richard , Tengnah Cassam 
Published: May 2014

Sickness absence across the NHS costs a billion pounds a year with accidents at work accounting for a significant proportion of that absence. Over half the major injuries in the health service are caused by avoidable slips and falls. Under the Management of Health and Safety at Work Regulations 1999 the NHS as an employer and district nurses as employees have a duty to manage health and safety effectively and to ensure that others are not put at risk by work-related activities. Breaching a requirement of health and safety law is a criminal offence so it is essential that district nurses are able to fulfil their duty and so avoid prosecution.
District nurse clinics: accountability and practice
Authors: Griffith Richard , Tengnah Cassam 
Published: May 2014

The numbers of district nurse clinics are continuing to grow in primary care and they provide timely and more cost effective intervention for patients. The clinics provide exciting opportunities for district nurses but also carry an increased risk of exposure to liability. This article discusses some of the key areas of accountability underpinning the duty of care of district nurses working in nurse-led clinics.
Shared decision-making: nurses must respect autonomy over paternalism
Authors: Griffith Richard , Tengnah Cassam 
Published: May 2014

Shared decision-making lies at the heart of the Government's reforms of the NHS in England. The slogan, ‘No decision about me without me’, underpins shared decision-making that sees patients as active participants in their treatment decisions. In this article, Richard Griffith and Cassam Tengnah argue that for ‘no decision about me, without me’ to be a reality, district nurses must guard against paternalistic decision-making that excludes the views and wishes of their patients.
Venepuncture and cannulation: theoretical aspects
Authors: Hobson Pat 
Published: May 2014

Historically venepuncture and cannulation were procedures undertaken predominately by nurses and doctors, however, in recent years, this role has extended to HCAs. As both procedures involve an invasive process, knowledge and skill is required. This article is the first of a two part series focusing on the key theoretical and practical aspects involved in venepuncture and cannulation and the implications this has for HCAs. There is a glossary at the end of the article which provides definitions of words you may not be familiar with.
Choice, capacity, treatment and care
Authors: Nazarko Linda 
Published: May 2014

Mrs Margaret Metcalf is confused, dirty and dishevelled and is declining to bath. She has been assessed as lacking capacity to make decisions so staff have a duty to provide care in her best interests. This article uses a fictional case study to explore how staff can work with family and friends to provide care that meets the needs and aspirations of people who lack capacity. This article follows on from ‘When patients refuse treatment’ published in the January issue of the British Journal of Healthcare Assistants which considered the issue of patients who refused care when they had been assessed as having capacity (Nazarko, 2008).
Pharmacology - a systems approach: thyroid disease
Authors: Hennefe Dawn , Lawson Elizabeth 
Published: May 2014

This article continues the endocrinology theme looking at disorders associated with the thyroid gland. Thyroid disease is a common disorder that healthcare assistants (HCAs) and assistant practitioners (APs) may encounter both in the hospital and community environments. The aim of this article is to describe the symptoms experienced by patients with thyroid disease and identify the drugs used in the management of these disorders. Evidence shows that in relation to an underactive thyroid 40-48% of individuals receiving treatment are either over or under treated (Vaidya and Pearce, 2008). It is therefore important that HCAs and APs are aware of this and are able to support patients undergoing these treatments.
Best practice statement 3: wound infection in clinical practice
Authors: Jones Menna Lloyd 
Published: May 2014

Wound infection continues to be a challenging problem for clinicians and is the result of complex interactions between micro-organisms and the host environment ( World Union of Wound Healing Societies (WUWHS), 2008 ; Patel, 2009 ). Wound infection results in a huge financial burden for both the NHS and the patient. It is therefore important, where possible, to prevent wound infection. Where this is not possible, it is essential to diagnose the infection and commence appropriate treatment as soon as possible ( Patel, 2009 ). In the third of our analyses of best practice statements, we look at a powerful introduction to this important subject.
Maternity support workers and the newborn blood spot test
Authors: Hutchinson Janet 
Published: May 2014

The maternity support worker (MSW) is frequently undertaking procedures traditionally carried out by the midwife. As an MSW studying for the Foundation Degree in Healthcare Practice (FDHC), I feel well prepared to deliver high-quality, evidence-based care to the families I support while working within my scope of practice. Working autonomously in the community, I am frequently required to carry out procedures, including the newborn blood spot test (NBBS). Although the Royal College of Midwives (RCM) states, that with training, this is an appropriate task for the MSW, it does not feel the MSW has the knowledge to gain informed consent for the procedure. This article discusses the screening process and asks if it is time for the RCM to change its stance.
A team approach to the complexities of Parkinson's
Authors: Nazarko Linda 
Published: May 2014

As the population ages, the number of people with Parkinson's disease is set to rise. Providing quality care that meets the needs of the person with Parkinson's disease can present particular challenges to care givers. The disease means that self care ability and care needs may be difficult to predict. It is vital that we understand and meet the care needs of the person with Parkinson's because there are increased risks of the person developing complications if care is not of the highest quality.
It is key for HCA/APs to be alert to signs of anaphylactic shock
Authors: Peate Ian , Holmes Edward 
Published: May 2014

This article provides the healthcare assistant and assistant practitioner (HCA and AP) with information regarding a life-threatening condition: anaphylactic shock, which is a serious allergic reaction. The incidence of anaphylactic shock in the UK is increasing. Shock results in an acute widespread decrease in effective tissue perfusion, which causes an imbalance in oxygen supply and demand, along with a variety of other adverse actions. Vital organs and tissues may be ineffectively perfused. The article discusses antibody and antigen interactions and the results that occur when there is an allergic response. A discussion concerning the pathophysiological changes that occur in conjunction with anaphylactic shock is offered. The signs and symptoms are described and the management of the condition is highlighted. The role of the HCA and AP are briefly addressed. Health education activities are described. A glossary of terms is provided.
Organisational contexts of communication in healthcare
Authors: Hayes Catherine , Collins Michael 
Published: May 2014

Patient-centred healthcare revolves around the implementation of effective communication and the interpersonal and interprofessional relationships that form the basis of them. Patient-centric approaches inevitably involve acknowledging the personal expectation of the people receiving healthcare and are at the crux of virtually every quality management process for all service providers. Skill in communication works on the assumption that behaviour resulting from it will demonstrate a high degree of skill and professional behaviour. This is subsequently dependent upon personal and professional values and the manner in which these are translated into practice. Underpinning all of these issues are the organisational contexts within which communication takes place. The central focus of this article is to give healthcare assistants an insight into the contexts of the workplace, which will ultimately frame their ability to effectively communicate in patient-centred care.
The provision of education and training to HCAs
Authors: Kelly Michael , Gilding Moorene , Rigg Sophie , Walsh Hannah 
Published: May 2014

The recent debate about the healthcare assistant workforce within the National Health Service has prompted discussion about the education and training of this staff group. This article outlines the education and training opportunities available and identifies that, with such a disparate picture nationally, further work needs to be done to ensure HCAs are sufficiently supported to undertake their role to meet the needs of their patients in an evidence-based manner.
Is your emotional Wi-Fi on? Improving our communication
Authors: Lynall Anna 
Published: May 2014

A crucial element of the work of healthcare assistants and assistant practitioners is the ability to listen effectively to patients using clear communication to aid interactions so that high quality person-centred care can be achieved. This article looks at how, as individuals, we bring our own uniqueness (beliefs, emotions and processes) to the way we interact (and respond) to patients, and how with this awareness we can build on and improve our listening skills. Key words: Communication skills Information Effective listening