bluuebunny/crossref_metadata_2025_split huggingface dataset:
An audit of nurses' conduct and recording of observations using the Glasgow Coma Scale
Authors: Waterhouse Catheryne 
Published: May 2014

Objectives: The Glasgow Coma Scale (GCS) is routinely used to assess patients following head injury or other acute neurological events. The aims of this project were: to assess and evaluate registered nurses' baseline knowledge of the three behavioural responses that make up the assessment tool; to review the recording of GCS in neuroscience areas compared with non-specialist units; and to ascertain when the GCS is taught during nurse training and the background experience of the lecturers who teach it. Methods: Sixty questionnaires were used across six clinical areas: neurosurgery, neuro-intensive care, neuromedicine, general medicine, accident and emergency, and general intensive care. Observational studies compared nurses' performance, recording and documentation of GCS observations in each of these units. The unpublished standards for making GCS observations, written by the Neuroscience Nursing Benchmarking Group, were used to identify questions for examination in the audit. Results: Several areas for improvement were identified; including the use and application of painful stimulus. The use of sternal rubbing and nail bed compression continues to be common practice. Data collected also suggested a lack of knowledge of the patho-physiology underpinning the three components that make up the scale. Problems were evident in the record keeping, with very few examples of documentation within nursing records of the separate components of the GCS. Finally, the questionnaires returned from the universities revealed that students were introduced to the assessment tool during the first year of training, normally by lecturers with a critical care or accident and emergency clinical background. Conclusions: The data demonstrated wide variation in GCS scoring across all specialties. While the benchmarking standards are applied in neuroscience wards, the guidelines are not widely available for use in other units. It is pertinent to consider whether access to a clear and comprehensive protocol would help remove some of the ambiguities and ensure a more consistent approach to assessment. Novel approaches to education are required to maintain knowledge and skills in this area of practice. Documentation needs to improve and include the results from component parts of the scale. Instruction on the performance of GCS observations, if taught in the first year of training, should be re-examined, linking theory to practice prior to qualifying. The findings from this study will provide a useful basis for future research using more precise methods.
Marking 20 years of Parkinson's disease nurse specialists: Looking to the future
Authors: Osborne Lynne 
Published: May 2014

This year we celebrate 20 years since the introduction of the first Parkinson's disease nurse specialist (PDNS) in Cornwall. Vast improvements in Parkinson's care have resulted from the creation of about 270 posts, throughout the UK, since 1989. With a population of 100000 people with Parkinson's disease (PD) in the UK and 10000 new cases of this long-term condition each year, this specialist role is clearly needed. Nationally, access to a PDNS varies, and in areas of the country where there is an established PDNS service there can be problems with unmanageable caseload numbers. This has been an issue in Cornwall, so a combined approach of utilising alternative models of care along with the extension of practitioners' roles, has helped meet service demand. However, with a possible reduction in commissioning of nurse specialists in the next few years different approaches to care will be essential to provide care effectively for the growing caseloads of such nurses.
Spasticity management, part 3: Surgery and the use of intrathecal baclofen
Authors: Keenan Elizabeth 
Published: May 2014

Spasticity is a common symptom of neurological conditions such as cerebral palsy, multiple sclerosis, traumatic brain injury, stroke and spinal cord injury. It occurs when there is an imbalance between inhibitory and excitatory signals from the spinal cord and brain. Spasticity is complex and requires careful evaluation within a multidisciplinary team so that treatment options can be tailored uniquely to the individual's needs. Many patients with spasticity try a combination of anti-spasmodic medications over a period. Unfortunately high doses of anti-spasmodic medication can be hard to tolerate as significant side effects can impair quality of life, causing fatigue and cognitive side effects. Intrathecal baclofen is often recommended if all other management strategies are failing. Other more invasive neurosurgical and orthopaedic interventions are considered occasionally; however, these are used infrequently in the adult population and are beyond the scope of this paper.
The personal impact of disclosure of a dementia diagnosis: a thematic review of the literature
Authors: Mitchell Gary , McCollum Patricia , Monaghan Catherine 
Published: May 2014

Background: Decisions around disclosure of a diagnosis of dementia are not always patient-centred; a plethora of literature supports the notion that physicians do not always clearly and directly disclose the diagnosis to the person with dementia. Aim: To conduct a thematic review of the literature in relation to the effects of disclosing a dementia diagnosis to the person with dementia. Method: The literature was searched between February 2013 and June 2013. To enable detailed appraisal and analysis, only studies conducted from 2006 onwards were reviewed. Results: The perceived negative impacts of disclosure, i.e. depression and suicidal tendencies, were not as common as the background literature suggests. Disclosure had many positive outcomes, for example in terms of future planning and the ‘relief’ that a recognised disease was the cause of the symptoms as opposed to ‘old age’. Discussion: The person with dementia has a right to disclosure in all instances, even if to decline a formal diagnosis. Through omission of a clear diagnosis, the person is disempowered. A clear diagnostic framework is absent. Diagnosis should take place over multiple sessions, not only to facilitate coping but also for practical reasons, for example to allow adequate recall.
Can midwives respond to the needs of fathers?
Authors: Lavender Tina 
Published: May 2014

An exploratory study was conducted In a regional midwifery unit in Liverpool in August 1995 to discover the knowledge and feelings of a group of first-time expectant fathers in their anticipation of labour. The study design was a combination of specifically designed questionnaires and semistructured interviews. The data was presented following qualitative analysis. Three main themes emerged from this analysis — support, information and role conflict. This study demonstrates that the inclusion of expectant fathers in the birth experience needs greater consideration by health professionals.
Webwatch
Authors: McDonnell Cheryl 
Published: May 2014

The wide availability of contraception in Britain can mask the fact that pregnancy for many women is an unanticipated and sometimes unwelcome event. Those who believe, or find, themselves to be unexpectedly pregnant may look to internet sources for further guidance. Two sites that women may use under such circumstances are the Family Planning Association (FPA) and the British Pregnancy Advisory Service (BPAS): www.fpa.org.uk www.bpas.org
Support for infant feeding: mothers' perceptions
Authors: Cairney Patricia A , Alder Elizabeth M , Barbour Rosaline S 
Published: May 2014

This study was designed to elicit how first-time mothers felt about the amount and type of support they received from health professionals about infant feeding. The study took place in Eastern Scotland. Two hundred and ninety-seven women, of 23 years and over, expecting their first baby and experiencing a pregnancy free of complications, were included in this report. Six statements about perceived behaviour and the attitudes of different health professionals were scored on a Likert scale. In this sample new mothers perceived midwives as giving less support than doctors or health visitors, and they were seen as more likely to favour breastfeeding women. Additionally, women who were giving some or exclusive formula feeds were more likely at one month to perceive midwives in this way.
Symphysis pubis dysfunction: women's experiences of care
Authors: Wellock Vanda K , A Crichton Margaret 
Published: May 2014

This paper explores the interaction between health care professionals and pregnant and newly delivered women, who have symphysis pubis dysfunction (SPD). The aim of this research was to identify women's experiences of the care offered by health care professionals when they were diagnosed with SPD. Recent media coverage has suggested it is poor. A qualitative, phenomenological approach using semi-structured interviews was used so that women's experiences with health care professionals could be told. The study was carried out in a large maternity hospital in the north-west of England. Twenty-eight women were interviewed at diagnosis of condition, 36 weeks gestation and 6 weeks postpartum. Three themes and four sub-themes were identified in the study relating to women's interactions with their carers. Midwives, doctors and physiotherapists were the main carers highlighted. There were positive and negative comments in all cases. The sub-themes of pain, negative labelling, dismissive staff and feelings of dissatisfaction were expressed by most women. Women with SPD found that pain and the inability to perform the normal activities of daily living had a profound effect on them. Some women found that professionals lacked knowledge about how to manage their condition.
Exploring maternity care for asylum seekers and refugees
Authors: Briscoe Lesley , Lavender Tina 
Published: May 2014

The aim of this study was to explore and synthesize the experience of maternity care by female asylum seekers and refugees. The approach was a longitudinal exploratory multiple case study that used a series of interviews, photographs taken by the women, field notes and observational methods to contextualize data obtained during 2002 and 2003. Data was collected in the women's home and a hospital trust. Four women agreed to participate, three women were asylum seekers and one woman was a refugee. Three key themes were generated: the perception of ‘self’ understanding in practice, and the influence of social policy. The women perceived ‘self’ as a response to social interaction. At times, ‘taken for granted’ communication in practice created a barrier to understanding for the women. Social policy related to seeking asylum, dispersement, housing and health directly affecting the lives and subsequent maternity experiences of the women. The theory of symbolic interactionism and transformational educational theory was applied to the findings, highlighting that self-awareness is of paramount importance in care delivery. The strength and resilience of migrating women is acknowledged and should be used as a starting point to develop partnerships in care and to build the woman's self-esteem during their maternity experiences.
Nothing ventured, nothing gained: a journey into phenomenology (part 1)
Authors: Snow Sarah 
Published: May 2014

The application of phenomenology within midwifery research is intellectually challenging and theoretically complex, yet ultimately rewarding.In this first article of two the attempt to think phenomenologically set against the background of a Master's research methodology and study findings is explored. A discussion of the origins and unique challenges presented by phenomenology is offered. The article aims to encourage debate about the potential offered by phenomenology towards a better understanding of women's experiences.
Infant feeding in emergencies
Authors: Cook Vivienne 
Published: May 2014

This article addresses the range of issues that arise when an area is struck by disasters of natural and human origin, and considers how infant feeding practices are affected in a compromised environment. Strategies to enable mothers to continue to feed infants safely are considered, along with the role of emergency workers, health-care providers and the media in influencing how women choose to feed their infants in disaster zones. The article focuses on promoting safe infant feeding practices by highlighting the risks posed by unsanitary conditions, and the benefits of supporting, promoting and protecting breastfeeding, particularly in compromised environments.
Maternal and fetal heart rate confusion during labour
Authors: Bhogal Karnie , Reinhard Joscha 
Published: May 2014

Continuous electronic fetal heart rate monitoring is commonly used by clinicians during labour and delivery to assess fetal wellbeing. The Doppler ultrasound cardiotocograph (CTG) detects the fetal heart rate (FHR) and the uterine activity (toco) simultaneously and displays it in the form of graph. There have been reports of the FHR being substituted by the maternal heart rate (MHR) with this method of monitoring. FHR/MHR confusion left undetected can lead to adverse outcomes. This article gives an overview of the pattern of the MHR during labour in continuous maternal and fetal heart rate monitoring using an abdominal maternal and fetal electrocardiograph monitor (abfECG) in contrast with more traditional Doppler methods. The exploration of the pattern of the MHR during labour and delivery demonstrates how an incorrect assessment of fetal wellbeing could be made if the monitor was used in isolation and the MHR was being reported rather than the FHR. This article also explores how midwives can minimize the risk of such incidents occurring.
When a baby dies: Motherhood, psychosocial care and negative affect
Authors: Nordlund Ewa , Börjesson Astrid , Cacciatore Joanne , Pappas Carissa , Randers Ingrid , Rådestad Ingela 
Published: May 2014

Background: The process of giving birth to a baby who has died is a significantly traumatic experience for the mother and her family and also for health professionals. Support, or even the perceived lack of support, from professionals often influences whether or not the parents choose to see and hold their baby. Psychosocial clinical care may also affect long-term psychiatric sequelae. The purpose of this study is to explore the lived experiences of mothers following the death of a baby and their interaction with healthcare professionals. Methods: Through a web-based survey, a content analysis of this open-ended question was conducted: ‘Do you currently feel sad, hurt, or angry for something health professionals did in connection to the birth of your baby?’ Results: Mothers reported feeling sadness when they perceived too little support from professionals, particularly related to bonding time with the baby. They reported feelings of disappointment when health professionals neither acknowledged nor validated their motherhood. Mothers reported anger in response to professionals they perceived to be indifferent or callous toward their loss. They also reported that they felt hurt when health professionals lacked respect and when they felt abandoned by the personnel. Conclusions: There are crucial implications for practice; it is important for women who experience a stillbirth to have their motherhood actively acknowledged and validated and to have the humble, empathic presence of their health professionals.
Use of homeopathic Arnica among childbearing women: A survey
Authors: Carter Jenny , Aston Gillian 
Published: May 2014

Background: Anecdotal evidence suggests some childbearing women self-prescribe the homeopathic remedy Arnica, but not necessarily according to established homeopathic principles. This could, theoretically, lead to lack of benefit or adverse effects.Objectives: To explore childbearing women's use of homeopathic Arnica and need for further information.Method: A literature review was carried out prior to a cross-sectional survey of maternity service users of a large inner-city teaching hospital between December 2008 and March 2009. In addition to establishing prevalence, a judgment was made as to whether Arnica users had taken the remedy according to homeopathic principles using a novel method developed for this study.Findings: Of 373 women who agreed to participate, 228 returned questionnaires— a response rate of 61%. Of the 27 respondents (12%) who reported using Arnica, 22 (81%) were judged to have ‘possibly’ or ‘probably not’ taken it correctly. Of those using Arnica, n = 16 (59%) would have liked more information.Conclusion: Findings suggest a need for maternity services to provide information to childbearing women who self-prescribe homeopathic remedies.
Pregnant women's knowledge about the prevention of gestational diabetes mellitus: A qualitative study
Authors: Poth Megan , Carolan Mary 
Published: May 2014

Background: Rates of gestational diabetes mellitus (GDM) have been steadily increasing over the last two decades ( Ferrara, 2007 ). A diagnosis of GDM has major implications for a woman's pregnancy and care management. At the same time, a healthy lifestyle and diet may significantly reduce the risk of GDM in pregnancy. Aim: This study explores the ‘knowledge’ of at-risk pregnant women about the role of lifestyle and diet in the prevention of GDM. Setting: A large hospital that provides secondary-level medical care as well as having a large midwifery group practice in Australia. Methods: The methodology used for this study is qualitative and was informed by phenomenology. A purposive sample of six women over 30 years old participated in a conversational interview using an interview guide. Results: Transcripts were analysed thematically and four broad themes emerged from the study: knowledge of GDM; effect of GDM on mother and baby; diet and exercise as part of a healthy lifestyle; and prevention of GDM. These findings indicated a range of gaps in the women's understanding of how lifestyle and diet can reduce the risk of GDM. Gaps included misconceptions about the cause of GDM, an incomplete understanding of lifestyle risk factors, limited awareness of the effect GDM has on mother and baby, incomplete knowledge of a healthy diet, inconsistent views of recommended physical activity and frequency, and limited understanding of GDM preventative measures. Conclusion: The lack of dietary and lifestyle knowledge demonstrated in this study may suggest that women need more appropriate health information on diet and exercise during their antenatal care.
Facilitating the implementation of lifelong learning in nursing
Authors: Gopee Neil 
Published: May 2014

Lifelong learning in nursing comprises an essential conceptual shift from the notion of the registered nurse (RN) being merely a competent health service incumbent to one who engages in professional learning continuously throughout their career in order to keep their knowledge and skills up to date. Since the 1990s, lifelong learning has appeared as a rhetoric within nursing literature in the UK, with a seemingly general assumption that there is a shared understanding and acceptance of the concept among all nurses. A literature review on lifelong learning shows that the concept comprises a number of components. However, because the literature does not seem to address the application of the concept to nursing, a study that aimed to ascertain RNs' perceptions of lifelong learning, and their views on the mechanisms that would enable effective implementation of the concept, was conducted. This qualitative study entailed individual interviews with 26 RNs and two focus groups with another 12 RNs. The findings suggest that there are positive perceptions as well as certain reservations about lifelong learning among RNs, and that structural mechanisms could be more firmly and equitably anchored. Additionally, profession-based and informal personal networks tend to play a key role in encouraging and supporting learning. The results of the study are configured into a conceptual framework for the implementation of lifelong learning in nursing and possibly in other health professions.
Evaluation of innovations in nursing practice: report and discussion
Authors: Patrick Hannah , Roberts Natasha , Hutt Ruth , Hewitt Pauline , Connelly Jim , Oliver David 
Published: May 2014

Aim: To assess whether a pilot study conducted in the UK achieved its objective to reduce admissions to hospital and bed days in patients identified as suitable recipients of case management by community matrons. Background: The Department of Health has advocated the use of nurse-led case management to improve the coordination of care and prevent inappropriate hospital admissions. Method: 66 patients and another 66 controls were identified for the ‘Evercare’ caseload according to criteria set by United Healthcare. Admissions data for the 6months after entry into the study were collected from the hospital information system. Findings: Admission rates in both the control and intervention group decreased over time and there was no significant difference in rates between the two groups at 6months. There was no demonstrable effect on length of stay either. Users were satisfied with the service and nurses cited several clinical stories implying benefits for individual patients.
Use and complications of peripheral vascular catheters: a prospective study
Authors: Zafar Abbas Syed , Shaw Steve , Qamar Abbas Syed 
Published: May 2014

Peripheral vascular catheters (PVCs) are important medical devices but their insertion and usage are associated with discomfort and potential complications such as thrombophlebitis. This article looks into the various aspects of the practice of using PVCs, especially their complications and ways of avoiding them. Aims: To determine the complications (and their associated factors) related to PVCs. Design: Prospective Setting: District General Hospital Patients: A study was undertaken of 86 of the 106 patients consecutively admitted as an emergency over a period of 2 weeks who had a PVC inserted. Methodsand interventions: The admitting doctors inserted the PVCs at their discretion. PVC sites were inspected daily. Analysis and results: Of the 86 PVCs inserted, 42 were never used, while 43 were of large gauge and 29 were left in situ for over 72 hours. Eight patients developed thrombophlebitis, of which four had a large gauge PVC, two were never used and two were left in situ for over 72 hours (P=0.016). Conclusions: Incidence of thrombophlebitis may be reduced by re-siting or removing PVCs within 72 hours. PVC gauge and whether it was used, were not associated with this complication.
Pulse oximetry knowledge and its effects on clinical practice
Authors: Paul Thomas 
Published: May 2014

Aim: to explore literature pertaining to registered nurses’ and/or doctors’ knowledge in relation to the pulse oximetry in clinical practice. Background: pulse oximeters provide non-invasive readings of both pulse rate and peripheral oxygen saturation, leading to quick identification of potential/actual problems. Because of this, clinicians, like nurses, may become too dependent on it, neglecting other aspects of the holistic assessment process. Methods: a literature search was carried out between 1980 and 2006, with much of the data skewed towards 1994–2006. As the central focus was to be on pulse oximetry knowledge of nurses and/or doctors, articles included had to contain a central theme addressing this. Other criteria for inclusion were links between pulse oximetry and knowledge in clinical practice, nurses and/or doctors as participants in studies addressing this, as well as the clinical competency in relation to the device. Conclusion: improving knowledge may not necessarily be the answer in improving clinical competency. Future research will need to be carried out to measure the connection between knowledge and competency and to use that as a basis for education and training.