bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of midwives’ communication skills
Authors: Alimoradi Zainab , Taghizadeh Ziba , Rezaypour Afsar , Mehran Abbas 
Published: May 2014

Background: Communication is the core clinical skill in primary health care. Diagnostics, treatment, and prevention always take place within a context of communication. Midwives are often the primary maternal-child health providers, and the way in which they communicate with patients can have a significant effect on health outcomes. The aim of this study was to evaluate midwives’ communication skills in relation to their demographic characteristics. Methods: Fifty midwives working in clinics in Tehran, Iran participated in a correlational survey. Data collection methods included an observer checklist used to rate the frequency of midwives’ communication skills application during midwife–client encounters and a questionnaire-guided interview to obtain demographic information. Results: The midwives’ communication skills (verbal and nonverbal) were undesirable. There was no relation between midwives’ age, work experience, educational status, economic satisfaction, or number of clients and their use of communication skills. However, there was a relationship between marital status and nonverbal communication skills used (P<0.07). Single participants had better nonverbal communication skills than married midwives. Conclusions: Midwives’ communication skills may be undesirable and not improved by work experience. Thus, interim training programmes administered by experienced personnel using effective educational methods are recommended for practicing midwives. Furthermore, it would be of value to add communication skills training to the midwifery curriculum.
Cardiac rehabilitation for patients with heart failure: A service development audit
Authors: Chester Tim 
Published: May 2014

Background: Chronic heart failure (CHF) is a growing public health problem. Interventions such as drug treatments education and specialist nurse involvement have all improved outcomes. Evidence suggests tailored exercise programmes reduce hospitalization levels and improve mortality. National and international guidelines recommend that exercise programmes form part of an overall care package for patients with CHF. However, conventional cardiac rehabilitation services have been reluctant to prescribe exercise for this group of patients. Objectives: The aims were to investigate whether tailored classes for patients with CHF can be provided safely and without excessive costs and whether they can improve quality of life. Methods: Patients attending the nurse-led heart failure clinic were assessed for their suitability for cardiac rehabilitation. Those considered suitable were invited to attend an exercise-based cardiac rehabilitation programme lasting between 14 and 16 weeks. Twelve patients took part and they were divided into two groups. Baseline physiological and psychological assessments were undertaken at the beginning of the programme and these were reasessed at the end using the Borg and the Hospital Anxiety and Depression Scales. Results: Both groups showed improvements in exercise performance. As a result their ability to perform routine daily tasks was improved. In addition, some of the patients showed reduced levels of anxiety, 82% of patients felt that the programme helped them deal with their problems and some patients reported increased confidence levels. Conclusions: Cardiac rehabilitation can be provided safely for patients with CHF. The classes produced improved physical and psychological wellbeing for the patients. More research is needed into the benefits of cardiac rehabilitation for patients with heart failure.
Glycaemic control in critically ill patients: Where are we now?
Authors: Naughton Corina 
Published: May 2014

In many intensive care and coronary care units glyceamic control is part of the standard management of critically ill patients, regardless of whether or not they have diabetes. This change in clinical practice is based on an increased understanding of the metabolic changes associated with critical illness and large numbers of observational and interventional studies. Interventional studies have demonstrated that controlling blood glucose can reduce mortality and morbidity in patients with a variety of critical illnesses. However, not all patients have demonstrated a survival benefit and more research is required to identify these subgroups. Instigating a glycemic control regimen requires inter-disciplinary co-operation, education and additional resources but these can be offset by a reduction in hospital cost. The ultimate success and safety of such a regimen relies on developing a positive attitude among nursing staff in particular, and encouraging both a practical and theoretical understanding of how glycaemic control works.
Tenecteplase: A fibrinolytic agent
Authors: Potts Katherine 
Published: May 2014

Thrombolysis is an established therapy for acute myocardial infarction in the UK. ST-elevation myocardial infarction almost always occurs owing to coronary atherosclerosis and coronary thrombosis which develops because of plaque disruption. Fibrinolytic agents act to dissolve the clot. Tenecteplase is a fibrinolytic agent that is given over ten seconds using the intravenous route. It is a fibrin-specific agent that has a prolonged plasma half-life and a high resistance to plasminogenactivator inhibitor type 1. These features mean that there is a potential decrease in the amount of time from the decision to thrombolyse and administration. In addition, because of the fibrin specificity and its resistance to plasminogen-activator inhibitor type 1, tenecteplase is more likely to restore a patent coronary artery.
The role of ezetimibe in cholesterol management
Authors: Pottle Alison 
Published: May 2014

Raised cholesterol is a recognized risk factor for cardiovascular disease (CVD). If lifestyle changes do not result in cholesterol levels reaching the desired targets, then pharmacological agents may be required. Statins are the first-line treatment, but sometimes other classes of lipid-lowering drugs are required. Ezetimibe is a novel agent, which acts by inhibiting the intestinal absorption of cholesterol. Nurses caring for patients with CVD or at risk of developing CVD need to be aware of all the agents which may be used to control cholesterol levels. This article will outline the process of cholesterol metabolism and examine the role of ezetimibe in the reduction of cholesterol levels. It will also discuss side effects and contraindications to this therapy so that nurses are able to safely care for patients taking ezetimibe.
Nurses’ perception of their learning needs to deliver CVD prevention programmes
Authors: Kennedy Susan 
Published: May 2014

Aims: To determine nurses’ perception of the knowledge and skills needed to deliver cardiovascular disease (CVD) prevention programmes and to describe their continuing professional development (CPD) needs. Design: Two cross-sectional descriptive surveys using two postal questionnaires were conducted with first, past students (n=83) of the ‘Managing Cardiovascular Risk Factors’ course and second, practice nurses (PN) (n=690), taken from a purposeful sample of Scottish health boards. Results: Past students rated knowledge and skills possibly needed to deliver CVD care. Those categorized as ‘advanced clinical’ were rated significantly higher than ‘management’ or ‘nurse development’ (P<0.001). Past students considered their future learning needs required more advanced-level courses (P=0.006, 95% CI 0.21, 0.45). PNs (9%) seeking a Masters-level course were more likely to perceive they had a high input into patient management (P<0.001) or have completed courses on CVD (P<0.001). PNs (19%) not attending any CVD CPD indicated this was due to lack of opportunity (P<0.001). Conclusions: Nurses perceiving they had a high input into CVD care or who had completed courses on CVD were more likely to seek further higher-level education. This has implications for CVD CPD delivery.
Nurse practitioners in cardiothoracic care: Practitioners’ perspectives
Authors: Swainston Katherine 
Published: May 2014

Background: Redesigning the cardiothoracic workforce at one teaching hospital to meet government targets and changing patient needs has led to the introduction of several new healthcare roles including that of nurse practitioner. Methodology: Nurse practitioners at one tertiary care centre were interviewed using a semi-structured process. The interviews were used to gain insight into the nurses’ roles. Findings: This article reports the results of a qualitative evaluation into nurse practitioners’ perspectives on this new way of working. Thematic analysis of semi-structured interviews with eight nurse practitioners revealed five themes: professional development; making a difference; support; frustration of working in an evolving role; and uncertainty. Implications: The findingsindicate that the nurse practitioner role can provide a rewarding career in which nurses can develop in a clinically oriented profession. Conclusions: Contact with patients throughout their continuum of care can enhance job satisfaction and is likely to produce long-term benefits for cardiothoracic patients. As the boundaries of medicine and nursing, and the associated professional identities become less defined, the need for continual evaluation that does not neglect practitioner perspectives is apparent.
Cognitive dissonance theory applied to CPR, DNAR, and the practice of slow codes
Authors: de Vriesis Jan MA 
Published: May 2014

Cognitive dissonance theory holds that inconsistencies in our thinking or between beliefs and actions generate mental discomfort. This motivates efforts to reduce the inconsistencies by adapting behaviours or thoughts to make them more consistent with one another. This article demonstrates how the theory can be applied as a framework to understand internal conflicts which health professionals may experience when they encounter inconsistencies between their principles and practice, in the implementation of cardiopulmonary resuscitation and ‘do-not-attempt-resuscitation’ orders. The author suggests that the discomfort generated by these conflicts has been a motivating factor in the emergence of so called ‘slow codes’ (cardiopulmonary resuscitation efforts intentionally conducted too slowly or not long enough to be successful). Interventions are suggested that may help prevent the occurrence of slow codes.
An audit of specialist nurse pharmacological intervention in chronic heart failure
Authors: Burke Katie , Penston Helen , Riley Jillian 
Published: May 2014

Aim: Chronic heart failure (CHF) is a complex clinical syndrome associated with recurrent hospitalizations and high mortality. Evidence suggests that many patients are not receiving effective pharmacotherapy. The aim of this retrospective audit was to formally describe and evaluate the pharmacotherapy of an established heart failure nurse led clinic in North West London. Methods: A retrospective audit was undertaken in January 2007 on all patients diagnosed with CHF attending the out-patient nursing clinic between October and December 2006. Descriptive statistics were used to summarise patient data. Results: 77 patient letters were audited. Mean age 73 years (SD ± 13), with 32 patients (42%) female and 14 (18%) South Asian. ACE inhibitors were prescribed in 60 (78%) patients, with beta blockers and loop diuretics prescribed in 47 (61%) and 71 (92%) respectively. No statistically significant difference was found in prescription rates between male and female patients. A statistical significant difference (P=0.043) was observed in the age of patients prescribed aldosterone antagonists. Conclusions: Demographic data is consistent with survey evidence from the EuroHeart failure surveys (EHFS) and ADHERE registries and is appropriate to the local population. Pharmacological prescription rates are comparable with national and international survey standards and adhere to the European Society of Cardiology (ESC) guidelines.
What are the experiences of patients waking from fast-track
Authors: Perkins Claire 
Published: May 2014

Nationally, the majority of cardiac surgery centres practise some type of rapid recovery or fast-track (FT) system in which low-risk cardiac surgical patients are extubated quickly following surgery to relieve the pressure on scarce critical care resources and improve patient outcome. In order to facilitate early extubation, FT patients often receive less sedative and analgesic medication than their conventionally-recovered counterparts while in the intensive care environment. Research was undertaken into the initial waking experiences of these patients as the intensive care unit (ICU) is well recognized to be a stressful place. This phenomenological study highlights that nurses play a vital role during the immediate post-operative period that goes beyond the more widely-recognized technical aspects of their role. The results of this study could be used by nurses to enhance patient experiences and potentially lead to improved physical and psychological outcomes for FT cardiac surgical patients in the future.
Erectile dysfunction and CHD: Related risk factors and implications for nursing practice
Authors: O’Sullivan Brid , Savage Eileen 
Published: May 2014

Erectile dysfunction needs further attention in nursing. The purpose of this article is to raise nurses’ awareness about the link between erectile dysfunction (ED) and coronary heart disease (CHD). This paper considers ED as a risk factor for CHD, discusses the pathophysiology and prevalence of ED and reviews the shared risk factors for ED and CHD. Knowing that ED can occur before the onset of CHD may further encourage nurses to ask questions about sexual function. Understanding the link between ED and CHD may equip nurses in primary and secondary care settings to educate and empower patients to initiate lifestyle changes to improve both their sexual health and general wellbeing. This may potentially delay the onset or reduce the risk of other acute and chronic vascular conditions in their patients.
Clinical usefulness of B-type natriuretic peptide in cardiac rehabilitation and heart failure
Authors: Leslie Rosalind 
Published: May 2014

Biomarker assays for B-type natriuretic peptide (BNP) and its precursor N-terminal pro-BNP(NT-proBNP) are recommended in heart failure clinical practice. Cowie et al (2010) have recently reported that there is firm evidence for natriuretic peptide (NP) testing as part of the heart failure diagnostic pathway and as a prognostic tool, and the recent 2010 update to the National Institute for Health and Clinical Excellence guidelines on heart failure refers to the use of NP testing to aid diagnosis and identify patients requiring further treatment. In addition, there is growing evidence for use in monitoring treatment. This article summarizes the existing well-reported evidence for the diagnostic, prognostic and therapeutic uses of BNP. In addition, it discusses possible applications in a cardiac rehabilitation setting.
A multi-professional approach to managing anaemia in heart failure
Authors: Whittingham Katharine , Dring Belinda , Quinn Miriam 
Published: May 2014

The presence of anaemia in heart failure is a widely-recognized phenomenon. Anaemia is an independent predictor of mortality risk and is linked to a large increase in mortality. Evidence shows prevalence is higher in patients with severe, symptomatic heart failure. A systematic review and meta-analysis of interventions to treat anaemia in heart failure indicates that management with erythropoiesis–stimulating agents (erythropoetins) led to improvement in symptoms, lower classification in New York Heart Association (NYHA) scale; approximately 90% reduction in hospital admissions and an increased exercise tolerance. This paper will use a case study to illustrate how a multi-professional approach was used to manage and monitor a heart failure patient with anaemia. The role and interventions provided by the heart failure nurse and renal nurse will be outlined. Reflections on the learning and recommendations for future clinical practice will be briefly discussed.
Postoperative bleeding in the cardiac surgical patient
Authors: Laidler Sandra 
Published: May 2014

As cardiac nurses we need to be aware of the signs, symptoms and potential outcomes of excessive bleeding and learn to recognise, prevent and treat it promptly to maintain quality care for our patients. The cardiac nurse requires specialist skills and knowledge in managing surgical patients both pre and postoperatively. This article follows the patient journey and highlights the role and responsibilities of the cardiothoracic intensive care nurse and the cardiac ward nurse in assessing, preventing and managing bleeding following cardiac surgery. It covers preoperative assessment, risk factors for bleeding, tests and assessment at different levels of care.
Public health doctors and general practitioners: Poles apart?
Authors: Dilloway Mark 
Published: May 2014

On 1 April 1996, the new health authorities will be created. This organisational change will be accompanied by a wider remit for public health doctors than the traditional definition of public health. The future public health roles and responsibilities will include ensuring that public health considerations drive the authority's purchasing and commissioning activities, the monitoring of health outcomes of interventions, and improving the effectiveness and value for money of clinical and non-clinical interventions. Public health doctors, in particular Directors of Public Health, will have a strong influential role in the corporate management team. As a result there is a possibility that general practitioners may feel threatened by what they see as a “top down” approach to the provision of health care, erosion of their clinical freedom and the doctor-patient relationship. Although their perspectives may differ, there is considerable common gorund between public health doctors and general practitioners. Collaboration in the undergraduate curriculum and representation in the annual public health reports are just two ways in which liaison may be encouraged. Developing and sustaining an effective relationship will depend on both parties. General practitioners need to overcome their mistrust of the corporate role of public health doctors, while the latter could meet this criticism by showing an independent spirit through their annual reports and support for equity.
Community hospital nurses: raising the profile
Authors: Antrobus Mollie 
Published: May 2014

Community hospitals, and the staff who work in them, tend to wax and wane in political attention and interest. Mr Dorrell, in his millennium speech, currently has them high on his agenda, as he recognises the value of an interim provision between hi-tech hospital facilities and primary and community health care services. Those who live in the locality and receive the benefits of local health care provision will always value community hospitals and their staff. Local support is one feature of their survival – especially from a financial perspective. Community hospitals may: ●Be a part of a community trust, as in Devon. ●Be a part of an integrated acute and community trust, as in Salisbury. ●Form an individual trust, as in Andover and Teddington.
Psychiatric patient violence: assessment and management of risk
Authors: Keirle Peter 
Published: May 2014

The relationship between violent behaviour and mental illness is both complex and contentious. In recent years, public attention has focused on what may be considered tragic failures of care in the community. Partly in response to subsequent enquiries, new government guidance and legislation have emerged which seek to reinforce the role of the mental health practitioner in assessing and managing the risk of psychiatric patient violence. This paper describes the development of a risk assessment framework in relation to psychiatric patient violence. The framework focuses on the evaluation of past behaviour as a key element of risk assessment, and offers guidance on appropriate areas of enquiry. The central aim of assessment is to identify in what circumstances the risk of violence may be increased, and to plan care accordingly. This approach reflects an emphasis on the situational factors that may surround violent behaviour and in doing so, moves away from viewing risk assessment as a one-off decision that can somehow distinguish the safe from the dangerous.
Health visitors' ideologies regarding health promotion for men
Authors: Williams Robert 
Published: May 2014

‘Is there scope within health visiting practice for health promotion with men?’ This research question and the specific objectives employed to develop the project were pursued using a qualitative and descriptive methodology. Fieldwork with participant managers and health visitors, within a community NHS trust, was undertaken in December 1995 and January 1996. Findings suggest that although a range of diverse perspectives is present, there are nevertheless dominant individual and organisational ideologies that encourage marginalization of men’s health. There are certainly ideas, experiences, and practices reported by participants within the project which identify work with men taking place, and also indicate potential for service development. However, to address health promotion with men within health visiting effectively, recommendations for individual and organisational change are produced and outlined.
Practical stoma care: a community approach
Authors: Black Patricia K 
Published: May 2014

Successful rehabilitation of the stoma patient in the community depends on several factors: understanding the type of stoma constructed and whether it is temporary or permanent; understanding which type of appliance is the correct one to use; having a knowledge of alternative appliances if the original is found to be difficult to use or causing skin problems; and trouble shooting for the common problems sometimes seen after stoma surgery. Obviously, a new stoma patient with no previous experience of a stoma or appliances will rely totally on the stoma care specialist or the community nurse. In many areas of the UK new stoma patients are often referred to the community nurse for follow up after hospital discharge, However, community nurses may easily come across ‘lost ostomists’ and need to give help and advice on problems or new appliances. Once a stoma patient is discharged from hospital, community nurses have a valuable role to play in the patient’s rehabilitation and return to a normal and productive life.
Urinary catheterization: selection and clinical management
Authors: Pomfret Ian 
Published: May 2014

Urinary catheterization is a common medico-nursing procedure in both acute and primary care. There is a variety of catheters and associated equipment available on prescription in the UK, how do nurses and other healthcare staff ensure that patients are able to access the most appropriate products for their individual needs? This article will look at the common reasons for catheterization and the rationale for the selection procedures in selecting the optimum method of catheterization, equipment selection and management options to ensure best practice for patient care. Different methods of catheterization, intermittent and indwelling, both urethral and suprapubic, will be considered in regard to preventing infection and providing optimum catheter management.
Proposals for legal reform in the coronial process 3
Authors: Griffith Richard , Tengnah Cassam 
Published: May 2014

In the final article reviewing the role and function of the coronial service Richard Griffith and Cassam Tengnah consider the proposals for reforming the system to take account of the recommendations of the Shipman Inquiry and the Bristol Royal Infirmary Inquiry. The Government’s proposals are in the form of a Draft Bill that allows district nurses to consider the impact of the reforms on their practice and provides an opportunity to contribute to the debate on reform before it is presented to parliament.