bluuebunny/crossref_metadata_2025_split huggingface dataset:
How personal health budgets may affect community nursing teams
Authors: Hewitt-Taylor Jaqui 
Published: May 2014

In social care, there has for some time been the option for individuals to use direct payments to manage their own support, and more recently individual budgets have been piloted. While this approach has not been available for healthcare payments, there is the potential for this to change. This paper outlines the implementation of direct payments and personal budgets and then discusses some of the issues which should be considered if such arrangements are introduced in healthcare. These include: preparing existing staff for such changes in funding and the implications for them; clarifying the new roles and responsibilities of community nursing teams, training opportunities for staff who are employed directly by individuals; staff recruitment and retention, and designing evaluation mechanisms which assess quality as well as cost.
Consent to organ donation part 1: the current arrangements
Authors: Griffith Richard , Tengnah Cassam 
Published: May 2014

The debate over how best to seek consent from people for the donation of their organs after death continues unabated. Despite a significant change in approach in seeking consent for donation introduced by the Human Tissue Act 2004 there has been little improvement in the numbers of harvested organs. This has led to calls by various organizations to adopt a more radical approach to consent for organ donation. The Welsh Assembly Government favours a presumed consent approach where a person is assumed to have consented unless they formally opt out, while more recently the Royal College of Physicians has changed its stance and is now calling for a system of mandated choice where a person is compelled to decide if they want to donate their organs. District nurses see first hand the need for an increase in the number of donated organs as they provide the care for those waiting for a transplant and so it is essential that they inform this debate. In the first of a short series of articles the current arrangements for consenting to the donation of organs are considered.
Stroke survivors with aphasia: personal experiences of coming home
Authors: Pringle Jan , Hendry Charles , McLafferty Ella , Drummond John 
Published: May 2014

Although communication difficulties affect a significant number of stroke survivors, specialist stroke follow-up in the community may not always be available. It is therefore vital that community nurses have the skills and confidence not only to engage well with stroke patients with communication difficulties in their daily work, but also to encourage their inclusion in research and other projects. This article reports on the experiences of a small sample of stroke survivors and their carers during the first month at home following discharge from hospital. Their journey involved discovering and adapting to new situations and abilities. The article also details how participants with virtually no speech can be included in research studies.
Professional identity and the culture of community nursing
Authors: Drew Dee 
Published: May 2014

Using an ethnographic approach, data collection was carried out using participant observation and semi-structured interviews. Two teams of nurses from one primary care trust in the West Midlands participated in this study. Data were analysed using James Spradley's (1979) thematic cultural analysis. Findings include: sharing information and planning ahead, helping across teams and busyness and how other professions view community nursing. Issues of community nurses invisibility and the articulation of expertise are presented. Conclusion: Although many studies have been carried out exploring the handover, there is a dearth of work focusing upon community nursing. In the current social and financial climate it is essential to make the case for continuity of care to be safeguarded. Additionally, the importance of protecting reporting time for community nurses is suggested. The reporting time serves to enhance group identity, reduce anxieties and relieve isolation. Finally, report time crucially encourages the articulation of expertise between community nurses at a time when they are feeling professionally devalued.
An investigation of food provision and consumption in a care home setting
Authors: Cunneen Sinead , Jones Jacklyn , Davidson Isobel , Bannerman Elaine 
Published: May 2014

Background: Malnutrition and dehydration are life-threatening conditions affecting a large proportion of the elderly community in care homes. Despite the provision of guidelines aimed at ensuring the nutritional requirements of individuals are met, the prevalence of malnutrition remains particularly high in institutionalized older adults. This article describes a study carried out in one Scottish care home to assess food and fluid provision and consumption among care home residents and also identify the contribution different eating occasions make to food intakes. Participants: Participants for the study were recruited from a private long-term care home facility in the Edinburgh locality. Individuals receiving palliative treatment were excluded from this study. Participants needed to reside full time at the nursing home for inclusion to the study. Study Design: Cross-sectional observational study (case study) to determine food provision and also food consumption of care home residents. Dietary intake of each participant was recorded and analyzed for a 24 hour period using plate-wastage methodology. All foods and fluids throughout the day were weighed using calibrated scales (1.0 g) both before foods were served to residents and any leftovers were weighed following consumption. Foods were recorded as per each eating occasion, namely breakfast, lunch, evening meal and also any snacks or drinks. Estimated energy, fluid and macronutrient content of the food provided and consumed was estimated using Windiets dietary analysis software ( 2005 ) and then compared to FSA Guidelines ( FSA 2007 ) using one sample t-tests (P < 0.05 indicated statistical significance). Results: Food provision and consumption for a total of 25 residents was measured (n = 3 males: n = 22 females); mean (SD) age 86(8) years. There was no significant difference between energy provided (mean ±SEM) 2001 ± 59 kcal compared with recommended provision 1955 kcal (FSA, 2007). However, significantly less energy than recommended (mean ± SEM) (1634±72 kcal) was consumed (P < 0.01). More than 95% of snacks provided were consumed, as a result these contributed an equivalent proportion to overall energy intake as breakfast and lunch, but these were not rich in protein. Conclusion: Provision of food and fluids within the care home meets FSA guidance, but residents tended to consume significantly less than what was provided thus nutritional deficiencies may exist. Further investigation into snack provision is warranted.
Clinical challenges and ongoing role changes for primary health-care nurses
Authors: Boström Eva , Hörnsten Åsa , Persson Chatrin , Rising Inger , Fischer Regina Santamäki 
Published: May 2014

Objective: To investigate the perceptions of primary health-care nurses (PHNs) about clinical demands and future challenges. Method: Qualitative content-analysis of open questions from a questionnaire. A total of 121 PHNs from health-care districts in northern Sweden filled in a questionnaire during a mandatory educational day. Results: Key issues that were raised included: defending the specific professional role of the PHNs; strengthening their self-governance and authority; and ensuring adequate care in the future through education that focuses more on nursing practice than on academic work. Conclusion: To ensure that the role of the PHN continues to develop, it is necessary to enable them to articulate, discuss, and evaluate their profession and to learn, in concrete forms, how to implement science in clinical practice.
Medicines law overhaul with
Authors: Griffith Richard 
Published: May 2014

The Human Medicines Regulations 2012 are a major consolidation of medicines law. They largely replace the Medicines Act 1968 and some 200 further pieces of secondary legislation, including the Prescription Only Medicines (Human Use) Order 1997 that defined and set out the authority of non-medical prescribers. Although the 2012 regulations mainly consolidate medicines law into one piece of secondary legislation it does introduce some policy changes that will influence district nurse practice by allowing non-medical prescribers to issue patient-specific directions in primary care settings and allowing community pharmacists to make changes to a prescription without the need to contact the prescriber beforehand.
The psychosocial impact on patients with altered body image from burns
Authors: McRobert John 
Published: May 2014

Advances in plastic surgery techniques using autologous skin grafts and bioengineered skin substitutes, combined with a greater understanding of fluid management and intensive care treatment, have increased the chances of survival in patients with major burn injuries. Today, patients are being discharged home from hospital after sustaining burn injuries that 20 years ago would have been considered unsurvivable. This has in turn increased the number of patients who have to cope and adjust to life with larger wounds and disfiguring scars. The body image care model ( Price, 1990 ) comprises three related key components: body reality, body ideal and body presentation. Our body reality only rarely meets our body ideal, and thus body presentation is used in an attempt to balance the ideal and reality. The fear avoidance model ( Newell, 1999 ) attempts to distinguish between patients who adapt to disfigurement and reintegrate into society and those who do not. This article questions if both models consider body image as a dynamic, continually changing concept, and if these care models give community nurses a strong basis to provide holistic, patient-centred care. The author also explores whether nurses using psychosocial models alongside biomedical models can successfully provide effective psychological assessment and care for patients with large wounds and disfiguring scars.
Negative pressure wound therapy: a study on patient perspectives
Authors: Bolas Niamh , Holloway Samantha 
Published: May 2014

Aim: to explore patients' lived experience of using negative pressure wound therapy (NPWT). Method: A phenomenological approach based on Heideggerian philosophy was undertaken. The study population consisted of 6 participants who had used NPWT for a minimum of 4 weeks. Semi-structured interviews were transcribed verbatim and investigated for themes using interpretative phenomenological analysis. Results: Three superordinate themes were identified: altered sense of self, new culture of technology and leading a restricted life. Themes associated with an altered sense of self and leading a restricted life were in keeping with other wound care studies. Identification of barriers such as managing technical difficulties, practicalities of daily living, and improved understandingof NPWT for both patient and practitioner, can foster hope and reduce anxiety. Conclusions: Recommendations include holistic assessment of patient suitability for NPWT, education for patients and health professionals on NPWT, use of lighter, quieter devices, and the inclusion of a technology domain in future health-related quality of life studies on NPWT.
Work-based learning: a different approach
Authors: Neville Lilian , Owens Denise , Rutherford June , Rosen Lyn 
Published: May 2014

This article outlines a range of work-based learning opportunities which are suitable for healthcare assistants, healthcare support workers and assistant practitioners. Innovation and imagination, plus a sound evidence base, are the foundations for work-based learning opportunities based in the School of Nursing at the University of Salford. Student choice and flexibility combined with a rigorous learning experience are the guiding principles. The process of learning focuses on ‘real life’ work-related issues that make a difference to clients and service provision. This is achieved through partnership and negotiation between the student, their employer and the university and acts as the medium for the valuing and changing of practice. As one student on the course suggested ‘it's good to able to concentrate on what I'm actually doing... I can make what I am doing meaningful within my work’ (student comment, module evaluation, 2006).
Regulation: why it should be introduced
Authors: Hopkins Susan 
Published: May 2014

The importance of the role of healthcare support worker (HCSW) is now being recognized in terms of workforce planning. However, as roles emerge and responsibility increases, patient safety and care is paramount and must not be compromised. Regulation would bring with it standards for HCSWs, protection for patients and staff, and some value to this vital role for the future of healthcare in the UK. It is important to keep up to date with this issue as it will move on quickly in the near future. The next issue of the Journal will include an article on the argument against regulation.
Ankylosing spondylitis: living with the condition
Authors: Swann Julie 
Published: May 2014

Ankylosing spondylitis (AS) can cause pain, fatigue and limitation of joint mobility, particularly within the spinal column. These symptoms can affect a person's ability to cope with many activities of daily life. By the adoption of alternative techniques, many tasks can be made easier to manage. However, sometimes it may be necessary to consider the provision of assistive devices and adaptation of property or the alteration of a work environment. This article explores the impact of AS on a person's daily life and outlines ways to help to make activities easier to manage. It suggests ways that healthcare assistants and assistant practitioners can facilitate this process.
Should I be an advocate? A good question for HCAs
Authors: Megson Denise Yuen 
Published: May 2014

The paper will define advocacy and discuss the various types and settings where the various types may be used or in evidence. It intends to explore the importance of the knowledge and practice of advocacy for HCAs in current health and social care environments. A format by which HCAs could prepare for and be assessed on their knowledge and skills of advocacy is suggested, based on the National Minimum Training Standards and Code of Practice for HCAs released by Skills for Health and Skills for Care earlier this year. The national minimum standards for training specified 10 areas for HCAs. Apart from the roles, it targets areas of effective communication, equality, diversity and inclusion, duty of care, safeguarding, person-centred care which are core elements for the practice of advocacy.
HCAs and patient observations: evaluation of OSCE approach
Authors: Hensler Edda 
Published: May 2014

This article describes the use of a simulated assessment method to assess the competence of HCAs in taking routine patient observations. In the context of the expanding role of healthcare support workers and discussions about training requirements, it outlines the related national and local standards in this area. The preparation and process of the Objective Structured Clinical Examination (OSCE) is then described, followed by an interpretation of the results. Perceived challenges in using this assessment tool are outlined, as well as opportunities for HCAs and their managers.
Early years support worker education: impact on practice
Authors: Beirne Pauline 
Published: May 2014

This article describes the development of education and a capability framework for support workers working with children in a variety of early years settings across health and social care. The education was developed through collaboration between education providers, Scottish Social Services Council (SSSC) and NHS Education for Scotland (NES), with the intention of creating a skilled and mobile workforce capable of working across organisational boundaries to support improved outcomes. The education content, the learner experience and the external evaluation of the education are described. The learning from the delivery of the education and the future direction of support worker education in Scotland are also discussed
NICE e-learning tool to detect acute kidney injury
Authors: Mavahalli Pranam 
Published: May 2014

Acute kidney injury (AKI) is a common and serious condition that can be easily prevented. Early detection of AKI is important in order to prevent potentially fatal complications from occurring, and healthcare assistants can play a vital role with this. In order to improve awareness of AKI, the National Institute for Health and Care Excellence (NICE) has developed an e-learning tool together with the Centre for Pharmacy Postgraduate Education. This article discusses AKI, and how the e-learning tool can help healthcare assistants improve the care of patients with the condition.
The health improvement role for primary care
Authors: Abbot Stephen , Gillam Steve 
Published: May 2014

Primary Care Groups and Trusts (PCG/Ts) are required to improve the health of their populations. How are they going about this? This survey of 72 PCGs found that most are embracing national priorities, assessing local health needs, and contributing to Health Improvement Programmes (HImPs). Although their focus is still on health care rather than on health, most are establishing partnerships with other agencies with a role in improving health.
The mark on staff: the impact of stigma associated with mental health on the recruitment, retention and status of professionals
Authors: Gale Elizabeth 
Published: May 2014

Recruitment and retention within the mental health sector has provided a challenge to managers tasked with delivering effective mental health services and supporting the National Service Framework for Mental Health. The mental health promotion charity ‘mentality’ was commissioned by the Department of Health to consider why these problems were exacerbated within the mental health system.
A concept analysis of self-management in long-term conditions
Authors: Embrey Nikki 
Published: May 2014

Self-management is a complex, ill-defined concept often promoted in the clinical management of chronic disease. Ambiguity about the meaning of self-management can cause confusion and misunderstanding among health professionals about its purpose and application.Aim and method: The aim of this article is to help define and clarify what is meant by self-management through a critical appraisal of the evidence using an abridged version of Walker and Avant′s approach to concept analysis.Findings: Self-management is regarded as an intervention in health care which increases a patient′s power and responsibility for making decisions, and helps ensure that necessary health-care actions are taken.Conclusions: It is recommended that self-management be adopted more widely.
Inclusion in the mainstream: Challenges in the care of people with intellectual impairment
Authors: Clark Louise L , Barriball K Louise 
Published: May 2014

The effect of care in the community and integration into mainstream health services for people with intellectual impairment (including learning disabilities and other neurological disorders such as acquired brain injury that result in diminished cognition) has proved variable. The Department of Health's policy Valuing People: A New Strategy for Learning Disability for the 21st Century (2001) advocates continued ‘inclusion’ into mainstream services for this client group. While the development of specialist services under the Learning Disability Development Fund is planned for clients who present with complex issues such as severe behavioural problems, there are concerns that such provision is inadequate. The aim of this paper is to highlight some of the challenges associated with the drive to inclusion for many people with intellectual impairment, and the factors that limit their integration with the non-intellectually impaired community. A consideration of the conceptual foundations of the policy of inclusion will help shed light on these challenges and on ways to address them. It is important that nurses working in all fields of neuroscience are aware of some of the pitfalls and problems associated with the policy of inclusion so that they can support their patients and advise colleagues working in mainstream services on caring for this group. It is argued that the benefits of inclusion and the initiatives that have resulted from its development have not been proved and cannot be assumed.
Counselling of women with epilepsy on anti-epileptic drugs: The value of nurse-led clinics
Authors: Lewis Sheila , Smith Dave 
Published: May 2014

Objective: To improve the information received by women with epilepsy of childbearing age about gender-specific issues. Methods: The case-notes of 100 women of childbearing age (including pubertal adolescents) attending epilepsy clinics were examined before and after the introduction of a specialist nurse-led clinic. Data were collected on the documentation of counselling about contraception, pregnancy and the genetic risk of epilepsy. Results: The introduction of a nurse-led clinic for women demonstrated an increase in the amount of information given. There was a 30% increase in advice given about contraception, 89.7% of those on enzyme-inducing anti-epileptic drugs were informed of the risk of failure of the oral contraceptive pill compared to 53.2% before the intervention. Information given about the risks associated with experiencing generalized tonic-clonic seizures during pregnancy, as well as the need for compliance, increased by 40%. Conclusions: The introduction of a nurse-led clinic resulted in an increase in the amount of information given, and has also provided a better basis for evaluating that information.
The use of rasagiline in conjunction with levodopa in Parkinson's disease
Authors: Brown Joanne , Lewis Simon 
Published: May 2014

The key goals of drug treatment for idiopathic Parkinson's disease are to control symptoms, maintain function and minimize side effects. Modern therapeutic strategies aim to introduce levodopa as late as possible, thereby postponing the development of levodopa-related motor complications, as well as preventing the emergence of drug-related symptoms such as confusion and hallucinations. Levodopa-sparing strategies include the use of dopamine agonists and catechol-o-methyltransferase inhibitors. While these drugs are effective, some patients cannot tolerate them at the doses required to control their symptoms, and they lack a simple dosage regimen or titration schedule. As a result, new treatments are needed. Rasagiline is a second-generation, potent, irreversible and selective inhibitor of monoamine-oxidase type B. A 1 mg tablet is licensed in the UK for use as monotherapy in idiopathic Parkinson's disease and as adjunct therapy to levodopa in those patients with end-of-dose motor fluctuations. It offers once-a-day dosing, with no need for titration, which makes it simple to use in a condition where complicated dosing regimens are common. It has an acceptable side-effect profile and three key trials show it to be effective in, and well tolerated by, patients in early and advanced Parkinson's disease, including the elderly. Trials have also shown a high rate of compliance that should be mirrored in practice. For nurses managing Parkinson's disease patients with end-of-dose fluctuations and for newly diagnosed patients, rasagiline offers a promising new treatment option.