bluuebunny/crossref_metadata_2025_split huggingface dataset:
Training midwives in inner-city Karachi, Pakistan
Authors: Gibson Hannah 
Published: May 2014

This article recounts the author's experiences as a midwife in Pakistan where she has worked since 1998. The Lady Dufferin Hospital is situated in a slum area of Karachi, — 90% of the women come from very poor families. Most of their care is subsidised or free. Pakistan has a deplorable maternal mortality rate. Approximately 30000 women die each year from pregnancy and childbirth related causes, (UNICEF, 1997). While midwifery training exists, it appears that few midwives work outside hospitals. A shocking 80% of women deliver with untrained attendants, either relatives or Dais — untrained birth attendants (Tinker, 1998). The author's job has been to improve the standards of midwifery care, by upgrading the clinical skills of the midwives. The experience has been very positive, with most of the midwives trained now at the stage where they can practise independently.
Vulval preparation in labour: use of lotions or tap water
Authors: McCormick Carol 
Published: May 2014

Evidence-based practice is all well and good when there is sound evidence to guide the decision-making process. But how do midwives challenge current practice or introduce changes without such evidence? This article describes, in the light of little or no evidence at the time of change, Nottingham City Hospital NHS Trust Maternity Unit's experience of challenging the ritual of perineal swabbing with Savlon (chlorhexidine gluconate 0.15% and cetremide 0.15%) along with the routine use of sterile vaginal examination packs during labour and delivery. This innovation was triggered by one midwife questioning current practice, and then using local expertise to help facilitate and inform the process of changing practice.
Licensed to treat infant colic?
Authors: Jones Kath 
Published: May 2014

Infant colic is a particularly distressing condition for both infants and their parents. Many new parents are anxious and the added stress of an unhappy and crying baby compounds their anxiety. This article will discuss the physiology of colic and the use of appropriate treatments. Simethicone is a clinically proven treatment and its advantages, backed by the relevant research, will be demonstrated. In recent years there has been a tendency to confuse colic with lactose intolerance, often resulting in inappropriate advice and treatment. The difference will be addressed in this article.
Letters
Authors: Inch Sally 
Published: May 2014

Confusion surrounding breastfeeding terms ‘positioning’ and ‘attachment’ In recent years, midwifery terminology surrounding breastfeeding has become increasingly precise. At the inception of the Baby Friendly Hospital Initiative (WHO, 1989), WHO and UNICEF agreed to use consistent terms which were easy to translate and non-idiomatic in order to make teaching easier. Thus in the breastfeeding course participant's manual (WHO, 1993) a distinction is made between positioning and attachment.
Webwatch
Authors: Hassall Jenny 
Published: May 2014

The 26th Triennial Congress of the International Confederation of Midwives raised some poignant issues pertaining to the realities of pregnancy and childbirth from a global perspective. While these were passionately embraced by midwives at the time, there is a danger of forgetting them once we return to the realities of our own working lives. For this reason I have chosen to review: www.safemotherhood.org
Prenatal cleft lip and palate parent programme – phase 1
Authors: Martin Vanessa 
Published: May 2014

The first child diagnosed with a cleft prenatally in a the Nottingham Cleft Lip and Palate Unit, was aborted after another parent had given misleading information. Concern over this incident led to a protocol of care being developed at the unit followed by an evaluation of expectant parents' responses to this protocol. Ten parents were interviewed as part of a study. The aim of this research was to assess whether the information and support given to families was appropriate and helpful; explore parent's feelings about their pregnancy and their child and identify ways of further developing support for these parents. From an analysis of parents comments the study found that in cases of cleft lip and palate, what parent wanted most was: an accurate diagnosis; prompt referral to a cleft team; support from a named clinical nurse specialist; pictures relevant to their child's diagnosis to show family and friends; and a meeting with professionals to plan the care of their child.
Development of an Integrated Care Pathway for natural birth
Authors: Clarke Paula , Bowcock Malcolm , Gales Philomena 
Published: May 2014

Birmingham Women's Hospital aspired to extend the choice of childbirth options available for women to include natural birth for all who met the clinical criteria. The development of a purpose-built midwifery-led birth centre prompted the authors to review the care they provided for women anticipating a normal birth. They were confident that the physical attributes of the birth centre, namely the provision of a homely, relaxing environment would support natural birth. However, they also acknowledged that environment alone would not guarantee that physiological birth would be protected, particularly bearing in mind the location of the birth centre within a large regional unit. The development of an Integrated Care Pathway (ICP) was an opportunity the authors embraced to assist with supporting natural birth. This article will describe the adoption of the care pathway model and discuss the planning and development process as well as reporting on progress so far.
Delivery suite assessment unit: auditing innovation in maternity triage
Authors: Nolan Sheila , Morgan Jane , Pickles Jacky , Haith-Cooper Melanie , Phipps Fiona MacVane 
Published: May 2014

A Delivery Suite Assessment Unit (DSAU) has been established at a large Northern teaching hospital. This was as a recommendation of ASQUAM (achieving sustainable quality in maternity) to reduce antenatal admissions to delivery suite and provide a more appropriate environment for women attending for antenatal or labour assessment. The DSAU has also provided an effective teaching environment where skills such as effective telephone triage, diagnosis of labour and care of women with pre-labour spontaneous rupture of membranes (SROM) have been developed by junior staff. The first twelve months' audit results indicate that the establishment of the DSAU has been successful in reducing antenatal admissions to delivery suite by increasing the transfers of clients home, rather than to the antenatal wards. This may reflect the confidence of the highly skilled midwives working in this environment and the confidence women feel about their ability to obtain prompt and accurate advice over the telephone.
Exploring changes in practice: when midwives and nurses become mothers
Authors: Redwood Tracey 
Published: May 2014

The impact motherhood has on midwives and nurses should be understood by both those professionals within its own ranks and the greater UK health sector. These professions remain predominately female (89.3%) (NMC, 2007), and at some stage during their professional lives 90% become mothers, directly impacting on staffing levels and ultimately the care given to women and patients. The aim was to explore transition to motherhood for midwives and nurses, including their perceptions of its impact and implications on their professional lives. Twenty-two participants volunteered from the health professions of midwives and nurses (including health visitors) providing narratives through two sets of interviews. This article focuses on midwives' and nurses' knowledge levels and changes in professional practice resulting from their experiences of becoming a mother, childcare and treatment on return to work. Understanding these midwives' and nurses' unique perspectives may contribute to allaying the stress related to returning to work, and ensure these professionals are retained as the valuable practitioners they become as a direct result of motherhood.
Protecting the perineum: have we been duped by HOOP?
Authors: McCarthy Rosemary 
Published: May 2014

The maintenance of an intact perineum following vaginal birth is a fundamental objective of the midwife. Traditional techniques adopted to protect the perineum were evaluated by McCandlish et al's (1998) pivotal ‘HOOP’ study some ten years ago. The findings have largely been interpreted as suggesting that the custom and practice ‘hand on’ approach, adopted by many midwives, was inconsequential in preventing perineal trauma. This finding has impacted practice significantly. Management of the perineum during the second stage of labour is now varied and largely dependant on the preference of the midwife in attendance. Consequently student midwives are taught an assortment of approaches but appear to lack clear understanding of the rationale, let alone evidence, on which their practice is based. Corresponding with changes in practice, there is local audit evidence to suggest that the incidence of significant perineal trauma, involving damage to the external anal sphincter, anal sphincter complex (external and internal anal sphincter) and in the worst cases also involving the ano-rectal mucosa, is increasing. Given the considerable implications of this, perhaps it is time to re-visit HOOP and challenge the notion that traditional protective measures are of little value in preventing substantial trauma.
Nutrition for maternal and fetal wellbeing: folic acid and iron
Authors: Edwards Joanne , Thomas Grace , Wyn-Davies Janine 
Published: May 2014

Prospective parents generally aspire to give their child the best start in life and, if their babies are born healthy, this good health is more likely to continue into adulthood (Barker, 2003). There is no better way to facilitate this than being in an optimum state of health before conception and throughout pregnancy (Hunt, 2004). For many years it has been recognized that maternal environment and adequate nutrition are imperative for the development of the fetus and the wellbeing of the mother (Tiran, 2004a). Over the past decade, evidence has been accumulating showing that insufficient maternal nutrition can result in low birth weight, which increases risk of chronic non-communicable disease in later life such as coronary heart disease, hypertension and non-insulin-dependent diabetes (Godfrey and Barker, 2001; Barker, 2003). This article is part of a literature review for a BSc dissertation that seeks to appraise some general aspects of nutrition during pregnancy and, specifically, the effects that folic acid and iron can have on the mother and fetus.
Guideline for the systematic assessment of perineal trauma
Authors: Stevenson Linda 
Published: May 2014

This article discusses the prevalence of occult anal sphincter injuries (OASIS) and highlights the importance of recognition and accurate classification of perineal trauma. It is suggested that many ‘occult’ injuries may, in fact, be ‘overt’ injuries, which have been missed or wrongly classified as second degree tears. Even with recognition and immediate repair of OASIS the prevalence of distressing symptoms such as anal incontinence remains high and it is vital that practitioners are competent in the diagnosis of anal sphincter injury. Clinical assessment at the time of delivery, before and following suturing, is the optimum method to accurately diagnose OASIS. It is recommended that systematic assessment, including a rectal examination, should be carried out following all vaginal births or, at the very least, where genital trauma is identified, with referral to a more experienced clinician if required. Clarification of the preferred method for performing this examination is necessary and a guideline has been drafted to assist in the accurate diagnosis of OASIS at Nottingham University Hospitals NHS Trust (NUHS).
Integrated continence services and the female Bangladeshi population
Authors: Wells Mandy , Wagg Adrian 
Published: May 2014

Continence services should be developed to cater for the needs of the entire population, including those of ethnic minority groups. This study undertook focus groups and meetings with the local Bangladeshi community and with local GPs to assess the needs for continence care provision and to assess current understanding of the problem in this community. The aim was to identify appropriate models for provision of care. Method: Questionnaires were devised which related to access to services for bowel and bladder problems for women and GPs. Focus groups which people’s views and suggestions on improving service accessibility were ascertained. Results: A 50% return was achieved for the GP questionnaire. GPs did not routinely enquire about bladder and bowel function and did not feel that Bangladeshi women needed any different service to that in the white population. The majority of the women in the focus groups considered bladder weakness as a loss of selfcontrol, and emphasized the major impact on everyday life. There was little awareness of available services. Conclusion: Despite the cultural differences this study found that women tended to accept their bladder problem; did not consider it important enough to discuss with their doctor (who may also not take the problem seriously) and considered bladder problems as a normal part of womanhood or ageing.
Evaluation of three commonly used pressure ulcer risk assessment scales
Authors: O'Tuathail Claire , Taqi Rebecca 
Published: May 2014

Pressure ulcers are a huge concern for health professionals, cause suffering to patients and are associated with increased morbidity. Aim: This literature review provides an overview of the literature on the three most commonly used pressure ulcer risk assessment scales — the Waterlow scale, the Braden scale and the Norton scale. Method: A search was undertaken through the databases CINAHL, MEDLINE, British Nursing Index, ProQuest and Cochrane Library. Key terms included pressure ulcers, pressure sores, risk assessment, Braden scale, Norton scale and Waterlow scale. Results: While risk assessment scales are beneficial they should not be used without the aid of nurses' clinical judgment. Over-predicting pressure ulcers is a common problem when using risk assessment scales. However, ethical considerations preclude investigation into the predictive capacity of a scale. Ongoing education in the prevention and management of pressure ulcers is essential for nurses. Risk assessment scales should be adapted to suit the needs of the clinical setting in which they are used. Conclusion: The Waterlow scale is the most widely used risk assessment scale in the UK and Ireland, even though there is no evidence to suggest it is more effective than the other most commonly used scales.
Effective management of peristomal pyoderma gangrenosum
Authors: Hanley Judy 
Published: May 2014

Peristomal pyoderma gangrenosum (PPG) is a skin disorder which manifests as painful exudating, ulcerative lesions. It is generally associated with inflammatory bowel disease (IBD) when affecting patients with a stoma. Patients with PPG typically present to the stoma care nurse (SCN) in the first instance, when the discharging ulcers cause pain, prevent effective stoma appliance application and result in leakage. Anecdotal evidence suggests that clinical nurse specialist posts, such as that of the SCN, are being diluted within some trusts, with a demand for staff to work on wards to cover clinical shifts. As a consequence there is a possibility that these patients will not receive a prompt diagnosis and treatment plan. This article will examine the role of the SCN in managing the patient with PPG, including the use of effective topical treatments. The importance of early diagnosis to prevent escalation of PPG and subsequent prolonged patient discomfort—and the SCN's crucial role in this—is discussed.
Paediatric community home nursing: a model of acute care
Authors: Ng Sze May , Mariguddi Shyam , Coward Shirley , Middleton Holly 
Published: May 2014

Aims and objectives: The aim of this pilot service development was to determine if the community children's nursing outreach team (CCNOT) service, as a model of care, was effective and efficient in its delivery of reducing unscheduled care and admissions to hospital, and improving patient satisfaction. Background: CCNOT was developed to manage acutely ill children at home and to reduce the demand for unscheduled care. Design: This is a pilot prospective study within a dual-site integrated care organisation. Methods: The CCNOT service was developed with the aim of determining the effectiveness of the CCNOT model of care and service delivery in the following outcomes: 1) reducing length of hospital stay (LOS) 2) reducing A&E admissions 3) reducing non-elective admissions 4) reducing readmissions and 5) improving patient satisfaction. Data were obtained from hospital episode statistics (HES) and patient satisfaction questionnaires. Results: The data indicate that, after the implementation of the CCNOT service, A&E attendances fell by 5% per month, non-elective admissions by 15.8% and readmissions by 17.3%. Overall, LOS rose by 2.3%—0.88 days compared with 0.9 days—but the difference was not significant. The results of the patient satisfaction survey show high overall satisfaction with the service. Conclusion: A paediatric CCNOT as a model of service delivery in acute paediatric care is effective in reducing hospital admissions. It also increases patient and carer satisfaction with care provision for sick children in the home environment.
Prostate cancer follow-up needs: do patients and professionals agree?
Authors: Vieira Irina , Burke Linda , Marks-Maran Di 
Published: May 2014

Background With recent changes in the economy and the drive for cost-effective health care, current practices in the NHS need to be reviewed and revised. In light of this, the aim of this study is to investigate the perceived benefits of routine follow-up of patients with prostate cancer and to examine perceptions of prostate cancer patients and health professionals about who should follow-up patients and where and when this should take place. Methods A service evaluation was carried out on a sample of patients receiving follow-up assessment following radical treatment for prostate cancer and health professionals in a specialist cancer urology unit in an acute NHS trust in south-east England. Data were collected through patient (n=47) and health professional (n=17) questionnaires and through a group discussion with a sample of patients (n=52). Results There was agreement between patients and professionals that the main purpose of follow-up consultation was to review the prostate-specific antigen (PSA) blood test and assess urinary symptoms. The majority of patients and professionals wanted follow-up in the hospital with face-to-face consultation. There was general agreement that assessments should be carried out every six months. An overwhelming majority of patients (95%) felt that it was important to have easy access to the urology cancer nurses and doctors. Conclusion Patients want to maintain the traditional model of hospital based follow-up in specialist urology cancer clinics. However, this approach is not economically sustainable. If this is to change we need to work with our patients to develop a service that meets their needs. For a new approach to follow-up to meet the needs of patients, they need to be confident that they have access to expert advice and support, and are assured of referral back to the urology team if required. Nurses are ideally placed to play a key role in the development of such a service.
More financial investment in school nurses is needed
Authors: Sherwin Sarah 
Published: May 2014

Dear Editor, As a group of school nursing and public health nursing lecturers we are increasingly concerned about the current lack of investment in school nursing and health visiting training. The numbers of school nurses and health visitors undertaking Specialist Community Public Health Degrees (which enables them to register on the Nursing and Midwifery Council Register) has drastically reduced over the past year across the country and it appears that this trend is set to continue for the forseeable future.
Children's perspectives on height and weight screenings
Authors: Blood Emma , Grogan Sarah 
Published: May 2014

Aim: The objective of this short study was to gain an insight into children's views, experiences and thoughts in relation to height and weight screenings carried out in school, and to use these to make recommendations for school health practitioners to make these screenings as positive as possible for children. Methods: Twelve children (nine girls and three boys) aged between 10 and 11 years were interviewed individually and in groups and asked questions about their experiences of height and weight screenings in school. Results: Six main themes emerged: information; the importance of secrecy; social support at time of testing; being the correct height and weight; teasing; and weight and health. Conclusions: Children discussed the negatives and positives of height and weight screenings and ways to improve these. Recommendations for practitioners working on the National Child Measurement Programme and further research are made.
Mental health education programmes: Role of theatre
Authors: Stephens Helen , Short Clare , Molodynski Louise 
Published: May 2014

Aims and method: To pilot and evaluate an innovative theatre and mental health education programme, designed to increase awareness and understanding of self-harm in adolescents and improve awareness of avenues of help. Working in collaboration with the Myrtle Theatre Company a play on the theme of self-harm in adolescence was commissioned, and was shown to staff from Bristol secondary schools. Workshops were held following the performance of the play. Results: Participants completed evaluation questionnaires before (n=20) and after (n=15) the play. The responses indicated an increase in understanding of self-harm and confidence to discuss the related issues. Ideas about developing the programme in schools were proposed. Clinical implications: A combination of theatre and workshops can be a non-confrontational yet powerful tool to engage an audience in a meaningful way to think about difficult emotional issues, including self-harm.
Systems for supporting people with neurological dysfunction in higher education
Authors: Viney D S 
Published: May 2014

The focus of this article is support for students with neurological dysfunction in higher education. The University of Southampton's disability service and the students it supports are used as an example to demonstrate some of the possibilities. An indication of the number of people with neurological impairment at the University is provided, as well as some suggestions for ways in which applicants may best be supported. There is also a brief description of the Disabled Students' Allowances, detailing their purpose and application, and information on the systems that may be used to support academic activities, which include equipment, information technology hardware and software and human support systems. The purpose of this article is to inform colleagues who work in neuropsychology and rehabilitation fields of the practical and financial support that may now be available to those people who either return to or commence study in higher education while managing the consequences of a neurological impairment.