bluuebunny/crossref_metadata_2025_split huggingface dataset:
An audit of oxygen therapy on a respiratory ward
Authors: Hickey Steven 
Published: May 2014

Oxygen therapy can be a life-saving intervention, which is widely available and commonly prescribed by medical staff. Patients often receive oxygen therapy in hospital but, like any other drug, oxygen can be dangerous when given in the wrong concentration. Aims: To review the current literature. To examine current prescribing practice plus methods of oxygen delivery on a respiratory ward. Method: A prospective audit was conducted on patients receiving oxygen therapy over a 4-week period. The ward was audited pre- and post-education sessions. Education was on oxygen prescribing and oxygen therapy. Results: The literature revealed that oxygen was often poorly prescribed by doctors and at times poorly administered by nurses. Of the 55 patients audited pre-education, only 5% of patients had a prescription. This increased to 20% post-education (P=0.042). The initial audit uncovered 14 issues surrounding oxygen delivery. This fell to one post-education (P<0.001). Reassuringly, all patients had arterial oxygen saturation recorded. Conclusion: Current rates of oxygen prescribing remain unsatisfactory despite doctors being made aware of the audit findings. Education on oxygen therapy improved the delivery of oxygen therapyto patients on a respiratory ward.
Effects and experiences of warm versus cold skin disinfection
Authors: Wistrand Camilla , Nilsson Ulrica 
Published: May 2014

The intention of preoperative skin antisepsis is to reduce the risk of postoperative surgical wound infections through the prevention of contamination of the wound site from the patient's skin flora, and to provide a sterile work area. This pilot study aimed to compare warm versuscold skin disinfection with a chlorhexidine solution on bacterial growth, skin temperatures and the experiences of the disinfection. Ten healthy volunteers without any association to Sweden's healthcare services were included in an experimental study with crossover design. The results showed that warm (38°C) disinfection seems to be comparable with cold (20°C) disinfection in reducing bacterial growth. Experiences differ, but warm disinfection is generally considered more pleasant than cold as a result of heat-loss to the skin. However, further research with larger sample sizes and on patients undergoing surgery is needed.
Return on investment: workload, complexity and value of the CNS
Authors: Oliver Susan , Leary Alison 
Published: May 2014

The rheumatology nurse specialist (RNS) has become an integral and vital part of the multidisciplinary team and is valued by patients. Yet, a number of challenges regularly face all clinical nurse specialists (CNS) in the UK. The perception that CNS are an expensive and poorly defined nursing resource results in regular threats to their sustainability, particularly that of the RNS. This study examined return on investment of the RNS. Method: An interrelational Structured Query Language (SQL) database collected data on the day-to-day activities of the RNS based on previous models of CNS and RNS work, and qualitative narrative data were then subjected to data mining. Results The RNS represented an excellent return on investment, in terms of income generation activity, patient safety and efficiency. These outcomes were achieved using key principles of proactive case management using vigilance, rescue work and brokering. The mean average per whole time equivalent (WTE) RNS per annum represents £175 168 in terms of income/savings to an employing NHS Trust. This figure is likely to be an underestimation, as calculations on reduction in bed days in hospital have not been included.
Workplace wellness for HIV/AIDS-affected nurses in South Africa
Authors: Basson Helena Aletta , Roets Lizeth 
Published: May 2014

Purpose: The development of a framework for a workplace wellness programme for HIV/AIDS infected and/or affected nurses in South Africa, who comprise registered nurses and midwives, enrolled staff nurses and auxiliary nurses. Research objectives: To identify and describe components for a framework of a workplace wellness programme. Background: Registered nurses and midwives, enrolled staff nurses and auxiliary nurses (referred to as nurses) in the South African nursing workforce are confronted daily with HIV/AIDS in the workplace due to the high HIV/AIDS prevalence rate among sexually and economically active adult women between 15–49 years of age. The research explains how health and wellness could be promoted by instituting a workplace wellness programme. Research design: Quantitative descriptive research. Findings: The nurses emphasised the threat of HIV/AIDS and considered a workplace wellness programme a priority. Conclusion: A logic model underpinned the workplace wellness programme framework.
What are the roles of clinical nurses and midwife specialists?
Authors: Wickham Sheelagh 
Published: May 2014

Research shows the increasing part the Clinical Nurse Specialist (CNS) plays in healthcare today. But what does a CNS actually do in their day-to day-work? This study, set in the Republic of Ireland, aimed to explore the CNS and clinical midwife specialist (CMS) roles in practice. Quantitative methodology was used to explore the roles and activities of the CNS and CMS. Following ethics approval, a valid and reliable questionnaire was circulated to the total population of CNS/ CMS in Ireland. The data were analysed using SPSS. This study articulates the individual role elements and activity level. The findings show the CNS/CMS to be active in the roles of researcher, educator, communicator, change agent, leader and clinical specialist, but the level of activity varies between different roles and individual role elements. The CNS/CMS is seen as a valuable resource in health care today and has potential to have a positive effect on patient care. The majority of CNS/CMSs are active in varying roles but the analysis shows lesser activity in some areas, such as research. The findings merit further study on role activity and possible variables that influence role activity.
Nursing documentation of inpatient care in eastern Ghana
Authors: Asamani James Avoka , Amenorpe Frank Delasi , Babanawo Felicia , Ofei Adelaide Maria Ansah 
Published: May 2014

Background: Despite the usefulness of a well-documented nursing care record, documentation still has its setbacks and receives varying levels of priority among nurses and other health professionals. However, since the quality and standard of patient care is often measured from retrospective records, it is imperative to examine the practice of nursing care documentation. Aim: The study described in this article examined current practices of nursing care documentation in Ghana. Method: By means of multiple sampling strategies, a retrospective approach was used to evaluate 100 patient care records in two hospitals between 1 November and 31 December 2012. Findings: Major findings are that 46% of care given to patients was not recorded in the nursing care records; that nurses’ progress notes were not written for 63% of patients after the first day of admission; and that 57% of documentation was not signed by nurses. Conclusion and recommendation: The standard of nursing care documentation is not on a par with that in developed countries, partly owing to a lack of guidelines, as well as a persistent shortage of nurses and the limited use of nursing care records. It is recommended that nursing stakeholders use a multidisciplinary approach to develop policies/guidelines on nursing care documentation and provide training opportunities for nurses on effective documentation.
Conceptions of school-based youth health nursing
Authors: Sendall Marguerite C , Fleming MaryLou , Lidstone John 
Published: May 2014

The aim of this research is to explore the meaning of the experience of school-based youth health nursing in Queensland, Australia. The research follows a qualitative approach and is based on in-depth interviews. The dominant experience is negative because participants feel they have to battle to gain respect and survive in the school environment. The small, positive experience of school-based youth health nursing is related to student consultations. Student consultations are a ‘golden egg’ because participants gain a sense of reward from making a difference to student wellbeing. This paper proposes operational recommendations including those related to health promotion and professional development and strategic recommendations regarding this model of school nursing. The authors conclude, first, that this ‘golden egg’ should be promoted to ensure all school nurses reap the rewards, second, that this model of school nursing is not the most effective model.
The health promoting school and the school nurse: A content analysis of school staff's views
Authors: Alexandropoulou Marianthi 
Published: May 2014

Aim: To explore school staff perspective on health promoting school (HPS) and on school nurses. Background: The literature mainly refers to health professionals’ perspective while clients’ views are not widely documented. Method: A content analysis was conducted on textual data from two open-ended questions answered by 180 people through a self-completed questionnaire. Findings: Data produced three categories of HPS staffs’ views (positive, sceptical, negative), and five categories of HPS attributes (methods used in activities, content of health promotion, target population, purpose of activities, person in charge). School nurse data were divided into four categories (scope of school nursing practice, school nurse's target group, school nurse's position among the school staff, school nurse's legal responsibility over health situations). Conclusions: Participants believed schools could contribute to health promotion, focusing more on health education and ill-health prevention. Essential elements of school nurse practice included providing first aid, medication, and involvement in health education for pupils and school staff.
Supporting positive mental health development in adolescents with a group cognitive intervention
Authors: Garmy Pernilla , Berg Agneta , Clausson Eva K 
Published: May 2014

Background: Supporting positive mental health development in adolescents is an important school health concern, but there is a need to investigate the suitability of the interventions used. Aim: The aim is to investigate the experiences of school health professionals in conducting a universal school-based programme aimed at preventing depressive symptoms in adolescents. Methods: Twenty-two school health professionals participated in four focus groups. The interviews were analysed using qualitative content analysis. Findings: The overall theme identified in the study consists of ‘striking a balance between strictly following the manual and meeting the students’ needs’. Three subthemes emerged: ‘doing good and sowing seeds for the future’, working with insufficient tools, and ‘personal development as a professional and as an individual’. Conclusions: School health professionals conducting the programme found it valuable in a school setting, but considered support from the school administration essential.
Isolated facial diplegia: a diagnostic dilemma
Authors: Tayal V , Hollingsworth J , Cooke RPD 
Published: May 2014

A 43-year-old man presented to his GP with a right facial palsy of 1 day's duration. He was prescribed a 5-day course of oral prednisolone for a diagnosis of Bell's palsy. Two weeks later he presented to the emergency department with a left facial palsy. He had a 2-month history of back pain, generalized myalgia and paraesthesia. There was no history suggestive of any other neurological deficit. There was no history of fever or weight loss. However, he had travelled to the Scottish Highlands 3 months previously and had noticed an itchy red rash over his buttock (approximately 3 cm in size) 4 weeks after his holidays. The rash was diagnosed as cellulitis and he was prescribed a 5-day course of oral flucloxacillin. The patient, however, did not recall having sustained a tick bite or having a characteristic migrating rash.Examination revealed a bilateral lower motor neurone facial palsy. Detailed examination of the central and peripheral nervous system was otherwise normal. No vesicles were found in either external auditory canal. Tuning fork tests were normal. The initial investigations undertaken in the emergency unit are listed in Table 1.Repeat serology 8 weeks later was positive for Borrelia burgdorferi immunoglobulin G (IgG) antibody by both enzyme-linked immunosorbant assay (ELISA) and immunoblot assay. The initial CSF sample was not subsequently examined for B. burgdorferi antibody as the sample had been discarded. A repeat lumbar puncture was not considered appropriate.This patient's right-sided facial weakness showed spontaneous improvement over 4 weeks from the initial presentation by which time his left-sided weakness had improved.Based on the history of travel to a tick-infested area, together with the neurological and serological findings, a diagnosis of early Lyme neuroborreliosis was made. Although antibiotic treatment does not hasten resolution of 7th cranial nerve palsy associated with B. burgdorferi infection, doxycycline was prescribed to prevent further sequelae.
Acute abdominal pain in a 16-year-old woman: the pitfalls of sexual history
Authors: George Akram , Aziz Omer , Shah Anand , Baxter Steve 
Published: May 2014

A 16-year-old woman presented to the authors' emergency department in the early hours of the morning with a 3-day history of cramping lower abdominal pain and watery diarrhoea, following a meal of reheated rice. The remainder of her history (including gynaecological history) was unremarkable. Examination revealed that she was clinically dehydrated, had a tachycardia of 100 beats per minute, and although she did not display any signs of peritonism, she did have lower abdominal tenderness, not more so on any one side. Rectal examination was deferred by the patient. Chest and abdominal radiographs (Figures 1 and 2) were unremarkable, and initial blood tests revealed a white blood cell count of 3.4×109/litre, with C-reactive protein of 156 mg/litre. Her urine did not contain nitrites, leucocytes or blood, and a beta-human chorionic gonadotrophin pregnancy test was negative. A diagnosis of gastroenteritis and tachycardia secondary to dehydration was made and the patient was admitted to hospital. The following day her abdominal pain worsened and despite rehydration she remained tachycardic, developing profound swinging pyrexia (peak of 40°C). On examination, her abdomen was noted to be extremely tender and peritonitic below the umbilicus, with marked guarding on examination. She was immediately referred to both general surgery and gynaecology teams. The on-call gynaecologist was able to question the patient about her sexual history separate from her family, who until now had been with her at all times. At this stage, the patient admitted that she had sexual intercourse for the first time 4 days before admission, but denied any relation to the onset of symptoms. Vaginal examination was refused, but the patient did allow a rectal examination, performed by the general surgical consultant, revealing marked tenderness and fullness in the pouch of Douglas. Although the sexual history was noted, it was felt that appendicitis was the most likely cause for her pain, and the patient was taken to theatre for a diagnostic laparoscopy. At laparoscopy, a large amount of pus was seen in the abdomen limiting visualization and necessitating conversion to laparotomy. Although a mildly inflamed appendix was seen and appendicectomy performed, this did not account for the pus, and further careful examination of the abdominal cavity was carried out. In the pelvis and careful palpation of the pouch of Douglas revealed a traumatic, full thickness, 1 cm transverse tear of the posterior vaginal wall, through which the cervix could be felt. After discussion with the gynaecology team, this was treated with copious pelvic lavage and a carefully placed pelvic drain. Further questioning during the postoperative period revealed that the intercourse had been consensual but very painful. The patient had an uneventful postoperative recovery and was discharged after 7 days to be followed up in the gynaecology outpatient department.
Pain and agitation in long-term care residents with dementia: use of the Pittsburgh Agitation Scale
Authors: Zieber Colin G , Hagen Brad , Armstrong-Esther Chris , Aho Morgan 
Published: May 2014

Aim To explore the relationship between total and sub-scores of the Pittsburgh Agitation Scale (PAS) and five proxy measures of pain in long-term care (LTC) residents. Study design Descriptive correlational design. Sample and setting Fifty eight residents in three LTC facilities in rural Western Canada with moderate to severe cognitive impairment took part in the study. Six full-time registered nurses working in the facilities and three palliative care nurse consultants provided pain and agitation assessments. Measurements Registered nurses used PAS to assess agitation. The five proxy measures of pain were the Discomfort Scale for Dementia of the Alzheimer’s Type (DS-DAT), number of pain diagnoses, use of analgesic medications, and pain ratings by both facility nurses and palliative care nurse consultants. Results There was a moderately strong relationship between total PAS agitation scores and total DS-DAT pain scores (r=0.51, P<0.01). The PAS sub-score ‘resisting care’ was significantly correlated with total DS-DAT scores (r=0.46, P<0.01), and pain ratings by both facility nurses (r=0.48, P<0.01) and palliative care nurse consultants (r=0.51, P<0.01). Conclusions For certain residents with dementia, PAS may allow assessment of both agitation and uncommunicated pain. It is possible that the PAS form of agitation ‘resistance to care’ may indicate pain that individuals cannot otherwise communicate. One possible response to such resistance would be to trial pain medication and reassess agitation. Nursing staff in LTC facilities may need additional training in pain assessment of residents with dementia.
Terminal restlessness: perspectives of an interdisciplinary palliative care team
Authors: Brajtman Susan 
Published: May 2014

Aim To explore an interdisciplinary team’s perceptions of families’ needs and experiences surrounding terminal restlessness. Design A qualitative exploratory design using two focus groups. Sample Participants were members of an interdisciplinary palliative care team working in a palliative care unit in a university teaching hospital in Israel. Results The palliative care team confronted several challenging and stressful issues surrounding the management of terminal restlessness that influenced their treatment decisions and relationships with families. Four themes reflected the participants’ perceptions and experiences: suffering, maintaining control, feelings of ambivalence and valuing communication to reduce conflict. Conclusion Findings suggest the need for comprehensive treatment plans to meet the special supportive and information needs of these families, specific supportive strategies for the professional caregivers and further studies to develop ethical criteria and evidence-based guidelines for the use of sedation in the management of terminal restlessness.
Bereaved carers' views of a hospice at home service
Authors: Exley Catherine , Tyrer Freya 
Published: May 2014

Introduction In recent years, there has been an increase in specialist palliative care services in the home. Despite this, there have been relatively few published evaluations of such care. Methods This is a qualitative study which used semistructured interviews to explore bereaved carers' views and experiences of a hospice at home (HAH) service in the East Midlands, UK. Eleven interviews were conducted and analysis followed the framework approach. Results Carers' views were divided into four themes: caring for someone at home; formal care provided by HAH; access to out-of-hours care; and provision of specialist equipment. Conclusions Bereaved carers generally gave very positive accounts on care delivered by the HAH service. Shortcomings identified were the provision of out-of-hours care and the untimely supply and removal of specialist equipment. It is suggested that bereaved carers provide useful insights for qualitative evaluations of end-of-life services delivered in the home.
Managing beyond an uncertain illness trajectory: palliative care in advanced heart failure
Authors: Hoyt Zambroski Cheryl 
Published: May 2014

A lack of comprehensive and effective palliative care is clearly evident in a number of studies describing the end of life for patients with advanced heart failure. These patients have been portrayed as experiencing a wide array of poorly managed symptoms. The primary rationale for the lack of care has been the uncertain illness trajectory that characterizes living with advanced heart failure. Nurses must manage care beyond the illness trajectory from an emphasis of palliative care as each of these patients may face significant illness burden and even sudden death. The purpose of this paper is to: Discuss the current status of palliative care for patients with advanced heart failure Explain the basic pathophysiology and resulting signs and symptoms of advanced heart failure Describe pharmacological and non-pharmacological symptom management strategies for patients with advanced heart failure.
Caring for patients with terminal delirium: palliative care unit and home care nurses’ experiences
Authors: Brajtman Susan , Higuchi Kathryn , McPherson Christine 
Published: May 2014

Aim To explore palliative care unit and home care nurses’ experiences of caring for patients with terminal delirium. Design A qualitative exploratory design using individual interviews. Sample Participants included five nurses working in an interdisciplinary palliative care unit located in a large Canadian city hospital, and four nurses from a palliative home care nursing team located in the same city. Results Nurses in both sites experienced multiple challenges caring for delirious patients. Additional education on delirium and collaborative teamwork were viewed as key factors in enhancing their ability to care for and support this patient and family population. Four core themes reflected the participants’ perceptions and experiences: experiencing distress; the importance of presence; valuing the team; and the need to know more. Conclusion Findings suggest the need for interdisciplinary educational initiatives focused on the identification and management of terminal delirium, and targeted to the specific context in which nurses practice.