bluuebunny/crossref_metadata_2025_split huggingface dataset:
Philosophy and principles of supportive and palliative care in heart failure
Authors: Flynn Maria , Connolly Michael , Booth Katie 
Published: May 2014

This paper is the first of two that consider the broad philosophy and principles of supportive and palliative care as applied to patients living and dying with heart failure. It is widely recognized that in order to provide the best possible care to patients suffering heart failure there is a need to deliver supportive and palliative care. Although the prediction of life expectancy in end-stage heart failure is problematic, the provision of supportive and palliative care can do much to minimize distress for the patient, their family and carers. Within the context of modern NHS services, this paper provides a broad outline of the philosophy and principles of supportive and palliative care and applies these to the care of patients with heart failure. Some common clinical symptoms at the end of life are discussed together with strategies for their palliative management.
Exploring the information needs of patients who have undergone PCI
Authors: Corones Katina , Coyer Fiona M , Theobald Karen A 
Published: May 2014

In Australia percutaneous coronary intervention (PCI) rates have significantly increased over the last decade. However, often, in the hospital setting, there is little time for comprehensive patient education due to the urgency for coronary artery catheterisation, and short length of patient stay. Aim: The purpose of this study was to explore the information needs of first-time PCI patients four to six weeks post-procedure. Method and Results: This study was based on a naturalistic inquiry approach using semi-structured interviews with 10 participants and field notes as the methods of data collection. Data were analysed utilising Thomas’ (2003) five steps to a thematic analysis, incorporating a constant comparative approach. Four themes were identified: ‘Events leading up’; ‘Information prior’; ‘About the procedure’; and ‘Lifestyle’. Conclusions: Findings highlighted the numerous educational needs of participants for PCI across the continuum of their clinical admission and discharge. Furthermore, the study uncovered the need for a tailored approach to PCI patient information delivery. Findings also demonstrated the need to further identify and trial different information delivery methods and timing of PCI education to patients and their families.
Identifying patients with hypertension using ABPM
Authors: Fallon Noeleen , McKee Gabrielle , Finn Caroline , O'Mahony Rose , Flynn Nora , McGeary Patricia 
Published: May 2014

The aim of this study was to assess the effectiveness of the systematic identification and sustained follow-up protocol of hypertensive patients using ambulatory blood pressure monitoring (ABPM) superimposed on Phase III cardiac rehabilitation (CR). Methods: Patients with elevated blood pressure (BP) (clinic measurement) on entry to CR had protocol cycles of ABPM, lifestyle education, medication changes and clinic BP monitoring, throughout CR and up to 6 months follow-up until BP control was achieved. Results: Initial assessment using clinic measurement identified 30% (129) patients with uncontrolled hypertension but following initial ABPM 62% (n=80) were normal with 38% (49) diagnosed as uncontrolled. These were followed-up using protocol cycles up to six times. Of those originally identified as hypertensive, 81% (104) achieved control. Conclusion: This systematic identification and sustained follow-up of hypertensive patients using ABPM in CR was a convenient, successful method in identifying and controlling a significant amount of uncontrolled hypertension.
Empowerment: a critique
Authors: Jacob Frank 
Published: May 2014

Historical analysis reveals that empowerment has its roots in the social action ideology and, it is argued, empowerment cannot be divorced from socio-economic and political factors. Various approaches to empowerment have been considered. It is argued that by adopting a cognitive/individual approach the individual may be able to feel empowered, but actual empowerment, in terms of economic and political power, does not occur. The concept of empowerment in terms of mastery and control has been questioned. This paper suggests that the assumption has a male bias which negates the need for interdependence and communion.
We listen but do we hear? The importance of patient stories
Authors: Hawkins Jen , Lindsay Ellie 
Published: May 2014

Patients’ perspectives on their illness and care are increasingly recognized as the focus for the organization of health care, yet patient stories are rarely examined on their own. Mostly, they are dissected for data, and so the impact is lost. This article presents a number of story tellers, all patients with leg wounds attending a social clinic. Reading their stories helps us understand the experience of being a patient and living with difficult and painful leg wounds. They also show how nurses can play a critical role in optimizing the power of the story in the patient's journey towards physical and psychological healing.
Understanding schizophrenia: a guide for newly qualified community nurses
Authors: Gillam Tony , Williams Robin 
Published: May 2014

Schizophrenia is a complex and severe mental illness affecting 1% of the UK’s population. For those affected, interaction with a mental health educated community nurse may prove invaluable in terms of increasing the chance of an early diagnosis and preventing future relapse. NICE guidelines issued in 2002 support this theory, giving recommendations such as getting help early for those suffering and making sure that the community mental health teams work in partnership with patients and carers. The guidelines also advocate the use of atypical antipsychotics for the treatment of schizophrenia, which are available as both oral medication and long-acting injectable preparations. The use of psychosocial interventions has developed alongside medication: discussion of symptoms with a community nurse can be beneficial in identifying early signs of relapse. This information can then be fed back to the wider community mental health team. Considering that 25–40% of long-term mentally ill people refuse specialist care, combined care between mental health specialists and community nurses ensures that individuals are seen more regularly, enhancing the quality of care that they receive. Treating this condition within the community for a group of nurses with little or no experience poses professional challenges. This article is intended to inform and explain in more detail how treatment can be delivered by a broader group of individuals.
Breast cancer-related lymphoedema: implications for primary care
Authors: Harmer Victoria 
Published: May 2014

As more women are surviving breast cancer, long-term complications of treatment that affect quality of life, such as lymphoedema, gain greater importance (Tsai et al, 2009). The various approaches to treating lymphoedema include skin care, elevation of the affected arm, the use of compression hosiery, multi-layer bandaging, massage (manual lymphatic drainage), and sometimes surgery. The increasing number of women who survive breast cancer partnered with the tendency to care for more patients in the community mean that community nurses may find themselves at the forefront of the management of this patient group, becoming more responsible for side-effects of treatment and the disease. This article will discuss lymphoedema, its treatments along with relevant evidence, illustrating current practice.
Home enteral nutrition NICE guidelines and nutrition support in primary care
Authors: Ojo Omorogieva 
Published: May 2014

The Home Enteral Nutrition team provides support to patients who are being fed via enteral feeding tube in the community. The use of the recently developed policy in combination with the National Institute for Clinical Excellence (NICE) guideline on nutrition support will change the way care is provided to patients and enhance service delivery. However, there are difficulties in the implementation of policies and guidelines which often militate against the delivery of high standard of care. This paper was an attempt to apply the Kotter’s eight-step change management model in the implementation of the HEN team policy and NICE guideline on nutrition support through training of district nurses, liaison with colleagues and carrying out a clinical audit. The clinical audit was aimed at institutionalizing the new approach for the delivery of quality care. The Kotter’s model recognized the urgency needed and it enabled the building of coalitions that is essential in meeting the desired standard in today’s NHS.
Palliative care provision for older people in care homes
Authors: Dobie Jan 
Published: May 2014

There is a paucity of research in relation to district nurses’ (DNs) experiences of palliative care provision in adult care homes (CHs) despite their substantial involvement. The aim of this study was to demonstrate the current involvement of DNs in CHs and identify the potential implications for future practice in providing palliative care in this setting. The findings suggested that even experienced DNs, wanted support and education about when to commence palliative care. They also wanted earlier involvement with CH residents who have a life-limiting condition and CH managers were seen as being essential contributors towards planning care. There was concern among DNs as to how the Liverpool Care Pathway could be introduced into CHs with untrained carers and finally, DN alignment to CHs was shown to improve continuity of care for residents and produce more effective partnership working between DNs, general practitioners and CH staff.
Chronic leg ulceration in the community: changing the focus
Authors: Brown Annemarie 
Published: May 2014

Compression therapy is considered the gold standard for healing chronic venous leg ulceration, and impressive healing rates are achievable for many patients. Unfortunately, this condition is chronic, characterized by frequent recurrences and, for some patients, ulcer healing may never occur. Within community services, commissioners of nursing services tend to focus on complete ulcer healing within a defined timescale as quality indicators. The challenge, therefore, will be for community nurses to demonstrate alternative but equally effective patient-centred outcome measures for nursing interventions when healing is delayed or does not occur. The current government health policy encourages active patient involvement in treatment, with an emphasis on self-care/management for patients with chronic conditions. Self-management interventions, such as the Expert Patient Programme (Department of Health, 2001) for chronic conditions, have been positively evaluated and have demonstrated considerable benefits for patients in terms of pain reduction and improved psychosocial wellbeing. This article briefly discusses the outcomes of such interventions and suggests that nurse-led self-care programmes could be adapted for leg ulcer patients in order to provide alternative outcome measures for nursing interventions when ulcer healing may not be achievable. This article also gives an overview of current innovations developed to encourage patient involvement and self-care in this client group.
Does complementary therapy have a place in wound care?
Authors: Knight Susan 
Published: May 2014

In general, it is accepted that chronic wounds will increase as the population becomes more obese, elderly and frail. In the UK complementary and alternative medicine (CAM) is, in the main, still on the fringe of patient treatment. The increased use of the internet and the general rise in interest in alternative health has led some patients to seek alternatives to current treatments. Therapies used in wound care are traditional plant-based topical oils and ointments. Other herbal remedies are associated in the treatment of disease patterns and associated problems of chronic wounds. This article aims to review the current position of CAM therapies and how they may link in to patients with wounds.
Identifying a deprivation of liberty: a guide for community nurses
Authors: Griffith Richard , Tengnah Cassam 
Published: May 2014

The ability to identify situations that amount to a deprivation of liberty is crucial to a district nurse's role in protecting the vulnerable adults in their care. The courts acknowledge that the elements that have to be applied when assessing if there is a deprivation of liberty are complex and technical, so it is essential that district nurses apply the elements is a methodical manner and inform their decision-making by reference to the case law and the Mental Capacity Act 2005, Deprivation of Liberty Safeguards Code of Practice. This article reviews the European Court of Human Rights and UK domestic case law on deprivation of liberty and highlights the elements district nurses must take notice of when identifying situations that amount to a deprivation of liberty.
Deprivation of liberty: the Mental Health Act or the Mental Capacity Act?
Authors: Griffith Richard , Tengnah Cassam 
Published: May 2014

Both the Mental Health Act (1983) and the Mental Capacity Act 2005 now have provisions that authorise the care and treatment of a person in circumstances that amount to a deprivation of liberty. In accordance with the requirements of article 5 of the European Convention on Human Rights both regimes require a person to be suffering from a mental disorder before they can be subject to a deprivation of liberty. This article rebuts the assumption that practitioners can pick and choose which method to use when authorising a deprivation of liberty. It goes on to highlight the primacy of the Mental Health Act (1983) when a deprivation of liberty is necessary to treat a mental disorder in hospital or care home.
COPD in primary care settings in Ireland: stories from usual care
Authors: Hyde Nicola , Casey Dympna , Murphy Kathy , Cooney Adeline , Mee Lorraine , Kirwan Colette , Tully Agnes , Mooney Bróna 
Published: May 2014

The aim of the PRINCE study was to determine the effectiveness of a structured education pulmonary rehabilitation programme for those living with COPD in primary care in Ireland. This qualitative element of the larger PRINCE trial aims to describe the constituents of ‘usual care’ for patients allocated to the control arm of the study. A descriptive qualitative study was used to explore the constituents of usual care. A convenience sample of participants (n=20) allocated to the usual care group were interviewed. Three main themes arose from the study: experiences of having and managing COPD, lifestyle advice, and factors that helped or hindered self-management. Usual care left many people grappling in the dark trying to manage their COPD. It was found that usual care was not at its optimum for people with COPD in the control arm of the PRINCE study.
Gestational diabetes mellitus— why awareness is paramount
Authors: Hayes Catherine 
Published: May 2014

Incidence and prevalence of gestational diabetes mellitus (GDM) and impaired glucose tolerance (IGT) in pregnancy have increased significantly in the past 10 years. Evidence indicates that these increases can be categorically linked to parallel increases in the incidence of pre-pregnancy obesity and the diagnosis of Type 2 diabetes mellitus on a national and international level. This article addresses the potential role of assistant practitioners (APs) and healthcare assistants (HCAs) to further develop their professional role in advocating healthy eating to women who might be pregnant or contemplating pregnancy in the near future. Raising the awareness of GDM and IGT in women who are not currently pregnant, the author suggests, might be one mechanism by which presenting cases could potentially be reduced. The article discusses the likely long- and short-term prognostic outcomes for both the mother and the neonate during pregnancy, following a diagnosis of either GDM or IGT and the specific needs of this patient cohort both during pregnancy and following parturition, when the statistical likelihood of women progressing to Type 2 diabetes mellitus is significantly greater. The article concludes with the recognition that APs and HCAs have a unique social opportunity to empower women of childbearing age to be proactive in the management of their reproductive health specifically and their general health and wellbeing overall, in relation to the potential development of GDM and IGT in pregnancy.
APs in ‘hospice at home’ and daycare in the northwest
Authors: Smith Joanne , Brown Trish 
Published: May 2014

The third article in this series of four will look at the role of the assistant practitioner (AP) in the ‘hospice at home’ and daycare services that are situated in the hospice. There will be consideration of the innovative nature of the ‘hospice at home’ service and an examination of the vision for the AP within the setting. Also, an examination of the importance of daycare, which aims to give more breadth to the provision offered to individuals. Advance care planning (ACP) will be looked at, as an area that should become of increased importance, as a forming knowledge, helping professionals and others to understand the wishes and choices of individuals. The importance of caring for those at the end of life and the experiences of carers will also be explored, seen to be of such importance in terms of offering holistic care. In addition, we have spoken with two APs about what skills escalation has helped them achieve.
Essentials of stroke for healthcare assistants
Authors: Hayes Catherine 
Published: May 2014

Within the context of medicine and healthcare, ‘stroke’ is a term applied to an array of diverse manifestations of neurovascular illness. While the role of the healthcare assistant (HCA) does not entail engaging with the specific pathological processes of the condition, it is useful for them to familiarise themselves with core concepts in the field of stroke rehabilitation, so they might best provide a high level of care, underpinned by a thorough basic knowledge of the stage of illness and its likely prognosis or outcome. Professions allied to medicine are often challenged to understand the pathology, classification and symptoms of stroke, which are pivotal to the accurate diagnosis and subsequent management of the condition. The role HCAs play in the ancillary care surrounding this process is invaluable. Their ability to work with patients who have suffered any form of stroke is significant, but arguably most beneficial in facilitating interaction with patients who might themselves be struggling to understand and come to terms with their newly diagnosed condition. This article is a brief guideline to stroke for HCAs who might wish to develop or refresh their knowledge of stroke. The overall aim of the article is to provide a quick reference system for HCAs to understand the nature of the condition with which their patient is presenting, in order to equip them to work knowledgeably within the context of stroke care.
The role of HCAs in a children's hospice and their L&D needs
Authors: Crighton Liz 
Published: May 2014

This article will review the role of healthcare assistants (HCAs) working in a children's hospice service. It aims to identify and evaluate the benefits and the challenges associated with working in this demanding and specialist area and make recommendations that will help support and develop HCAs working in children's hospice settings. Areas for focus in this paper include: clinical skills and competency, delegation and supervision, access to learning opportunities, professional development and career progression. With this in mind, a specific work-based education programme has been developed to meet the unique needs of HCAs working in children's hospices. It is paramount that HCAs work within their sphere of competence to protect the public and ensure patients get the highest standard of care. By developing an education programme suited to their needs, it is hoped the quality of care will improve and that errors, complaints and the potential for litigation will be reduced.
Welsh university and health boards’ HCSW collaboration
Authors: Williams Julie , Ledsam Robert , Suffin Majella , Jolly Sara , Bennet Elizabeth 
Published: May 2014

The UK Government's ‘Widening Participation’ agenda ( Public Accounts Committee, 2009 ) aims to ensure those who are able to benefit from higher education have the opportunity to do so. In 2008, in response to this and other Welsh Assembly Government (WAG) publications, the National Leadership and Innovation Agency for Healthcare (NLIAH) in Wales lodged monies with local health boards (LHBs) to develop accredited education at level 4, Credit Qualification Framework Wales (CQFW). This was to be aimed at developing the nursing support roles within Agenda for Change (A4C) pay bands 1-4 and providing evidence-based, patient-responsive care. Four LHBs in South Wales approached the University of Glamorgan and collaborated in the development of a higher education certificate, with the intention of providing education that would benefit the care patients received from support staff.
Wound care checklists—role and wound assessment
Authors: Andrews Hilary 
Published: May 2014

This article provides two quick reference checklists that the healthcare assistant (HCA) and assistant practitioner (AP) undertaking wound care can use in order to clarify this area of their role and to provide safe and effective wound care. The first checklist specifies step-by-step questions to ask when carrying out wound care. The second provides a list of wound assessment signs that the HCA/AP must be observant for while undertaking wound care that should be reported to the registered nurse. This article is based on a workshop given by the author at the 6th National HCA Conference in Birmingham on 15 November 2012.
Safety and quality of services: at the heart of all we do
Authors: Pond Christina 
Published: May 2014

In February 2011, the Government published the Command Paper, Enabling Excellence: Autonomy and Accountability for Healthcare Workers, Social Workers and Social Care Workers, in part as a response to prevent poor quality of care ( Department of Health (DH), 2011a ). There is a recognition in the paper that ‘a more flexible system is needed to enable employers to assure themselves that prospective employees have met adequate standards of training and competence and to enable individual members of the public who seek care directly from unregulated, self-employed workers to assure themselves about their standards’. In February 2012, the Department of Health commissioned Skills for Health and Skills for Care to jointly convene a project to develop a code of conduct and minimum training standards with a view that these could be used by a body (or bodies) establishing a voluntary register or registers for healthcare support workers who reported to registered nurses and midwives in England, including assistant practitioners (APs) but not those working in support of other registered healthcare professionals, for example, allied health professionals. The project, which was completed in January 2013, has delivered a Code of Conduct, National Minimum Training Standards and core competences mapped to National Occupational Standards and QCF units, for health and adult social care workers in scope of the project. This paper describes the objectives and methodology which underpinned this work and the resultant outputs from the project which offer the potential to contribute to driving up standards of care now and in the future.