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Issue 22 - 12 July 2012

Articles

1. Editorial: The future of clinical nursing: meeting the needs of patients for compassionate and skilled nurses?
By Bradshaw, Ann. Journal of Clinical Nursing. Jul 2011, Vol. 20 Issue 13/14: p1797-1800
Abstract:
The article discusses nursing and midwifery in fulfillment of the goal of providing compassionate and skilled care. British Prime Minister Gordon Brown established a Commission in 2009 to address the future of nursing and midwifery, focusing on compassion, competence and the role of the ward sister, charge nurse or community team leader. According to the article, it was during this time that reports on deficiencies in basic nursing were received from patients..

2. Contemporary cosmetic surgery: the potential risks and relevance for practice
By Gilmartin, Jo. Journal of Clinical Nursing. Jul 2011, Vol. 20 Issue 13/14: p1801-1809
Abstract:
To examine and critique the risks of cosmetic surgery and consider implications for practice. Cosmetic surgery is a growing industry with a significant global phenomenon. Feminists have been critical of aesthetic surgery practice, offering a range of representations in regard to 'identity', 'normality', 'cultural and social pressures', 'agency' and 'self-enhancement'. Discourses around minimising risk information acknowledge deficits in not supplying patients with full risk information. The results are usually devastating and lead to serious health complications that incisively diminish well-being for patients and increase health costs. Critical review. This paper represents a critical review of risks associated with cosmetic surgery. A Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medical Literature Analysis and Retrieval System online (Medline) and British Nursing Index (BNI) search with relevant key words were undertaken and selected exemplary articles and research describing and/or evaluating cosmetic surgery risk. Only papers in the English language from 1982-2009 were reviewed. The papers examined were mainly empirical studies; some opinion papers, policy documents, textbooks and websites were examined too. The literature revealed that several factors influence consumer risks including regulation vagaries, medicalisation processes, fear of ageing discrimination, wanting to avoid ethnic prejudice and media pressure. Government strategies in the United Kingdom (UK) have attempted to improve clinical standards; however, little attempt has been made globally to raise institutional and professional awareness of the huge impact of cultural and social pressures on consumers. Avoiding shattering complications by improving the provision of risk information for patients is a worthwhile goal. Therefore, health professionals need to consider consumer rights and autonomy more carefully, facilitate rigorous screening and develop knowledge in regard to relational autonomy and alternative interventions. [ABSTRACT FROM AUTHOR].

3. A systematic review of the use of volunteers to improve mealtime care of adult patients or residents in institutional settings
By Green, Sue M.; Martin, Helen J.; Roberts, Helen C.; Sayer, Avan Aihie. Journal of Clinical Nursing. Jul2011, Vol. 20 Issue 13/14, p1810-1823
Abstract:
The objective of this review was to locate and assess the evidence obtained from articles reporting empirical research that volunteers improve mealtime care of adults in institutional settings. Malnutrition in adult patients or residents in institutional care settings is common. Poor standards of mealtime care have been suggested to contribute to the development of malnutrition. A systematic review of the literature was undertaken. Key words were identified and used separately and in combination to search the electronic databases MEDLINE, CINHAL, BNI and EMBASE and the internet for relevant articles. Searches were undertaken in August 2008, April 2009 and July 1010. Ten studies fulfilled the criteria for inclusion. The methodologies of five of the 10 studies were unclear due to the brevity of the reports. The validity of the design of the other five studies varied. Generally the results suggested the use of volunteers in mealtime care increased satisfaction of patients, relatives, volunteers and staff concerning meal-time assistance (assessed using methods such as questionnaires and focus groups) and three studies found increased nutritional intake in groups assisted by volunteers. However, few well designed and reported studies were identified. There is some evidence that volunteers can improve mealtime care of adult patients or residents in institutional settings, however few well designed studies are reported. This review demonstrates that there is limited evidence that the use of volunteers improves mealtime care of adult patients or relatives in institutional settings. [ABSTRACT FROM AUTHOR].

4. Dying well: factors that influence the provision of good end-of-life care for older people in acute and long-stay care settings in Ireland
By Casey, Dympna; Murphy, Kathy; Aine Ni Leime; Larkin, Philip; Payne, Sheila; Froggatt, Katherine A.; O'Shea, Eamon. Journal of Clinical Nursing. Jul 2011, Vol. 20 Issue 13/14, p1824-1833
Abstract
: The aim of this study was to explore key stakeholders and direct care managers' perspectives on the current provision of end-of-life care for older people in acute and long-stay care settings in Ireland and to construct a model of these. Although the literature reveals a number of factors that impact on end-of-life care, no study has examined staff perceptions concerning the provision of good end-of-life care for older people in an Irish context. Grounded theory was used. Semi-structured interviews were employed to collect data between 2007-2008. A purposive sample of 33 staff involved in the delivery of end-of-life care to older people working in six sites were selected. Factors that influence provision of end-of-life care in Ireland were identified. The core category was 'dying well'. The potential to 'die well' was influenced by three factors, namely philosophy, culture and organisation of care, knowing the person and physical environment and resources. People are living longer consequently acute and long-stay care setting will increasingly become places where older people die. This study identified the factors that influence the provision of good end-of-life care for older people. Mobilising resources to ensure that these factors are considered is crucial to ensuring that regardless of where older people die in Ireland, they will receive the highest standard of care that nurses can provide. Understanding the factors that influence the provision of end-of-life care in acute and long-stay facilities in Ireland can help health professionals give more focused support and ensure that influencing factors are addressed so that older people at end-of-life receive quality end-of-life care. [ABSTRACT FROM AUTHOR].

5. Quality of end-of-life care for non-cancer patients in a non-acute hospital
By Woo, Jean; Lo, Raymond; Cheng, Joanna O. Y.; Wong, Florens; Mak, Benise. Journal of Clinical Nursing. Jul2011, Vol. 20 Issue 13/14, p1834-1841
Abstract:
Few surveys have been carried out documenting the quality of life for non-cancer patients in general district hospitals reaching the final trajectory towards death. We carried out a survey of 80 patients facing the final stages of their chronic illness as well as their carers and hospital staff. With increasing life expectancy, a large majority of patients are older, where palliative care principles for patients with cancer are equally applicable. Few surveys have been carried out documenting the quality of life for non-cancer patients in general district hospitals reaching the final trajectory towards death in terms of patients' and carers' perspective, compared with the more extensive literature for patients with cancer. Survey. Assessment tools include symptom check list, geriatric depression scale, Chinese Death Anxiety Inventory and the McGill Quality of Life Questionnaire for patients; SF-12 and the Chinese cost of care index for informal carers; and the Chinese Maslach Bumout and Death Anxiety Inventories for hospital staff. Lower-limb weakness (92·5%), fatigue (86·2%), oedema (85%), dysphagia (58·2%) and pain (48·8%) were the most common symptoms in this group of patients. The mean Chinese Caregiver Stress Index score was 45·93 (SD 6·45) (maximum score = 80). For staff, the mean SF-12 physical component score was lower than the Hong Kong population average. The findings suggest that there is room for improvement in the quality of end-of-life care. Patients in the final stages of many chronic illnesses have high prevalence of symptoms comparable to those of patients with cancer. Raising awareness and improving training for all health care professionals, formulating guidelines and care pathways and incorporating quality of care as key performance indicators are measures to improve the quality of end-of-life care. [ABSTRACT FROM AUTHOR].

6. Validity and reliability of two pain assessment tools in Brazilian children and adolescents
By da Silva, Flavia Claro; Santos Thuler, Luiz Claudio; de Leon-Casasola, Oscar A. Journal of Clinical Nursing. Jul2011, Vol. 20 Issue 13/14, p1842-1848
Abstract:
The aim of this research is to examine the validity and reliability of the Brazilian version of the Revised Faces Pain Scale and the Face, Legs, Activity, Cry, Consolability scale. Several self-report and behavioural pain tools have been shown to have good psychometric properties for the evaluation of pain in children and adolescents. This study was designed to analyse the correlation between two pain scales in school-age children and adolescents. This is a validation study. This research studied 90 children between 7-17 years old. They received care at the outpatient and the inpatient departments of the National Cancer Institute of Brazil. A self-report tool, the Revised Faces Pain Scale, was used by children and adolescents to measure their pain, while the observational Face, Legs, Activity, Cry, Consolability scale was used by the healthcare providers to measure pain. The Face, Legs, Activity, Cry and Consolability scale presented a good internal consistency (Cronbach a coefficient = 0·76). There was a moderate-to-good correlation between the Face, Legs, Activity, Cry and Consolability scale and the Revised Faces Pain Scale scores (Spearman's coefficient = 0·74). Findings support the reliability and the validity of the Face, Legs, Activity, Cry, Consolability scale and the Revised Faces Pain Scale as a measure of pain in the Brazilian population. The validity and the reliability of both scales will improve pain evaluation and treatment in Brazilian children and adolescents, leading to a better pain control. [ABSTRACT FROM AUTHOR].

7. Predictors of pain in nursing home residents with dementia: a cross-sectional study
By Pei-Chao Lin; Li-Chan Lin; Shyu, Yea-Ing L.; Mau-Sun Hua. Journal of Clinical Nursing. Jul 2011, Vol. 20 Issue 13/14, p1849-1857
Abstract:
The aim of this study was to investigate the association between care activities and pain and restraint and pain in residents with dementia. If pain in people with dementia is not identified or alleviated in a timely manner, it could lead to an adverse effect on their physical, mental, social health and quality of life. Care activities and restraint might cause pain, but little is known as to whether they are true risk-factors of pain in people with dementia. A cross-sectional research design was employed. One hundred and twelve people with dementia were chosen from two nursing homes located in northern Taiwan. The demographic and clinical data collected included diagnoses, analgesics, restraints, recent falls, etc. The severity of dementia was assessed using the Clinical Dementia Rating Scale. The researchers observed every participant immediately following instances of routine care and then recorded the level of pain using the Chinese version of the Pain Assessment in Advanced Dementia scale. About 36·6% of the participants had a Chinese version of the Pain Assessment in Advanced Dementia scale score above two points and an overall mean score of 1·50 (SD 1·81) with a range from 0-8. Only one resident with dementia received regular analgesic. Pain level in residents with dementia that needed assisted care was higher than in residents who were able to move about freely. It showed a positive correlation between level of pain and the severity of dementia among residents. The major predictors for pain in residents with dementia included restraint, assisted bathing and assisted transfer. The findings confirm the association between care activities and pain and between restraint and pain in residents with dementia. Formal caregivers need to minimise the triggering of pain when they assist residents' daily activities and avoid unnecessary restraints, while offering personalised, conventional nursing care to residents with late-stage dementia. [ABSTRACT FROM AUTHOR].

8. A pain education programme to improve patient satisfaction with cancer pain management: a randomised control trial
By Pi-Ling Chou; Chia-Chin Lin. Journal of Clinical Nursing. Jul 2011, Vol. 20 Issue 13/14: p1858-1869
Abstract:
The purpose of this study was (1) to evaluate the effectiveness of a pain education programme to increase the satisfaction of patients with cancer with regard to pain management and (2) to examine how patient satisfaction with pain management mediates the barriers to using analgesics and analgesic adherence. The patients' satisfaction with pain management is not merely an indicator, it is actually a contributor to medication adherence. However, very few studies investigate methods for improving patient satisfaction with pain management. This study used an experimental and longitudinal design. A total of 61 patient-family pairs ( n = 122) were randomly assigned to either experimental or control groups. The instruments included the American Pain Society outcome questionnaire, the Barriers Questionnaire-Taiwan form, self-reporting evaluations of analgesic adherence and the Pain Education Booklet. The experimental group ( n = 31) participated in a pain education programme, while those in the control group ( n = 30) did not. The two groups were compared using generalised estimation equations after the second and fourth weeks. A Sobel test was used to examine the mediating relationships among patient satisfaction with pain management, barriers to using analgesics and analgesic adherence. The experimental group showed a significant improvement in the level of satisfaction they felt for physicians and nurses regarding pain management. For those in the experimental group, satisfaction with pain management was a significant mediator between barriers to using analgesics and analgesic adherence. This research provides evidence supporting the effectiveness of a pain education programme for patients and their family members in increasing patient satisfaction with regard to the management of cancer pain. It is important for health providers to consider patient satisfaction when attempting to improve adherence to pain management regimes in a clinical setting. [ABSTRACT FROM AUTHOR].

9. Prospective observational study of postoperative epidural analgesia for major abdominal surgery
By Duncan, Fiona. Journal of Clinical Nursing. Jul2011, Vol. 20 Issue 13/14: p1870-1879
Abstract:
To describe the incidence and intensity of pain, hypotension and other epidural-related side-effects after major abdominal surgery and to identify factors associated with effective epidural analgesia. Evidence exists that up to 30% of patients with epidural analgesia still experience severe pain in clinical practice. When epidurals produce good pain relief, potentially harmful side effects can result. Data were collected prospectively from 480 consecutive general surgical patients in a large District General Hospital in the UK. Fifty-six per cent of patients were hypotensive on day one. Low pain scores were found to be a predicator for postoperative hypotension. Severe pain was associated with emergency patients, male gender, the absence of hypotension and an epidural that did not continue until planned removal. Significantly lower mean pain scores were found in patients who were 70 years of age and over. No correlation exists between chronic pain before surgery and the level of postoperative pain. This study contributes to the epidural versus standard analgesia debate by describing the population in whom epidurals are used and identifies factors associated with both the success and failure of the technique in everyday practice. The Audit Commission has proposed a standard whereby less than 5% of patients should suffer severe pain following surgery. This may prove to be an unrealistic goal with currently available techniques. As it is ward nursing staff who are primarily responsible for monitoring the effectiveness of the technique, it is important for nursing professionals to know the potential risks of postoperative epidural analgesia to be able to respond appropriately. The important measurements of an optimum acute pain assessment have been identified, based on the study results, allowing the development of a national acute pain registry to inform future practice. [ABSTRACT FROM AUTHOR].

10. The relationships between uncertainty and its antecedents in Korean patients with atrial fibrillation
By Younhee Kang. Journal of Clinical Nursing. Jul2011, Vol. 20 Issue 13/14: p1880-1886
Abstract:
The aim of the study was to examine the relationships between uncertainty and its antecedents, including education, social support and symptom frequency in Korean patients with atrial fibrillation. The antecedents of uncertainty were theoretically identified from Mishel's theory of uncertainty in illness. There is a need to examine empirically whether theoretically driven antecedents of uncertainty work in a way that the theory proposed. Descriptive correlational and cross-sectional survey design. Subjects were interviewed using structured study questionnaires. The data collected were statistically analysed by descriptive statistics and hierarchical regression analysis to determine the effects of antecedents on uncertainty. A convenience sample of 109 subjects recruited from three academic medical centres in South Korea. The overall model significantly explained 20·1% of the variance in uncertainty. Among antecedents of uncertainty, social support was significantly associated with less uncertainty (ß = -0·26), while the education was not associated with uncertainty. Persons with greater social supports perceived less uncertainty, and individuals with greater symptom frequency reported greater uncertainty (ß = 0·21). In Korean patients with atrial fibrillation, it was demonstrated that uncertainty in atrial fibrillation patients was predicted by social support and symptom frequency. Thus, the nursing strategies that reduce uncertainty which results in undesirable outcomes are required through maximising the social support patients perceived and minimising the symptom frequency. Therefore, these findings are relevant to clinical nurses who take care of patients with atrial fibrillation in terms of decreasing uncertainty that might result in patients' psychological distress. The findings from this study may be beneficial for clinical nurses to understand and assess the psychosocial and emotional needs of patients with atrial fibrillation. [ABSTRACT FROM AUTHOR].

11. Factors influencing iron nutrition among one-year-old healthy children in Sweden
By Bramhagen, Ann-Cathrine; Svahn, Johan; Hallström, Inger; Axelsson, Irene. Journal of Clinical Nursing. Jul 2011, Vol. 20 Issue 13/14: p1887-1894
Abstract
: To describe possible social, nutritional and biological factors influencing iron intake and iron status among healthy one-year-old children in southern Sweden. Iron deficiency is one of the most important nutritional disorders and increases the risk of delayed mental and motor development. Children are at risk because of rapid growth, which entails relatively high requirements of iron. A prospective study using survey methods. Randomly selected one-year-old children ( n = 90) and their parents participated. Parents answered a questionnaire enquiring about demographic data and the child's feeding and health during the first year. The child's total food intake and blood samples (haemoglobin, mean corpuscular volume, S-ferritin and transferring receptor) were obtained. Twenty-seven per cent of the children had an iron intake below the Nordic Nutrition Recommendations of 8 mg/day (). Follow-on formula and iron-fortified porridge contributed to 64% of the child's total iron intake. Partial breastfeeding and low maternal education correlated negatively with iron intake from complementary food. In total, 10·3% ( n = 9) of the children were found to be iron-depleted (S-ferritin =12 µg/l), and 2·3% ( n = 2) had iron deficiency with or without anaemia (Hb =100 g/l). One-year-old children in Sweden may be at risk of developing iron deficiency, but information about iron-rich food can improve iron status. Knowledge about factors influencing children's iron intake and iron status may improve the nutritional advice and education from the Child Health Services to prevent or detect iron deficiency. [ABSTRACT FROM AUTHOR].

12. The prevalence of urinary incontinence among women and men with chronic obstructive pulmonary disease in Sweden
By Hrisanfow, Elisabet; Hägglund, Doris. Journal of Clinical Nursing. Jul 2011, Vol. 20 Issue 13/14: p1895-1905
Abstract:
The aims of the present study were to investigate the prevalence, characteristics and status of urinary incontinence among women and men with chronic obstructive pulmonary disease in primary health care. Information on the prevalence of urinary incontinence in women and men with chronic obstructive pulmonary disease is scant. Such knowledge may be important to the development of care for patients with chronic obstructive pulmonary disease. A questionnaire survey. The study included 391 women and 337 men, aged 50-75 years, with chronic obstructive pulmonary disease. A self-administered, evidence-based questionnaire for incontinence was used. A response rate of 66% was obtained, of which 89·3% had spirometry-confirmed chronic obstructive pulmonary disease, and most patients had been diagnosed with moderate (Stage II) chronic obstructive pulmonary disease. The prevalence of urinary incontinence in women and men with chronic obstructive pulmonary disease was 49·6 and 30·3%, respectively. Women and men with urinary incontinence had a significantly higher body mass index than did women and men without urinary incontinence. The most common type of incontinence in women was stress incontinence (52·4%) and in men postmicturition dribbling (66·3%). Women with urinary incontinence had a higher presence of a symptomatic cough than did women without urinary incontinence ( p < 0·001). On the whole, incontinence affected women more than men concerning experienced bothersomeness of incontinence ( p < 0·001). More women than men with urinary incontinence refrained from activities ( p < 0·021) and had sought help for incontinence ( p < 0·012). The present results indicate that urinary incontinence content should be included in care plans for patients living with chronic obstructive pulmonary disease. In addition, the results imply that nurses and physicians working in primary health care should ask patients with chronic obstructive pulmonary disease about urinary incontinence and then offer appropriate assessment and management of it. In the context of primary health care, assessing and managing urinary incontinence should be included in care plans for patients living with chronic obstructive pulmonary disease. [ABSTRACT FROM AUTHOR].

13. From Primary Health Care: The RCN Community Health Nursing Journal, July 2012, Volume 22, Number 6
Editorial
13A.
Let the voluntary sector help
News and analysis
13B
. 'Appalling' variations in diabetes care across the UK
13C. 'Creeping tragedy' of decline in district nurse numbers - Christian Duffin reveals what is happening in community settings
13D.  Taking health care to young people - Julie Penfold reports on an innovative service in London
13E. Join the debate online - Do patients with diabetes on your practice list get all the correct checks?
Opinion
13F
. A history of useless remedies - Roy Lilley questions why venous leg ulcers remain a major health cost
Features
13G
. Reducing the risk of lower limb lymphoedema - Ways in which nurses can help patients reduce infection associated with this long-term condition are described by Denise Hardy
13H. Changes to medicines legislation - Molly Courtenay and Matt Griffiths discuss the law on controlled drugs
13I. From a service to a business: the development of a social enterprise -  Alison Hopkins reflects on setting up a community interest company
13J. Health needs of lesbians - Helen Barnes identifies the issues facing women who have sex with women and shows how services can be improved
Continuing professional development
13K.
Diagnosis, prevention and treatment of fungal infections - Nurses in primary care are well placed to offer advice about treatment and how to prevent the spread of fungal infections

News - National

14. New Briefing Paper asks What Will it Take?
A group of 80 New Zealand non-government organisations and child advocates are standing together to urge the Government to get it right for children in its forthcoming White Paper. A new briefing paper released today by UNICEF NZ, entitled What Will it Take, summarises the common themes from 80 organisations’ recent submissions to the Government’s Green Paper on Vulnerable Children
http://www.scoop.co.nz/stories/PO1207/S00130/80-organisations-form-collective-voice-for-nz-children.htm

15. UNICEF Briefing Paper July 2012
All Children  thriving, belonging, and achieving - what will it take?
http://www.unicef.org.nz/store/doc/Thriving,achieving,belongingwhatwillittakeBriefingPaper....pdf

16. Smokers who quit gain 5kg: study
ODT - Wed, 11 Jul 2012
Quitting smoking can lead on average to four to five kilograms of weight gain within a year but Australian experts say the benefits far outweigh the few extra pounds. A large international study published in the British Medical Journal on Tuesday analysed 62 clinical trials of people who sought medical help to stop smoking.
After 12 months of abstinence people gained on average four to five kilograms. However, 16 to 21 per cent of people actually lost weight.
http://www.odt.co.nz/lifestyle/health-fitness/diet-nutrition/216677/smokers-who-quit-gain-5kg-study

17. Teen sex a health issue
The Press - 8 July 2012
Are teenage girls putting their health at risk because of our relaxed attitude to sex? Michelle Robinson reports. Sex educators need to make young people more aware of the health risks involved in sex, and the benefits of abstinence until adulthood, American psychiatrist Dr Miriam Grossman says. Speaking at the recent annual Forum on the Family conference, she criticised the health information offered by both Family Planning and Rainbow Youth, for not emphasising the importance of putting off sex. "It's not a moral issue, it's a health measure." Teenage girls were vulnerable to sexually transmitted infections, which can cause lifelong fertility problems because the lining of the cervix is still developing and is less resistant to infection, Grossman said. "That's why girls are getting cervical cancer and infections."
http://www.stuff.co.nz/the-press/lifestyle/7241271/Teen-sex-a-health-issue

News - International

18. Aussie schoolboys to get Gardasil
Nine News - 12 July 2012
In a world first, Australian schoolboys will be vaccinated against conditions such as genital warts, and some cancers, under a new immunisation program announced by the federal government. The Gardasil vaccine protects against four types of the human papillomavirus (HPV) and is already being administered to Australian girls under a program introduced in 2007. HPV is associated with a range of cancers, including genital warts and cervical cancer.
http://news.ninemsn.com.au/health/8498150/aussie-schoolboys-to-get-gardasil

19. Elderly 'betrayed’ over care funding reform
The Telegraph - 11 July 2012
Charities and campaign groups accused Andrew Lansley, the Health Secretary, of betrayal after ministers failed to commit extra money to help pay for personal care. But Whitehall sources said it was “entirely possible” that there would be no reform to care funding at all, leaving vulnerable adults facing unlimited costs.
Officials estimate that 40,000 elderly or disabled people a year are forced to sell their homes to pay for long-term care.
http://www.telegraph.co.uk/health/elderhealth/9393742/Elderly-betrayed-over-care-funding-reform.html

 

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