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An editorial is presented on RCN Wales Director delivered a warning over the introduction of registered nursing associates (RNAs). Topics on RCN Wales Director delivered a warning over the introduction of registered nursing associates (RNAs); and RCN this is a radical change in patient care in Wales and it was disappointed there had been no public consultation or scrutiny.

A pressure ulcer prevalence of 17.3% at Odense University Hospital in Denmark in 2010 prompted action and a quality improvement project was planned. This had two aims: to reduce pressure ulcers at the hospital by 50% and to have no pressure ulcers at or above category 3. An project was established with a steering committee, a pressure ulcer specialist nurse, local dedicated nurses and nurse assistants to implement a pressure ulcer bundle in clinical practice at all departments at the hospital. Six years later the pressure ulcer prevalence was down to approximately 2% and in 2018 only one stage 3 pressure ulcer occurred in the hospital. Pressure ulcer prevention is now incorporated into clinical practice in all departments at the hospital. [ABSTRACT FROM AUTHOR]

A survey was undertaken with the aim of identifying health professionals' understanding of wound exudate and their ability to assess and manage it. The survey was carried out at Wound Expo, which is a large annual event that provides generalist nurses with interactive education on the core aspects of wound care, including wound exudate. The sample comprised 223 delegates. Almost all delegates (89%) included exudate in every wound assessment, but only 20% based assessment of excess exudate on colour, viscosity and malodour, with the majority (67%) basing it on leakage and increased frequency of dressing changes. While almost all (94%) delegates said they always assess exudate colour and most (80%) that they always assess its viscosity, 18% did not understand the clinical significance of exudate colour and 29% were unable to correctly identify the characteristics of lowviscosity exudate. Furthermore, one quarter of the sample did not always take absorbency into account when selecting a wound dressing. The results indicate that exudate assessment is often subjective, and there is scope for greater use of wound exudate assessment tools and exudate descriptors. [ABSTRACT FROM AUTHOR]

This article describes a study to ascertain what it is like to follow the processes in practice for prevention and management of pressure ulcers as one aspect of care among others. The participants in this study were bands 5 and 6 staff nurses and healthcare assistants (HCAs) (n=72) recruited from two acute and two primary NHS trusts. Data were gathered from open-ended questions via an online survey (n=61) and interviews (n=11). The interviews were transcribed and all the data were analysed by thematic analysis. The findings show that participants believe there has been a high-profile imposition of guidelines and policies by management during at least the past 18 months, resulting in perceived good outcomes in the form of fewer pressure ulcers generally and less fragmentation of care, particularly within primary care. However, a number of perceived obstacles to the implementation of recommended interventions remain, notably lack of time and lack of knowledge. [ABSTRACT FROM AUTHOR]

In Britain the last decade has witnessed the growth of the assistant practitioner (AP), a higher-level support worker role situated at band 4 of the NHS career framework, just below registered nurse. Various factors are given for the role’s development but little analysis is provided as to the economic reasons for its implementation. With reference to the period since the economic crisis of 2007-08, this article proposes that the AP’s implementation and function is influenced by the needs of the economy. With the UK Coalition Government refusing to increase public expenditure as it is thought detrimental to economic growth, emphasising instead the need to reduce public debt, an expansion of registered nurses is unlikely despite growing service user demand. As a result, the AP has become an important economic development in an attempt to maintain standards of nursing care in the present economic climate. [ABSTRACT FROM AUTHOR]

This article aims to reflect on handovers that take place in respite settings--a healthcare setting with little mention in the literature. The author presents a reflective account of the practice of handover in one respite unit in south-east England. As these are the author’s own observations and experience, no reflective model has been used as a guide. The article also reports on the findings of a small web-based survey conducted by Facebook and email contacts that aimed to understand the attitudes of health professionals, mainly from the respite-care setting, towards the practice of clinical handover. The findings showed that handover is an important part of safer care practice and is highly valued by the respondents as being a planning and organising mechanism for better management of shifts. This paper concludes by raising awareness of the lack of information available about the practice of clinical handover in respite settings. It also suggests the need for an in-depth study on handover practice in respite care. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Nurses and healthcare assistants (HCAs) involved in tissue viability are expected to be competent, but there is little agreement over how to define competence or the expertise required by people filling different roles. Most training in England is provided in house by tissue viability nurses or interested non-specialists; England is lagging behind Scotland and Wales in terms of learning materials and other resources. Staff members at a strategic health authority were surveyed so a consensus could be reached over a basic curriculum for tissue viability and the competence expected of nurses and HCAs at different levels of seniority. Respondents agreed that five topics should be covered by both nurses and HCAs: wound healing; leg ulceration; pressure ulceration; diabetic foot; and skin care. Levels of expertise and competence would depend on seniority. The curriculum provides a checklist that local tissue viability nurses can use as a basis for training colleagues. Trusts and educational providers should set a curriculum for tissue viability and standards of competence. [ABSTRACT FROM AUTHOR]

To allay public apprehension regarding the risk of nurses' uniforms transmitting healthcare-associated infections (HCAI), national and local guidelines have been issued to control use, laundry and storage. This paper aims to measure the knowledge of registered nurses (RNs) and healthcare assistants (HCAs) working within a rural NHS foundation Trust and their adherence to the local infection prevention and control (IPC) standard regarding uniforms through a Trust-wide audit. Stratified random sampling selected 597 nursing staff and 399 responded (67%) by completing a short questionnaire based on the local standard. Responses were coded and transferred to SPSS (v. 17) for analysis. The audit found that nursing staff generally adhere to the guidelines, changing their uniforms daily and immediately upon accidental soiling, and wearing plastic aprons where indicated. At home, staff normally machine-wash and then iron their uniforms at the hottest setting. Nevertheless, few observe the local direction to place their newly-laundered uniforms in protective covers. This paper recommends a re-audit to compare compliance rates with baseline figures and further research into the reasons why compliance is lacking to sanction interventions for improvement, such as providing relevant staff education and re-introducing appropriate changing facilities. [ABSTRACT FROM AUTHOR]

Values are perceived to be a key determinant of people's behaviour and actions. There is a limited amount of research into the value that nurses place on the prevention of pressure ulcers, but past studies have suggested that nurses place a low value on pressure ulcer prevention. This article describes a study that was undertaken to ascertain what value nurses place on pressure ulcer prevention. The participants in this study (n=16) were recruited from the non-acute adult medical wards of 14 hospitals of one NHS trust and a local university. Data were gathered via semi-structured interviews, then transcribed and analysed via Straussian grounded theory. The findings of this study show that the value that nurses place on pressure ulcer prevention is important because all nurses attempt to work in line with the value that they place on pressure ulcer prevention. The nurses who place a high value on pressure ulcer prevention appear to be more proactive and determined to deliver care that protects the care of their patients' skin. However, the findings suggest that the efforts of nurses to prevent pressure ulcers are often impeded by environmental factors like bed management, and the differing values placed on ulcer prevention by colleagues. It also shows that interventions to protect the skin of patients are often undertaken by healthcare assistants and students because nurses are too busy carrying out other tasks. [ABSTRACT FROM AUTHOR]

The need to build capacity between allied health practitioners in the management of the diabetic foot is becoming increasingly important as the number of people diagnosed with diabetes mellitus rises globally each year. This rise in newly diagnosed patients, who often present asymptomatically, highlights the need for a significant shift in emphasis from simply treating those with long-term complications of the condition. Incorporation of public health initiatives to promote awareness and prevention of the potential decline in functional and emotional health, and the subsequent decreased quality of life in later years, must become the responsibility of health professionals, who are able to break down interdisciplinary barriers at the level of patient interaction. Traditionally, long-term macrovascular and microvascular manifestations of diabetes mellitus have led to a convenient division of care for people with diabetes between the health professions. As the evidence base increases to suggest a more holistic impact of the condition on general health, the need to build capacity within and between professions in the management and prevention of future disease processes has never been clearer. This article highlights key issues in the management of the diabetic foot, which are of paramount significance in the emergence, development and maintenance of interdisciplinary professional relationships [ABSTRACT FROM AUTHOR]

As UK society changes, with people living longer and with chronic conditions, and less people available of working age to provide nursing care, there is a need to re-think how healthcare is organized and delivered. This is likely to have an affect on the non-registered component of the health-care workforce. However, if patient safety is to be maintained, it is paramount that the competence of individuals taking on roles that were carried out by trained staff must be ensured. This pilot study of a competency tool, National Incremental Competencies in Healthcare Education (Niche), demonstrated that individuals could expand or change their role as a result of completing the educational package. The evaluation aims to examine the usefulness of this competency tool in preparing nursing assistants to take on new roles and meet patients' needs. [ABSTRACT FROM AUTHOR]

The article discusses efforts to improve the nursing handover process which deals with the transfer of patient care between registered nurses (RNs) and healthcare assistants (HCAs) in Great Britain, and it mentions communication breakdowns and patient care-related mistakes on clinical decision units (CDUs) at British hospitals. Questionnaires are addressed, along with patient safety and the Plan, Do Study, Act (PDSA) handover methodology.

Emeritus Professor Alan Glasper, from the University of Southampton, discusses a recently published report from the Government on the response to proposals concerning the regulation of nursing associates in England [ABSTRACT FROM AUTHOR]

The article presents a commentary of registered nursing associate (RNA) who have started career in the British National Health Service (NHS). According to the author, government cuts on social care system and the welfare, poverty and social deprivation, also Brexit negative impact on national income and public finances hits disadvantaged communities most.

An editorial is presented which addresses the Editor in Chief's views about the British Nursing and Midwifery Council's (NMC's) revalidation process for nurses and nursing associates, and it mentions how each nurse must demonstrate the continued ability to practise in a safe and effective manner. Renewal rates for nurses and midwives are examined, along with the NMC's "Code" which outlines the standards for revalidation and readmission to the agency's register of nurses and midwives.

The article discusses the work of the organization Foundation of Nursing Studies (FoNS) in relation to change in healthcare. Topics include the role of curiosity in the author's experiences as a nursing auxiliary, the significance of evidence-based approaches to nursing, and the author's desire for knowledge about medical research when serving as a registered nurse.

Jackie Stephen-Haynes, Professor in Tissue Viability, Professional Development Unit, Birmingham City University and Consultant Nurse, Worcestershire Health and Care NHS Trust [ABSTRACT FROM AUTHOR]

The article focuses on an independent review of health care assistants and support workers in British social care settings and Great Britain's National Health Service that was conducted by Camilla Cavendish, the associate editor of the British newspaper "The Times". In the article the author offers his opinions on several points raised in the review and on the impact the review will have on medical care in Great Britain.

The author reflects on a 2013 British government response to a report on patient abuse at a National Health Service (NHS) facility which was issued by attorney Robert Francis. In the article the author offers his opinions on arguments within the government's response which question the role of nurse mentors and suggest that all undergraduate nursing students seeking funding from the NHS should be required to serve as health care assistants for one year.

The article discusses a 2011 decision which the British government made to not regulate non-registered health care assistants and assistant practitioners. In the article the author offers his opinions on the decision and on the impact it may have on the quality of medical care in Great Britain and on patient safety.

The author reflects on medical care in Great Britain, the ankle brachial pressure index (ABPI), and the claim that nurses should not view patients as numbers. According to the article, healthcare assistants are becoming more involved in patient wound care and the treatment of patients with leg ulcers. Decision making in medicine is examined, along with delays in diagnosing and managing patients' medical problems. Ulcer management education and experience are assessed.

Elizabeth Rosser, Deputy Dean (Education and Professional Practice) and Professor of Nursing at Bournemouth University, discusses the consultation over the nursing associate role and its implications for nurses [ABSTRACT FROM AUTHOR]

The author explains the role of the nursing associate profession in improving delivery of healthcare services. Topics covered include challenges affecting the nursing profession in Great Britain like staff shortage, new English-language standards for foreign nurses and over-reliance on temporary nurses, benefits and risks of creating the nursing associate role, and the potential of nursing associates in managing nursing staff shortage.

The author reflects on the role of nursing associate to bridge the gap between healthcare support workers and registered nurses in the modern hospitals in London, England. He highlights the important development of nursing associates to provide quality medical services to the patients. The author cites the investment of the British government to improve appropriate education and training for the nursing associates.

The article discusses the education, continuing education, and training of medical personnel in Great Britain, specifically for nurses. The author comments on the role of the National Health Services, budgets, and employee recruitment of foreign nurses. Other topics include educational attainment of nurses, quality care, and labor supply in Great Britain.

The article offers advice on interpersonal relationships between nursing staff and junior staff, part of a series on relationships in the nursing workplace. Topics include the amount of delivery of clinical care by healthcare assistants (HCAs), the feeling that HCAs are undervalued due to low compensation, and ensuring that HCAs receive breaks. The importance of showing HCAs respect is noted.

In this article the author discusses a successful nurse recruitment initiative which was implemented at Milton Keynes Hospital National Health Service Foundation Trust in Great Britain with assistance from the facility's excellent reputation and a recruiting company called TMP Worldwide. She is supportive of the initiative and of having all health care facilities establish a positive reputation for medical care and employment.

With a new academic year commencing, Emma Botten, a newly qualified mental health nurse, gives an insight into her experience as a student nurse. She offers her top tips on how to make the most of these three years and prepare for a successful future career in nursing. [ABSTRACT FROM AUTHOR]

In this article the author reflects on a British government response to a report on patient abuse at a National Health Service health care facility which was conducted by British attorney Robert Francis. In the article the author offers her opinions on the British government's response and on the training of medical professionals in Great Britain.

In this article the author discusses the British government's 2013 report "Patients First and Foremost", which states that every student who seeks National Health Service funding for nursing degrees should first serve up to one year as a health care assistant. In the article the author offers her opinions on several points raised in the report and on strategies which universities can use tor recruit nursing applicants who possess the values needed in a nursing career.

The author reflects on the case of three British health care assistants who were arrested in 2012 for allegedly abusing patients at facilities run by Great Britain's National Health Service. He suggests that until there is registration and regulation for assistants in Great Britain, unethical assistants will be able to move from one health care facility to another. He argues that in 2012 the time for the required registration and regulation of health care assistants in Great Britain has come.

In the article the author reflects on the impact of Great Britain's all-graduate nurse policy on nursing skills. She believes that band four employees, who are primarily nursing assistants, will become an even more important part of the healthcare team. She also comments on the commissioning of nursing students by the Strategic Health Authorities (SHA).

The article presents excerpts and quotes from Eleanor Rathbone from an article originally published in the June 1909 issue of the journal concerning an experiment being tried at the Liverpool Industrial Council to establish the first nursing assistants. Rathbone refers to nurses' aids as "sick-room helpers" and describes them as women competent enough to attend to patients with slight illnesses and assist nurses for more serious cases. Funding for nursing assistants is discussed.

Presents a case study of a registered nurse on duty at a nursing home for the care of older people who violated the code of professional conduct for nurses in Great Britain. Role of the care assistant in supporting the registered nurse; Details of the incident wherein the nurse failed to administer drugs to nursing home residents; Charges against the nurse presented to Great Britain's Nursing and Midwifery Council.

A multidisciplinary formulary group was established to create a standardized approach to wound management throughout Carmarthenshire. It was felt that a tool to aid nurses' decision making in dressing selection might enhance the process of formulary implementation. This article outlines the development of the tool. An action-research approach was chosen to investigate the idea. The project followed a series of cycles consisting of planning, action, data collection and reflection. The first cycle confirmed the need for such a tool. A reference card was produced. As a result of data collected in the second cycle, the card was reproduced with suggested improvements. The improved tool was then evaluated in the third cycle. Minor adjustments and incorporation of the completed Carmarthenshire formulary took place during the fourth cycle. The Carmarthenshire formulary is now in use and accompanied by the reference card. [ABSTRACT FROM AUTHOR]

The article discusses the role of nursing auxiliary or healthcare assistant. The training for the role of auxiliary nurse or healthcare assistant is still very varied, despite the national vocational qualification system. There has always been an issue over the education and training of nursing aides. The profession of nursing has always been very cautious about formalizing or developing the training for nursing aides, and yet over the years it has been very dependent upon them. It is essential for the future of nursing and health care in Great Britain that professional nursing sorts out what the role of the nursing assistant is, or could be.

Editorial. Comments on the proposal for the proper investment in the education of healthcare assistants (HCA) to solve the critical shortage of registered nurses in Great Britain. Use of HCAs to carry out traditional nursing activities; Competency training of the assistants in certain aspects of health care.

Reports on the desire of up to 75 percent of healthcare assistants (HCA) to train to be qualified nurses to address the nursing labor shortage in Great Britain. Move into higher education as a deterrent to many HCAs moving into nurse education.