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Intermittent self-catheterisation (ISC) is the method of choice for men with lower urinary tract symptoms who need to drain retained urine from the bladder. It is preferred to using an indwelling urinary catheter as it has lower risks of complications and catheter-associated urinary tract infection. Learning ISC can be challenging for men initially but, with the support of knowledgeable nurses experienced in teaching ISC, the technique can be learned, accepted and normalised, improving symptom control and quality of life. This paper discusses the results of a survey exploring men's experiences of learning ISC with the Hydrosil Go™ (C.R. Bard Inc—now part of Becton, Dickinson and Company) silicone catheter and to highlight issues important to men when learning and living with ISC. The survey collected data from four countries: UK, France, Netherlands and Italy. It aims to help nurses who teach ISC and inform them to discuss what matters to men when learning and living with ISC. [ABSTRACT FROM AUTHOR]

Maintaining competence and keeping skills and knowledge in children's orthopaedic nursing alive are problematic in both the UK and Australia. The dearth of dedicated postgraduate courses for this specialty has resulted in an array of unregulated in-house training, nurses' individual educational needs not being met and potential for children with an orthopaedic problem being put at risk of not receiving optimal care. This paper reports on a travel scholarship used to compare and contrast the UK with Australia, which supported an international scoping exercise to identify nurses' beliefs regarding expertise in children's orthopaedic nursing and explore provision for maintaining pertinent knowledge and skills. Potential ways to improve support for nurses in maintaining expertise in this field of practice are discussed. [ABSTRACT FROM AUTHOR]

This review paper explores the use of telehealth in relation to palliative care in the UK. Information technology (IT) developments are being harnessed throughout society, and there is growing interest in the ways in which they can be used to meet and support patients' health needs in the community. The aim of the literature review was to scope the information available from published and unpublished research, with particular reference to older people. The evidence suggests that, despite the challenges, there are numerous examples of good practice in relation to telehealth, palliative and end-of-life care, and older people. Developments in technology that have increased the capacity to improve care, through reaching greater numbers of people of all age groups, mean that telehealth has much to offer people living with and dying from advanced illness. However, some of the evaluative evidence is limited and further rigour is needed when evaluating future telehealth innovations. [ABSTRACT FROM AUTHOR]

Demand for district nursing services is increasing significantly. With increasing economic pressures, services are struggling to meet increases in demand, and are looking to become more proactive in planning for future demand. Traditional quantitative forecasting methods have limited use, because of the complexity of inter-linking factors that potentially drive demand for community services. Qualitative system dynamics approaches can be useful to model the complex interplay of causal factors leading to an effect, such as increased demand for services, and identify particular areas of concern for future focus. We ran a facilitated qualitative system dynamics workshop with representatives working across community nursing services in Cornwall. The generated models identified 7 key areas of concern that could be significantly contributing to demand for district nursing services. We outline the identified problem areas in this paper, and discuss potential recommendations to reduce their effects based on causal links identified in the models. [ABSTRACT FROM AUTHOR]

Background: Female genital mutilation affects an estimated 200 million women and girls worldwide. This article examines a midwife-led service that integrates health advocates and counsellors into a model of holistic woman-centred care and was the blueprint for new national clinics opened in 2019. Methods: This retrospective case note review examined referral patterns, clinical findings and interventions over 11 years at a UK specialist clinic for non-pregnant women with female genital mutilation. Results: More than 2000 consultations were conducted. Two thirds of women had type 3 mutilation. Most were Somali (73.4%) with 18 other ethnic backgrounds represented. Women presented with dysuria, dyspareunia/apareunia, dysmenorrhea, recurrent infections, post-traumatic stress disorder, nightmares, flashbacks and psychosexual issues. Interventions included deinfibulation under local anaesthetic (many as same day walk-in cases), clinical reports for asylum applications and trauma counselling. One in 10 attendees were healthcare professionals/carers. Nearly 5% were refugees/asylum seekers. There were 12 safeguarding referrals, three cases of mandatory reporting duty and two protection orders. Intersectional violence was frequently reported among women of West African origin. Conclusions: Significant numbers of non-pregnant women require specialist help. Innovative means to publicise clinics and routine enquiry during gynaecological consultations and GP registration, could ensure earlier signposting to services. Deinfibulation can be safely performed by an expert midwife in a community or outpatient setting. [ABSTRACT FROM AUTHOR]

While it is well known that team vision and values statements in nursing can promote person-centred care, practitioner role clarity and empowerment, and service effectiveness, especially during times of change, their use in district nursing is limited. Accepted practice is to formulate vision and values statements 'from the top', and then seek buy-in from other staff groups, however, this inhibits practitioner engagement. This paper describes the use of group facilitation, based on principle-centred leadership practices, to engage practitioners in all the creative aspects of developing a values statement. Increasing practitioner engagement would be expected to provide the above benefits by improving communication with service-users and other key stakeholders and by motivating performance evaluation and improvement. [ABSTRACT FROM AUTHOR]

Background: The UK Department of Health's End of Life Care Strategy highlighted the low percentage of patients who achieve their wish to die at home (~20%). Figures in south west London were below the London regional average. This paper reports an attempt to improve the proportion of patients from one hospital in the area achieving their preferred place of death. Methodology: A funded initiative by two local primary care trusts allowed the development of a 7-day-per-week fast-track discharge service provided by the hospital palliative care team. The hospital team acted as coordinators, ensured that the correct medication and equipment would be available at the home, and personally transferred the patients to community services. Results: Data is presented from the first representative period of fast-track discharging (June 2009-July 2010). A total of 110 discharges were facilitated over this time, with the rate increasing as the service developed. The vast majority of discharges occurred within 72 hours, and a significant number (~20%) occurred within 24 hours. Conclusions: The data indicate that the new service is effective. There are logistical problems in providing such a service and these are discussed. Further work is required to determine the feasibility of extending this service model to other acute hospitals and to evaluate its health-economic impact. [ABSTRACT FROM AUTHOR]

This paper, based on a presentation to the UK Association of Chief Children's Nurses, is the author's personal reflection on the nature and future of children's nursing research. Key constitutive elements of this concept are considered to arrive at the conclusion that children's nursing research is research undertaken by children's nurses into questions of relevance to children's nursing practice and services, or wider issues in which children's nursing has a vital role. Three possible futures are presented, of which only the last is positive and desirable: development in line with the reality of practice and population needs. An integrated approach is necessary, with responsibilities both for those in positions of authority in the service and for researchers themselves. In particular, this partnership is essential for children's nursing to evidence the impact of research and for children and young people to reap the greatest benefit from evidence-based practice. [ABSTRACT FROM AUTHOR]

Background: Urinary incontinence is a common and impactful condition. Despite the availability of incontinence pads specifically designed for the male form, many men use pads designed to fit the female anatomy. Aim: This clinical audit-based study compares female/unisex and male incontinence pads in male community patients with urinary incontinence. Method: A survey was used to collect Likert-scale data on overall satisfaction and satisfaction with specific aspects of female/unisex and male incontinence pads, as well as with their health and wellbeing and situation and attitudes before and after intervention. Qualitative data were collected on positive features of, reasons for dissatisfaction with and suggested changes to each pad. Results: Among 18 participants, and in all but one domain, satisfaction scores were higher for male pads overall, with the greatest increases in score (1-5) for physical coverage of genital area (1.5), ability to hold urine without leaks (1.4) and level of comfort when wet (1.3). Using a male pad had a positive impact on participants' sense of health and wellbeing. Positive qualitative feedback focused on comfort, ease of use and reliability, as well as the anatomical fit of the male pad. Conclusions: Sex-specific fit is an important factor in the acceptability of an incontinence pad for men with urinary incontinence. Wearing pads specifically designed for the male anatomy provides men with a greater sense of comfort and confidence. [ABSTRACT FROM AUTHOR]

In the UK there has been a widespread introduction of 'anticipatory prescribing' in community based palliative care. This involves general practitioners (GPs) writing prescriptions in anticipation of them being needed and has been encouraged to try to minimise the risk of patients suffering uncontrolled symptoms and distress; a key reason why terminally ill patients are admitted to hospital in contradiction of most people's preferences. This paper presents the findings from an ethnographic study of healthcare professionals across four care homes and four community sites in two regions (East Midlands and Lancashire/South Cumbria) of the UK. Data were collected from a range of community health professionals, resulting in 83 episodes of observation and 72 interviews. Findings highlight how essential good interdisciplinary communication is to the process of anticipatory prescribing and end-of-life care. This study found that when interdisciplinary communication worked well the anticipatory prescribing process could be carried out smoothly, optimising patient care. [ABSTRACT FROM AUTHOR]

Background: Lifestyle impacts the health of kidney transplant recipients (KTRs) who are at risk of weight gain, post-transplantation diabetes mellitus and dyslipidaemia. Their capacity to self-care is key to adapting the lifestyle choices that impact their health. Aims: This qualitative study aimed to understand KTRs' lifestyle choices in relation to their post-transplant life and explore the impact of support provided by healthcare professionals (HCPs) and significant others on KTR's self-care. Methods: The project involved 33 participants who were involved in one of five focus groups, or 15 one-to-one semi-structured interviews. The participants were KTRs who had received a transplant over 6 months or more ago, their significant others and healthcare professionals. Participants were all selected from one UK transplant centre. Purposive sampling ensured both a diversity of KTRs and a range of professionals participating, with data analysed using thematic framework analysis. Findings: The authors report on a number of selected themes. These themes draw from a larger, more extensive analysis and conceptual framework concerning health, wellbeing and lifestyle, and they identify how effective health communicative interactions and health literacy plays an integral role in developing KTRs' self-care. Conclusion: Supporting KTR's lifestyle choices post-transplant involves building self-care capacity through effective health communication and health literacy. [ABSTRACT FROM AUTHOR]

Research is vital to the future development of hospice care. However, research in hospice settings is very challenging. This paper describes a case study of a successful multidisciplinary research team approach (MDRT) to the recruitment of participants (hospice patients, family members and health professionals) for a study in a hospice setting on the economic evaluation of end-of-life care. A successful recruitment plan includes three key strategies: identifying key members of the MDRT early in the research process; having a clear and constant communication stream; and creating an environment where all team members have a shared commitment to the research, all voices are heard and valued, and everyone contributes to the research aims. An MDRT approach will be helpful to guide the development of successful recruitment plans for academic-community research partnerships in the hospice setting. [ABSTRACT FROM AUTHOR]

Background: With increasing demand for nursing services worldwide, the onus is on healthcare systems to implement measures to improve retention. The DAISY Award was designed to celebrate nursing with the suggestion that it may improve staff retention. Aim: To describe the experience and impact of winning the DAISY Award. Method: Data were collected through virtual semistructured interviews from award winners (n=4), nominees (n=4) and nominators (n=4). An analytical framework was developed to allow the responses of the three groups to be compared. Findings: Four major themes emerged from the responses: awareness of the DAISY Award; the nomination process, the impact on retention and winner benefits. Conclusion: Being nominated or winning a DAISY Award had a positive impact on nurses' feelings towards their role. This was a small evaluation in a single organisation, so the value of adopting the DAISY Award for recognising nurses' contributions to patient care merits further investigation, especially with regards to its effects on retention. [ABSTRACT FROM AUTHOR]

Background: Evidence acknowledges inequalities to progression and achievement for black, Asian and minority ethnic students within higher education, as well as barriers for promotion of black, Asian and minority ethnic staff within the NHS. In the UK, legislation and regulatory guidance requires students studying undergraduate midwifery to undertake their programme across both these institutions. Aims: To understand the experiences of black, Asian and minority ethnic students studying undergraduate midwifery at a UK university. Methods: This qualitative study used semi-structured interviews with five student midwives who identified as black, Asian or minority ethnic from a university, conducted by a peer researcher. Thematic analysis was used to analyse anonymised transcript data. Results: Three key themes were identified: 'invisibility', 'emerging visibility' and 'managing visibility'. Participants experienced a monocultural focus in the curriculum and in practice and were exposed to racist behaviours, causing them to modify behaviours. Conclusions: A need for diverse teaching materials and cultural inclusivity across institutions was identified to help combat outdated systemic Eurocentric practices and support the implementation of recently published midwifery standards. [ABSTRACT FROM AUTHOR]

Scant empirical information exists regarding the quality of district nursing (DN) services. This article reports the testing of 31 quality indicators (QI) in practice. Method: Twelve DN teams provided patient notes for audit. External auditors completed audit forms by cross-referencing between DN office records, patient notes from home, electronic GP records and discussions with DN team leaders. A patient experience questionnaire was piloted. Findings: 277 (77%) patients' records were audited. Access to records was problematic. QIs required further refinement of their wording, modification of inclusion criteria, deletion of some QIs and inclusion of others. Telephone administration of the patient experience questionnaire was not feasible for the DN patient population. Conclusions: QIs can not be used 'off the shelf' and need testing and modification before routine use. Trained, external auditors with clinical backgrounds ensure an informed, uniform, objective approach to data collection, which is desirable as QIs might inform commissioners in a competitive field in future. [ABSTRACT FROM AUTHOR]

Objective: This service evaluation aimed to collect data on clinical handover on labour ward and compare them with the local guideline. Design and methods: This service evaluation was structured in four stages, each using a different design and research methods. Setting: The study was undertaken between September 2013 and August 2014 in a maternity unit in a large NHS teaching hospital in London, UK. Findings and conclusion: Communication breakdown is widely considered to be a significant factor contributing to poor patient outcomes, with handover being a major risk point. The discrepancy between the local guideline and current clinical practice reinforces the belief that urgent action is needed to improve clinical handover on labour ward. The results of this service evaluation suggest that a drastic overhaul of the communication model during handover should be considered, ie from handover to takeover, and that the mnemonic SBAR may not be fit-for-purpose in maternity care and should be replaced with a different format that reflects the chronological flow of clinical events. [ABSTRACT FROM AUTHOR]

Aim: To analyse how midwives communicate Down syndrome screening information and explore whether women's understanding of this information is influenced by midwives' communicative style. Methods: Midwives (n=16) and women (n=100) were recruited from a regional NHS unit in the UK. A mixed-methods design encompassed two components; audio-recorded antenatal consultations to assess midwives' communication and quantitative surveys to assess women's understanding. Findings: Midwife communication was not significantly related to women's understanding of Down syndrome screening information. However, qualitative thematic analysis revealed midwife communication was often insufficient in fully describing Down syndrome and screening. Communication was not very interactive, midwives dominated conversations and did not sufficiently check women's knowledge/understanding. Conclusions: Policymakers need to consider these findings. Deficits in midwife communication in relation to established screening practice needs to be addressed through additional training ahead of full implementation of non-invasive prenatal testing into midwifery practice. [ABSTRACT FROM AUTHOR]

Introduction: Vaccines in pregnancy can minimise diseases with associated high morbidity and mortality in pregnant women, their unborn and newly born infants. Immunisations against influenza and pertussis are routinely offered in pregnancy in a number of countries including the UK, US, Australia and Belgium, but vaccine uptake could be improved. Methods: In January 2013, an online survey of pregnant women and women with children under 2 years of age was undertaken. The survey focused on vaccination in pregnancy. Results and conclusions: Of 1892 respondents, the majority indicated they definitely, or probably, would accept a nationally-approved vaccine offered by their midwife or GP during pregnancy for their own protection (94%) and/or to protect their baby when it was born (96%). Vaccine safety for the baby and for the woman, vaccine effectiveness and perceived seriousness of the disease remain key considerations for women. Health professionals, midwives in particular, are pivotal in informing women, promoting the vaccine and discussing concerns. [ABSTRACT FROM AUTHOR]

Background/Aims: Appropriate footwear is regarded as an important component of falls prevention in older people. Scant data exists regarding the types of footwear older patients wear in hospital, which may hinder the development of future interventions in this high-risk fall group. To address this, we conducted a service evaluation to examine and describe the style and quality of footwear worn by older patients in hospital. Methods: The footwear of older patients admitted to an acute NHS trust in England was assessed using the Footwear Assessment Tool. Patients were interviewed about their footwear choices. Results: A total of 730 pairs of footwear from 675 patients were assessed. The most common types of footwear worn were slippers (46%) and gripper socks (37%). Much of the footwear had a good fit, but over 50% lacked adequate structure, stability and support, more than 60% had no cushioning and 60% had no fixation. Approximately 60% of footwear was more than 12 months old, with signs of moderate to excess wear. Patients valued comfort and the familiarity of their own footwear. Conclusions: This service evaluation provides new information on footwear worn by older inpatients in hospital. Many patients are wearing footwear with insufficient structure to promote optimal stability or gait. Providing safe footwear that is suitable for use in hospital is potentially a low-technology and resource-efficient way to promote safety in older patients. [ABSTRACT FROM AUTHOR]

Objective: To study midwives’ knowledge, practice and opinions regarding advice about fetal alcohol syndrome (FAS), fetal alcohol spectrum disorders (FASDs) and alcohol intake in pregnancy. Design: A postal questionnaire was sent to 1862 midwives employed in 13 NHS Trusts in East Anglia, incorporating city and rural areas. Results: The authors received responses from 33.5% of the midwives contacted (n=624), of which 98% stated that alcohol abstinence in pregnancy would be their preferred advice, and 38% had seen an infant with FAS. Less than 2% indicated that they were ‘very prepared’ to deal with the subject. Only 10% identified all four classic features of FAS. Conclusions: More than a third of midwives had seen an infant with FAS. The advice given to pregnant mothers by participants varied. The midwives stated that they would like more information and support. Implications for practice: Expansion of midwives’ knowledge should improve the quality of antenatal advice, leading to better prevention, intervention and recognition of FASD in children. [ABSTRACT FROM AUTHOR]

A Cochrane systematic review has shown midwifery-led continuity models of care provide explicit benefits for mothers and babies compared with other models of maternity care, with a comparable level of safety. This study explored the local impact of the review, alongside other midwifery-led care evidence and guidelines. Electronic surveys were undertaken exploring women’s and health professionals’ awareness of models of maternity care evidence, including midwifery-led care and homebirth, and how they use evidence to guide their choices and practice. A low awareness of much of the available evidence was shown among the women and the professionals. There is a need for better dissemination of information to professionals as they are women’s preferred source of information about the options available for place of birth and midwifery-led care. [ABSTRACT FROM AUTHOR]

Background: Although informal end-of-life care is associated with significant physical and psychological morbidity for caregivers, few interventions have been developed to meet these needs. This study aimed to identify existing coping and support mechanisms among informal cancer caregivers in order to inform intervention development. Method: One-to-one semi-structured qualitative interviews were undertaken with 20 informal cancer caregivers of home palliative care patients. Results: Caregivers' existing coping strategies included distraction, mental stimulation, emotional release, looking for the positive aspects of caregiving, and disengaging from stressful thoughts. The majority of the participants described the importance of support and understanding from family and friends. Conclusions: The data suggests that feasible and acceptable interventions will be those that are targeted to caregivers to assist them in optimising existing coping strategies and support from family and friends. [ABSTRACT FROM AUTHOR]

The author focuses on the problems to gathering evidence in research for tissue viability in Great Britain. He cites the limited funding resources available to conduct research and adds that the focus of the grants is on the professional development of individuals. He notes the length of time needed to obtain ethical and research governance approval from local research ethics committees (LRECs). He explains why the dissemination of research findings can be a barrier.

Objective: To investigate and evaluate the effect of 20 commercial wound dressings on the pH values of selected fluids upon contact, over a period of 7 days. Method: The effect of the dressings on the pH of two different solutions, solution A (2.298g sodium chloride [NaCl], 0.368g calcium chloride [CaCl2] dihydrate added to 1 litre of de-ionised water) and distilled water, was investigated over a period of 7 days. Two different methods for contacting fluid with the dressings were used, to simulate wounds with different levels of exudate: i) immersing the dressing in 35ml fluid, and ii) adding 5ml drop-wise onto the dressing's absorbent pad on a daily basis. Results: On immersion of the dressings, the pH values of the fluids changed quite appreciably over time, with similar results for both methods. The lowest pH values were found with the hydrocolloid dressings, for both solution A and distilled water. The foam dressings had an alkaline effect on the fluids; in most cases, they increased the fluid's pH significantly. The non-woven dressings reduced the pH of both fluids to a lesser extent than the hydrocolloid dressings. The hydroactive dressings decreased the pH value of solution A and increased the pH of distilled water. Conclusion: This study demonstrates that the pH values of the fluids are not constant, likely due to the complicated nature of the dressings' chemical structures and designs. Thus, optimisation of pH level to meet the requirements of any specific wound types and healing processes must consider the complex nature of the dressing. The increase in pH value of the wound over time needs to be minimised in order to maximise the effectiveness of the healing therapy. Declaration of interest: This work was supported by a financial grant from the Turkish Council of Higher Education in collaboration with Marmara University, Turkey and the University of Bolton, UK. The authors have no conflict of interest to declare. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Perinatal psychiatric illnesses are a leading cause of maternal morbidity and mortality but difficulties still exist with the correct identification and management of these disorders. This study surveyed health professionals involved in the care of women with maternal mental health disorders and identified where improvements are required. Midwives, obstetricians and health visitors were asked for their views on the identification, treatment and management of a range of perinatal mental health disorders. The results showed that participants lacked the required knowledge/ skills to identify and manage these disorders effectively and most had not received any specific pre-qualification or postgraduate training in perinatal mental health. Most requested additional support, including specialist advice, training and guidelines and agreed that all women with perinatal mental health disorders should have the support of specialized perinatal psychiatric services. Systems are needed to develop and maintain practitioners' knowledge and skills and to ensure improved access to specialist advice and support when required. [ABSTRACT FROM AUTHOR]