Management review of nursing systems

This paper describes the systems of nursing operating at a major cancer centre in the United Kingdom. The review was undertaken over a period of 8 weeks and 11 wards were included. The systems being implemented were primary nursing, team nursing and patient allocation. Methods of enquiry included questionnaires, non-participative observation and interviews. The results of the review found the nursing systems to be at various stages of implementation, and that in reality, not all wards were operating the system they said they were. A pragmatic mixture of team nursing and primary nursing as described by Hegyvary (1982) was being practised on some of the wards. The report makes recommendations for change, and concludes by discussing the future implications for cancer nursing at the centre.     

Patient-centred evaluation and rehabilitative care

The evaluation of health care outcomes is becoming increasingly important in today's health service The wide range of measures used to evaluate these outcomes often makes clinical audit difficult and the comparison of research papers almost impossible In this paper we will discuss some of the issues surrounding outcome measurement in rehabilitative care, examine one of the most commonly used outcome measures from this area (the Barthel Index) and consider Goal Attainment Scaling, a technique which offers both clinicians and researchers the opportunity to evaluate health care outcomes on the basis of patient-centred practice We have identified certain methodological problems that need to be addressed if Goal Attainment Scaling is to become an acceptable measure in the area of physical rehabilitative care     

Pilot study of Sandostatin (octreotide) therapy of refractory HIV-associated diarrhea

Seventeen AIDS patients were enrolled in a prospective open-label dose-finding study of octreotide (Sandostatin) therapy for refractory diarrhea. Five were nonevaluable due to progression of AIDS symptomatology, and one was excluded because of lack of confirmation of HIV infection. Five of 11 evaluable patients responded to therapy (45%); two each at 50 g and 100 g, and one at 250 g thrice daily doses. A sixth patient demonstrated a moderate reduction in stool volume at 250 g thrice daily, which, although deemed clinically relevant, did not meet the criteria for response. On discontinuation of therapy, diarrhea recurred in all patients within 1–12 days, and responded to reinitiation of octreotide in those five patients who resumed treatment. Only one of the three patients with concurrent cryptosporidial infection responded to treatment. The drug was well tolerated, with mild symptomatology in three patients. Long-term treatment at a stable dose was effective in three of five treated patients for periods for seven months in one (moderate responder) and one year in two. One patient required dose increases to control symptoms, but after one year of treatment developed severe nausea following injections, which required dose cessation. One patient had partial control of his diarrhea for only three months despite two dose increases. These data suggest that octreotide may be of useful therapeutic value in HIV-associated diarrhea and that further studies are indicated.This study was supported by Sandoz Canada Inc.     

Students'' expectations of postregistration degree programmes

The needs of postregistration students pursuing degree-linked clinical courses have received little attention and there are few insights concerning their aspirations when they enrol on such courses. Thus the aim of this study was to explore postregistration students' perceptions of the specific needs of their patient/client group and to examine how they envisaged the course on which they had just enrolled might help them to meet these needs in addition to their own requirements for professional and personal development. Data were collected by group interview from 62 students enrolling on eight different postregistration courses, all employed in an acute hospital trust. The results were analysed inductively. They indicated that students had internalized the state of the healthcare market and were keenly aware of the need to fulfil the expectations of employers and the public, while fulfilling their own needs for education and pursuing their own professional and career trajectories. They appeared ambitious and yet appeared to demonstrate empathy for patients and their families and felt a tremendous desire to provide care of a high quality through the optimal development of technical expertise. Students' emphasis on the importance of keeping abreast of technological developments should not be lightly dismissed considering its prominent position within the acute areas where they were employed, especially as it did not replace their desire to promote the caring aspects of their work.     

An inquiry into the attitudes of qualified nursing staff towards the use of individualized nursing care plans as a teaching tool

This paper summarizes a research study inquiring into the attitudes of qualified nursing staff towards the use of individualized nursing care plans as a teaching tool. The survey was conducted in medical and surgical wards used for nurse training, in two hospitals. In common with many hospitals, the introduction ofthe nursing process into the surgical wards is of more recent origin than the medical areas, so would this be reflected in the attitudes of staff? Results indicated an overall positive attitude of all staff, although significant differences were identified between the grades of staff participating in the study and between the two hospitals. There was no significant difference shown in the comparison of all surgical staff with all medical staff, but the ward sister demonstrated a more positive attitude than staff nurses or enrolled nurses. The length of time care plans had been in use and whether the Open University Programme P553 had been completed, were taken into consideration. Analysis ofthe individual statements which clustered around the same theme is discussed. Possible factors affecting the attitudes identified are suggested and recommendations which include ongoing educational support, in particular for the enrolled nurse, and exploration ofthe ‘role model’ function ofthe ward sister made. Finally, the method of study is critically examined.     

A literature review regarding the management of varicella‐zoster virus

Chickenpox and shingles (varicella‐zoster virus [VZV]) pose a threat to individuals who are immunosuppressed and/or have rheumatoid arthritis or another inflammatory musculoskeletal condition. In this paper we present a literature review of the condition, management and prevention. Copyright © 2010 John Wiley & Sons, Ltd.     

A discussion of the legal aspects of female genital mutilation

The purpose of this paper is to examine the position of the nurse/midwife in the United Kingdom when involved with the care of a woman or female child who has suffered genital mutilation, which is an illegal practice in this country and most other areas of the world. The types of circumcision commonly practised are introduced, the prevalent reasons for the continuation of the practice among certain ethnic groups are presented, and the range of issues to be considered by the nurse is examined. These include international and national legal aspects which do not exist in isolation and are considered in context with cultural, medical, human rights and gender issues. Nursing legal issues include child protection, consent, advocacy and confidentiality, which invoke the Code Of Professional Conduct of the United Kingdom Central Council for Nursing Midwifery & Health Visiting. Midwives and nurses working in the field of gynaecology have raised questions regarding possible courses of action to take when presented with this issue. Increased knowledge can help to inform those decisions. Therefore, implications for future practice are addressed, together with recommendations to assist nurses with decision making when faced with this scenario in the future.