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Background: An 8-month rotation programme was implemented for five nurses employed in two kinds of children's palliative care environments: hospital wards and hospices. This study reports the views of the nurses completing the rotation. The research drew on appreciative inquiry and involved a pre- and post-rotation interview and questionnaire. Thematic analysis of the interviews revealed seven themes: adjusting to the rotation programme; support mechanisms; being safe; new knowledge and skills; knowledge exchange; misconceptions; future plans. These were supported by the questionnaire findings. Although the nurses identified some frustration at having to undertake competency assessments relating to previously acquired skills, as well as being out of their 'comfort zone', all the participants highly recommended the programme. They commented very positively on the support they received and the overall learning experience as well as the new insight into different aspects of care. In addition, they were able to share their newfound knowledge and expertise with others.

It is now common practice for preceptorship programmes to be offered to newly qualified nurses within the NHS. The Nursing and Midwifery Council expects newly qualified nurses to be given protected time for learning in their first year of qualified practice and to access support from a preceptor. This article discusses a preceptorship programme that has been implemented in a large integrated NHS Trust in north-west London and shares reflections and learning to date, which can benefit others wanting to roll out a similar programme in the UK.

Background: Patients with lymphoedema referred to a lymphoedema service from care homes in one health board area in Wales were often complex cases, with repeated cellulitis, a history of falls and other complications. A pilot project was initiated to develop education and raise awareness of lymphoedema among care home staff., Aims: To enable care staff to identify residents with lymphoedema, promote prompt referrals, raise the importance of skin care and exercise in the management of lymphoedema and estimate the likely costs from complications associated with lymphoedema., Methods: An education tool was developed and 47 care homes were asked to participate. A lymphoedema therapist carried out a scoping review of the residents., Results: Forty-four care homes agreed to participate in the project with 1216 education packs being issued to care home staff. Initial findings suggest that of the 960 residents reviewed, 262 had lymphoedema (27%); 4% suffered with frequent falls, 1% had wounds and 3% had recurrent cellulitis. Only 13% (35/262) of residents with lymphoedema were known to the local lymphoedema service. Of the 31 residents reporting cellulitis, 81% had lymphoedema; of the 11 residents identified with a wound, 100% had lymphoedema and of the 40 residents reporting falls, 70% had lymphoedema., Conclusion: This educational project has identified the value of raising awareness of lymphoedema within care homes.

Sam Foster , Chief Nurse, Oxford University Hospitals, considers the Government's promise of funding for continuing professional development, and calls for transparecy and further guidance.

Background: There is insufficient high-quality evidence to suggest that palliative care education can impact care home settings., Aims: To identify, appraise and synthesise all available evidence on the barriers and facilitators to providing palliative care education in residential and nursing care homes and to generate recommendations to increase the effectiveness of future palliative care education programmes in care homes., Methods: A rapid review searching CINAHL, Medline and ProQuest. One author screened full-text articles for inclusion. Any uncertainties were discussed with a second author., Findings: Twenty-two articles were included in the full review. Analysis of the included articles revealed the following overlapping themes: structural systems; cultural and personal issues; and knowledge translation issues with interaction., Conclusion: Addressing the barriers and facilitators when designing palliative care education programmes for care homes will lead to more successful outcomes.

Shortages in nursing are the single biggest and most urgent workforce issue that the NHS needs to address. This article sets out the early success of the Nurse Clinical Fellowship Programme established by The Royal Wolverhampton NHS Trust. The unique programme aims to attract and retain nurses by offering a staff nurse post with supported access to academia, fully funded by the NHS Trust. To date, the Trust has attracted 90 nurses (both UK and international registered nurses) to the programme. The programme is also offered internally and the Trust has a cohort of 10 internal nursing staff enrolled onto the programme completing either their BSc (top-up) or Masters, with a second cohort of 60 internal nurses due to start in September 2019. To support international registered nurses with demonstrating their competence to meet Nursing and Midwifery Council requirements the Trust has also established an objective structured clinical examination preparation course designed to embrace and enhance the existing knowledge and skills, while guiding staff in transferring these in line with UK and Trust policies and practices.

John Fowler, Educational Consultant, explores CPD for clinically based nurses.

Objective: To demonstrate the effectiveness of a simplified wound dressing regimen and develop a decision tree tool for wound management, for use by nurses in a residential aged care setting., Method: A three-phase process was used. Firstly, practice was audited, including a cost analysis of existing wound treatment. Secondly, staff were educated on wounds, wound care products and a simplified wound management protocol. In the final phase, the new wound care products and protocol used for skin tears and other wounds (as assessed by a nurse practitioner) were evaluated and ongoing education provided as required., Results: A total of 93 residents from two residential aged care facilities participated in the study. Overall, 178 wounds were identified, of which 121 were considered eligible for treatment under the new protocol. The majority of residents were aged >85 years and the major wound type was skin tears 72.7% (n=88). The mean healing time for skin tears was significantly shorter than for other wounds (19.7±14.2 days versus 30.9±25.2 days, p=0.0359). Most wounds were suitable for the simplified dressing selection regimen. Data collected from a survey of nursing staff demonstrated that the simplified protocol products were easy to apply, conformed well, were easy to remove and stayed in place. In addition, patient satisfaction was positive and removal of dressings was generally pain free., Conclusion: In summary, data collected from this project showed that the dressings were effective, performed well and simplified wound dressing selection for nursing staff.

Societies throughout the world are ageing and the proportion of people over 85 years of age is increasingly rapidly. In many countries a significant number of frail older people live in nursing care homes and will develop palliative care needs as they approach the end of their lives. In the United Kingdom around one fifth of those who die each year do so in a care home. Many of these will be cared for by generalist nurses and doctors without specific skills and knowledge in end-of-life care. Following a one-year pilot of the introduction of a nursing home facilitator post to introduce the principles of a palliative care approach into three nursing care homes for older people, the number of residents dying in hospital reduced by 25%.

Last year, urology nurses and continence nurse specialists took part in the second of two study days on urology. The events were delivered by the British Journal of Nursing with programme support in association with the British Association of Urology Nurses and Hollister Inc. Below are reports of some of the presentations.

John Fowler, independent education consultant, continues to explore the importance of leadership for clinically based nurses, focusing on staff training.

Mel Burden, Infection Prevention and Control Nurse Specialist, Royal Devon and Exeter Hospital, shares her experiences of volunteering as a nurse in Benin and South Africa, and reflects on the professional challenges.

This article provides an overview of approaches to and models of education to assist nurses involved in the delivery of education and continuing professional development. A number of models will be summarised to look at how learning, teaching and assessment can be integrated to benefit the learner, and the benefits this may have in nursing education and continuing professional development courses. The author also considers different domains of learning: cognitive, psychomotor and affective. This article presents the case for considering the constructive alignment of educational content as one means of increasing the likelihood of it being translated into practice.

Background: A pressure ulcer (PU) steering group was set up in Zhongda Hospital in China to develop a campaign to increase knowledge of PUs, to improve management and reduce incidence., Method: Questionnaires were completed by 275 nurses to ascertain their knowledge of PUs. The initial questionnaire indicated that the nurses had insufficient knowledge of PUs. The steering group then ran a campaign focusing on standardising the management of PUs. The measurement of PU knowledge for all nurses was tested after 2 years of training., Results: After 2 years, the nursing staff's knowledge of PUs had improved. Usage of the Braden scale had risen from (60.0±22.9) to (88.0±9.0) and showed a statistically significant difference (p<0.01). Moreover, the rate for patients reported as being at high risk of developing a PU had increased from 0.98% in 2012 to 1.24% in 2013, while the occurrence rate of PUs in the hospital had decreased from 0.09% in 2012 to 0.05% in 2013., Conclusion: The campaign significantly enhanced the knowledge of PUs and improved the ability of nursing staff to evaluate PU risks, resulting in a decrease in the occurrence of PUs.

This article outlines an evaluation of preregistration nursing students' views on the delivery of tissue viability during their preregistration education in preparation for registration with the Nursing and Midwifery Council (NMC, 2010). Data were collected from two cohorts of preregistration (n=170) over a 2-year period by means of interactive voting keypads. The author concludes that preregistration preparation within the university was inadequate for both the prevention and provision of tissue viability care in clinical practice.

This article explores and critically evaluates clinical practice competencies as a form of assessment within post-registration nurse education, specifically relating to competence assessment of intravenous (IV) therapy. In the first article in this two-part series, 'Competency assessment in intravenous therapy and vascular access: part 1' (BJN, 22(16)), an in-depth literature review was carried out and applied to current competency assessment design. Clinical staff opinion was sought to evaluate users' opinions of this assessment method against recommended literature. The aim of both articles is to describe critically and analyse existing practice using this form of assessment, and relate other forms of assessment to IV therapy and vascular access clinical competence. A small-scale study was performed to evaluate whether clinical competency assessment is the most appropriate form of assessment of IV therapy and vascular access skills. A questionnaire was designed to assess nurse opinion in relation to advantages (positives) and disadvantages (negatives) of clinical practice competency assessment; 35 randomly selected post-registered nurses were included in the sample. Findings illustrated that clinical competency assessment is the most appropriate form for the assessment of clinical skills in IV therapy. However, recommendations were made for the possible use of Objective Structured Clinical Examination (OSCE) assessment. Furthermore, this report recommends the assessment of theory and knowledge through written exams or multiple-choice questions (MCQs) as an addition to clinical practice competence assessment for IV therapy.

Nurse training and education programmes have changed in recent years, moving from a 'learning on the job' process of training and learning to a much more structured and academic approach. As professionals in health, we must continually update and refresh our knowledge and skills (Mann et al, 2009), a view supported by Fry et al (2003) who highlight that nurses are now encouraged to continue with lifelong learning. The Nursing and Midwifery Council (NMC) Code of Conduct 40 states: 'You must keep your knowledge and skills up to date throughout your working life'. Code 41 states: 'You must take part in appropriate learning and practice activities that maintain and develop your competence' (NMC, 2010). Within the hospital setting, most patients will receive some form of intravenous therapy (IV) treatment (Peterson, 2002: cited by RCN, 2010). Infusion therapy has therefore become an integral part of professional practice for most nurses, who must learn the initial skills in IV therapy and vascular access and achieve clinical competence. Education and clinical training by specialist teams in organisations must be delivered to ensure safe skills are learnt (RCN, 2010). This education and training must incorporate both theoretical and practical elements, with appropriate means of assessment. The delivery methods should be diverse, recognising that individuals have different approaches to learning. Clinical competency assessment frameworks are widely used within nurse education. But are they the most appropriate method of assessment, or can other methods be used? An in-depth literature review in this paper will highlight different approaches to learning, assessment and clinical competence.

End-of-life (EoL) care is a priority in health care and aims to provide services for all those who are dying, irrespective of their location. Providing this care to those in prison services is challenging. This paper reports a project that aimed to provide an education programme to both prison nurses and officers to support their understanding of EoL care and how it may be provided within the confines of the prison environment. On offer was a mixed-methodology education programme incorporating a pre-existing university module not specifically tailored to the prison setting. The mentorship of a clinical nurse specialist already known to the prison staff proved crucial to its successful implementation. Following the educational programme, both the nurses and the prison officers reported having a deeper understanding of the issues and more confidence in providing EoL care to prisoners who are patients. Further delivery of the programme to a wider group is planned, and similar initiatives nationally may provide a flexible, affordable approach to EoL care for those ending their days in prison.

This series of articles explores various ways of supporting staff who work in the fast-moving and ever-changing health service. In previous articles, John Fowler an experienced nursing lecturer, author and consultant, examined the importance of developing a supportive working culture, learning from experience and the role of preceptorship. This article examines how the principles of mentoring, as practiced in the business world, can be applied to nursing.

International students bring billions of pounds annually to the UK through higher education. Although nursing students may not contribute as significantly in monetary terms as traditional graduate and postgraduate learners, they do, however, bring with them other benefits in terms of wealth of experience, diversity and cultural capital, often looking after client groups sometimes marginalized by mainstream society. The reality is that many nursing homes and care homes simply would not function without internationally recruited nurses contributing to our health service and the wellbeing of society. The author of this article is a module manager for a Nursing and Midwifery Council regulated Overseas Nurses Programme, which runs up to four times per year at a large Faculty of Health, Sports and Science in South Wales. Anecdotal evidence from class disclosures by international nursing students provided the rationale for this independent enquiry. Listening to verbal accounts suggested that internationally-recruited nurses were experiencing episodes of 'unfair treatment' by patients under their care when undertaking the clinical practice component of the programme.

Background: A key aspect of the provision of high-quality palliative care is ensuring that qualified staff have ongoing education in this area., Aim: To explore the educational needs of palliative care link nurses., Method: A quantitative approach was adopted, using a questionnaire distributed to all of the palliative care link nurses (n=80) in an integrated health and social care trust in one UK region., Findings: Participants demonstrated a clear commitment to and enthusiasm for their role. More than two thirds had already completed some form of palliative care training and considered themselves to already possess the necessary skills, confidence, and competence to be palliative care link nurses. However, this competence tended to relate more to skill-based elements and less towards practice issues., Conclusions: Education for palliative care link nurses needs to incorporate strategies to develop competence and confidence in practice (knowing how) alongside skill-based learning (knowing that).

Objective: To gain an insight into current practice and practitioner opinions on the recognition and management of wound-associated pain as compared with that previously presented in the literature., Method: Delegates who attended Wound Expo 2009 and participated in the interactive learning workshops held in the wound pain educational zone were surveyed. This was therefore a convenience sample. All participants signed a consent form prior to the interactive voting session to allow their anonymous responses to be used. The survey consisted of questions that had been devised to generate a clearer insight into current practice and opinion on wound-associated pain. Questions were posed during the workshop (displayed in a PowerPoint presentation) and attendees were given 10 seconds per question to select their preferred responses, each using an individual electronic interactive voting panel. All responses were recorded electronically and the data were subsequently analysed., Results: The survey identified a number of positive approaches used by the delegates in their assessment of wound-associated pain. These include a high level of continuous assessment, an awareness of the wide range of pain assessment tools available and an acknowledgement of the need for a multiprofessional approach to pain management., Conclusion: The findings highlight the issues clinicians face in the recognition, assessment and management of wound-associated pain during their everyday practice. Although many of these issues are difficult to resolve entirely, a fundamental element is that the patient's experiences must be assessed and documented in a consistent and informed manner, and then appropriate management actions taken.

The reporting of adverse drug reactions (ADRs) by health professionals forms an important component of ongoing surveillance of post-marketing drug safety. The extension of responsibility for all health professionals to report ADRs has coincided with national immunization programmes, such as the national childhood immunization, human papillomavirus (HPV), and seasonal and H1N1 influenza programmes. The study objective was to evaluate knowledge of, and attitudes to, reporting ADRs among the professional groups most likely to see suspected reactions to vaccines. This included nursing professionals, whose views have not been included in previous studies. A survey of 91 practice nurses, health visitors, school nurses and GPs working in Ayrshire and Arran during June, July and August 2007 was undertaken. The respondents' knowledge of ADR reporting varied considerably. Although the majority of respondents recognized that it is the responsibility of health professionals to report suspected ADRs, there were lower levels of knowledge about the purpose of the Yellow Card system specifically; less than 50% of the respondents reported good knowledge about the system. The study suggests implications for practice with regard to the implementation of large-scale immunization programmes and potential solutions to under-reporting among these professional groups.

Aim: The aim of this study was to highlight community nurses' experiences of ethical dilemmas in palliative care., Background: There are many studies on palliative care but research on how community nurses experience ethical dilemmas in palliative home care is lacking. The ethical dilemmas to which these nurses are exposed seriously challenge their ethical competence., Method: Seven community nurses described their experiences of ethical dilemmas in palliative home care. The data was analysed by means of qualitative content analysis., Findings: The core themes that emerged were: powerlessness, frustration, and concern in relation to ethical dilemmas in palliative care. The nurses were motivated and felt responsibility for their patients' end of life, and their relatives, and took their duties seriously. They wanted to satisfy all parties; the patient, the relatives and other palliative care professionals., Conclusion: The study confirms the need for knowledge about how community nurses experience dilemmas in ethical decision-making. They have the freedom to act and the willingness to make decisions, but they lack competence and knowledge about how their colleagues' experience and deal with such issues.

Aim: Increasing numbers of older people are dying in the nursing care home setting. Little is known about the medication needs of the very old and frail in the last weeks of life and how they might differ from a model of care developed for people dying from cancer., Method: A baseline review of medication in the last month of life was undertaken to try and establish current practice of prescribing for this population. The notes of 48 deceased residents in seven nursing care homes were examined, alongside a questionnaire sent to 67 trained nurses., Results: Subcutaneous prescribing only occurred where specialist palliative care teams had been involved with the residents' care. Syringe drivers were used in 23% of cases; however, only three residents required a syringe driver for more than a day and a half. Nurses' confidence and competence in setting up syringe drivers was varied., Conclusions: The use of syringe drivers may not be the most appropriate way of managing symptoms during the dying phase in very frail and old people.

Lyn Karstadt discusses how an all-graduate profession will affect the skills set of nurses.

As the English National Health Service (NHS) celebrates its 60th anniversary, the challenges of providing equal access to health services for all remain numerous and complex. For certain groups in society, accessing appropriate, quality health care may be fraught with difficulties. While people with an intellectual disability (ID) may have additional health-care needs, they often struggle to acquire the health care they require, particularly when they have a life-limiting condition. This article introduces a qualitative research study conducted in a North Staffordshire hospice. This study explored the hospice staff's perceptions of their own professional needs while caring for a person with an ID who required palliative or terminal care within the hospice setting. This article will define the population involved, explore the literature which provides a contextual backdrop against which the research sits, introduce the methods and procedures used, and describe and discuss these findings in relation to the palliative care provision for people with an ID from a hospice perspective. It concludes by recognizing that appropriate education and training remain essential preparation for hospice workers when caring for someone with an ID. This article should be of interest to clinicians in both palliative care and ID services, to managers and providers of such services, to those educators keen to maintain contemporary palliative care practice, and to researchers.

The prevention and treatment of pressure ulcers continues to present a challenge across acute and long-term care settings, and costs the NHS up to pound2.64 billion annually. As well as causing a reduced quality of life for sufferers, they can prove to be fatal. The complexity of the exact causes of skin breakdown and accurate risk assessment has proved problematic to fully understanding this common nursing problem, yet despite limited evidence clear guidelines on best practice exist, suggesting that prevention strategies should encompass interventions in three areas: risk assessment; relief of pressure, and education. Evidence exists that where these strategies are adopted at an organizational level, and strong leadership provided, the outcomes can be remarkable. This article outlines effective prevention and risk-reduction strategies, together with interventions that can promote healing.

Aim: The aim of this research was to describe burnout among mental health nurses working in a city Trust and to develop an understanding of the variables involved in burnout for mental health nurses., Background: Mental health nursing is stressful and several authors have linked stress to burnout. Burnout results from high levels of occupational stress, and is characterized by: emotional exhaustion, depersonalization, and a perception of lack of personal accomplishment. There is a growing body of research regarding burnout among mental health nurses; however, there appears to be no research that considers UK mental health nurses working in cities., Methods: The study involved a questionnaire survey of all 475 mental health nurses working at a city NHS Trust. Data were collected in 2007., Results: A deeper understanding of burnout within the Trust was developed, with statistically significant relationships showing that nurses experiencing burnout were more likely to take sick leave and to be considering leaving their jobs or the NHS. Levels of burnout experienced were significantly related to academic qualifications, the frequency and adequacy of clinical supervision, feeling supported and valued at work and feeling involved in decision making and changes., Conclusion: The perceived quality and frequency of clinical supervision influences the level of burnout experienced. Nurses who have higher-level academic qualifications and who feel supported and valued at work have lower levels of burnout.

Advanced care plans provide an opportunity for patient choice and self-determination. This article describes the process, outcome and impact of the introduction of an advanced care plan into community and inpatient settings. It demonstrates the usefulness of the tool, and the way in which it improves the chances of people dying in their preferred place of care, particularly when used in the community. It also illustrates the effect on nursing practice of improved patient, family and professional communication, and through that, patient empowerment. It confirms the benefits of integrating evaluation into new initiatives, which facilitates useful feedback to stakeholders.

Making care safer for patients is currently a top priority for the NHS. Nurses, as the biggest group of health-care workers, have countless opportunities each day to contribute to this aim. One of the first challenges that arises is: how do we ensure that all nurses are aware of the size and extent of the problem? We must also ask what is being done locally to reduce avoidable harm and deaths.

Introduction: Self-awareness of one's own reactions towards patients and their relatives is of paramount importance for all professionals in palliative care. 'Core attitude' describes the way in which a person perceives himself and the world, and forms the basis for his actions and thoughts., Objective: The aim of this study is to explore what core attitude means for palliative care professionals and whether there is a specific core attitude in palliative care., Methods: Qualitative study with 10 face-to-face in-depth interviews with experts in palliative care (nurses, physicians, social workers, psychologists, chaplain) in Germany., Results: Core attitude in palliative care can be best described with the following three domains: 1) personal characteristics; 2) experience of care; and 3) competence in care. Authenticity is the most important characteristic of professionals, along with honesty and mindfulness. Core attitude primarily becomes apparent in the relationship with the patient. Perception and listening are key competences. The experts emphasized the universality of the core attitude in the care of ill people. They stressed the importance and relevance of teaching core attitudes in palliative care education., Conclusion: In the field of palliative care, core attitude consists predominately of authenticity, manifests itself in relationships, and requires a high degree of perceptiveness.

The aim of this article is to provide insight into the current state of nursing care for sleep problems in inpatient and outpatient psychiatric care for adults and the elderly, and to determine if there is any benefit to the implementation of alternative, evidence-based interventions. To research this, the authors carried out a cross-sectional survey by means of a specially developed questionnaire. Between October 2005 and June 2006, 1,181 questionnaires were sent to a sample of nurses working in inpatient and outpatient care for psychiatric patients in five different psychiatric institutions in the Netherlands. Descriptive statistics were used to describe the properties of the sample and its strata. The authors explored differences between subgroups using chi-square, Mann-Whitney or Students t-tests. The authors found that daytime interventions to prevent sleep problems are mostly structural, introducing a structured environment with, for example, set going to bed and getting up times, and stress management activities. Sleep problems during the night are typically approached by observation, environment control and stress management. Experience, knowledge gained by initial training and eminence advice (advice from peers, physicians or experts) are the most frequently used knowledge sources in the care of sleep problems. Nurses were seen to be aware of the importance of sleep and the importance of a good nursing management for sleep problems. However, interventions are rarely evidence-based. Although nurses are satisfied with the care being provided for sleep problems, they are willing to apply alternative evidence-based care. They identified the lack of knowledge, skills and time as obstacles for such implementation.

Following the NMCs review of pre-registration nursing education (NMC, 2008) and Lord Darzis appraisal of the NHS (Department of Health, 2008), the scene is now set for an all-degree nursing profession. This move to an all-graduate profession is a key force in the modernization of the nursing workforce but is not without potential pitfalls.

Background: Many children cared for in hospice settings are affected by a genetic condition. Therefore, children's hospice nurses require knowledge and awareness of the issues faced by families affected., Aim: The authors carried out a study to ascertain how important children's hospice nurses perceived genetics to be within care provision generally and explore how confident they were personally in meeting these care needs., Method: A questionnaire survey was sent out to 277 nurses working in children's hospices across the UK. The methods used are described in detail in part 1 of the study., Results: One hundred (36%) questionnaires were returned. Most children's nurses felt that an understanding of genetics was very important within children's hospice care. However, they were not confident about integrating most aspects of genetics into clinical practice., Discussion: Children's hospice nurses are required to care for children and families affected by life-limiting genetic conditions and many have complex support needs, which require an insight into issues associated with genetics. This study demonstrates that more education about genetics is required by children's hospice nurses. The focus of educational courses should be on the psychosocial aspects of care, which are needed in the context of hospice care, because this is considered the most important and where nurses were slightly more confident.

The End of Life Care Strategy (Department of Health, 2008) stresses the importance of education for all healthcare professionals in the delivery of care in any setting. According to the recent End of Life Care report from the National Audit Office (2008), few care home staff have sufficient training in providing end-of-life care, highlighting communication skills and pain management as two target areas for training. This article explores the development and implementation by a hospice education department of a palliative care link nurse programme in care homes with nursing as a means of providing aspects of the required training. Maintaining the motivation and commitment of the care home staff and managers is seen as vital in sustaining the programme, which has been running successfully for 4 years. It is important to differentiate between care homes with nursing (those that used to be called nursing homes) and care homes without nursing (those that used to be called residential homes). The terminology has changed to reflect the different client group. An evaluation of the programme was undertaken after 1 year and the key findings are discussed and future developments are highlighted.

Background: Many children receiving hospice care are affected by inherited genetic conditions. To provide appropriate care, children's hospice nurses require knowledge and awareness of the issues faced by the child and their family along with the implications of having, or being at risk from, an inherited genetic condition. Little is currently known about the competence levels of children's hospice nurses to support these children and their families., Aim: This study aims to explore how important children's hospice nurses perceived genetics to be within children's hospice care provision, and their level of confidence in meeting the care needs of children and their families with a genetic predisposition to disease., Method: This study involved two stages: a single-page survey to children's hospice directors of nursing designed to determine the nature of children's hospice care provision in England and Wales. Second, a postal survey using a structured, self-administered questionnaire was sent to nursing staff in a sample of children's hospices in England and Wales. A total of 277 packs were sent to the hospices for distribution to children's nurses working in their employment. Likert scales were used to rate the importance of genetic activities relevant to children's hospices, and nurses' confidence in performing them. Demographic data were also collected. The results, the discussion of the findings and implications for practice will be discussed in part 2.

Aim: The internet provides access to information and evidence that can support palliative care practice. This study aims to evaluate the use and utility of a palliative care website with particular regard to its use and issues for nurses. STUDY DETAILS: A survey of online visitors and a postal survey of staff working in palliative care services were conducted; 134 visitors completed the survey and 371 staff in palliative services responded., Findings: Users of the site found the content credible and over 95% would recommend the site to others. Over 90% of specialist palliative care nurses use online resources and half use the CareSearch website. Awareness of the resource was much lower for registered nurses than specialist nurses working in palliative care., Conclusion: Understanding attitudes to, and use of, online palliative care resources by nurses working in palliative care services could help to develop these resources to more effectively meet their needs and circumstances.

Peripheral intravenous (IV) cannulation is a procedure that involves breaching the integrity of the skin, exposing patients to the risk of infection. Acquisition of infection has associated costs both for patients and the NHS. The high number of peripheral IV cannulae (PICs) inserted annually has resulted in serious infection and significant morbidity (O'Grady et al, 2002). Risks associated with PIC infection must be addressed to reduce patient morbidity and increased cost of prolonged hospital admission and treatment. This article discusses the sources and routes of infection associated with peripheral IV cannulation, and examines healthcare management strategies for preventing infection when performing peripheral cannulation. These comprise: the Peripheral Venous Cannulation Policy, which empowers practitioners to challenge poor cannulation skills and standardize practice; education, which provides learning opportunities within programmes such as Infection Control Core Competencies Study Days, designed to promote infection prevention strategies directly related to cannula care and aimed at all levels of Trust staff; and the Peripheral Cannula Care Plan, which ensures accurate documentation of cannulation procedures. This last strategy is simple to use and provides a route for improving cannula-related documentation. A high standard of documentation will also assist audit, which is crucial to reducing PIC infection.

Research addressing the nature of hospice referrals focuses primarily on the effect of late referral and the majority of studies are based in North America. Using health care professionals as key informants, the goal was to describe the hospice referral system used in the Western Cape Province of South Africa from the perspective of nursing sisters, medical doctors, and social workers. Semi-structured interviews with 29 such individuals were conducted at 15 rural, urban and peri-urban sites, exploring their perceptions towards, and experiences with, patient referral to hospice programmes. Interpretative descriptive design allowed for a comprehensive description of the referral process as well as an extension of the data based on the perspectives of the three stakeholder groups. The majority of hospice referrals originated from either community-based clinics or state hospitals. Three main themes, centring around the process of referring, (lack of) standardization, and (lack of) knowledge, arose from the analysis of the transcripts. An interpretation of the themes led to the development of a model describing the ideal hospice referral system for South Africa.

The aim of this research was to develop and evaluate a programme comprising a series of supervision sessions (based on a social work model) to meet the needs of nurses working in the community. Nurses are now working in programmes such as drug and alcohol withdrawal and community-based palliative care where they are increasingly assuming more of a counselling role with their clients. This is typified by an increase in the emotional intensity of the relational engagement. In this new environment, the old skills, strategies and support frameworks are no longer sufficient. Nurses in the project were asked to evaluate their experience of the programme in relation to self-regulated learning, developing self-awareness, skills competence and increase in counselling knowledge. The small sample size means that there are important restrictions on generalising the findings. Nevertheless, the findings show that the programme has been evaluated positively by the participants and should encourage further research.

This paper describes how two tissue viability nurses, one from an acute trust and one from a primary care trust, joined forces to set up a link nurse group. This helped raise the profile of wound care and improve standards of care.