Nursing standard (Royal College of Nursing (Great Britain) : 1987)最新文献

Rationale and key points: A local anaesthetic infusion is a prescribed method of continuous analgesia to manage post-operative pain as part of a multimodal approach, which may also include an analgesic. During the infusion, local anaesthetic is infused into the tissues surrounding the surgical incision or wound via a multi-lumen indwelling wound catheter. The aim is to manage post-operative pain and reduce the use of other analgesia such as opioids. It is essential that nurses understand the indications for this form of pain management, how to care for the patient receiving it and the potential complications. Nurses must have the knowledge and skills required to undertake this intervention safely and must work within their level of competence. • Managing pain effectively after surgery or an injury requires multimodal analgesia, which is usually supplemented by a local anaesthetic either as a single injection or a continuous infusion. • The nurse has an important role in maintaining patient safety by advising the patient to report any changes they experience following local anaesthetic infusion, such as heaviness in the limbs, and by undertaking regular pain assessments using a structured approach. • Early recognition of side effects is important because the local anaesthetics used in the infusion can be both cardiotoxic and neurotoxic, therefore regular assessment and documentation are essential. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: • How this article might improve your practice when caring for a patient undergoing a local anaesthetic infusion. • How you could use this information to educate nursing students or colleagues about the appropriate care for a patient requiring a local anaesthetic infusion.

Gastrostomy tubes are commonly used in people who are malnourished or at risk of malnutrition and require long-term artificial nutrition support but have a functional gastrointestinal tract. They generally provide a safe and effective access route for nutrition, hydration and medicine administration. This article describes the two main types of gastrostomy tubes seen in clinical practice, percutaneous endoscopic gastrostomy (PEG) tubes and radiologically inserted gastrostomy (RIG) tubes. The author explores the main differences between these tubes in terms of insertion technique, aftercare, replacement and removal, and outlines associated complications. To ensure patient safety and the delivery of high-quality care, it is essential that nurses involved in the care of patients with a PEG or RIG tube have a comprehensive understanding of these enteral feeding tubes and can recognise, and ideally prevent, potential complications.

Rationale and key points: Suppositories are used in clinical practice for several purposes, including bowel evacuation and the administration of medicines such as analgesics and antibiotics. A common indication for their use is constipation. This article aims to support nurses to administer suppositories to adults with constipation in a safe, effective and dignified manner. • Suppositories contain lipophilic fats that melt following insertion into the rectum, releasing a medicine into the body for local or systemic absorption. • Different types of suppositories are available to treat constipation and the method of insertion varies slightly according to the type used. • The administration of a suppository for constipation can cause embarrassment and stress for the person, so it is important to take a professional and sensitive approach when performing this procedure. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: • How this article might improve your practice when administering a suppository to an adult with constipation. • How you could use this information to educate nursing students or colleagues about the technique for administering a suppository to an adult with constipation.

Rationale and key points: Peak expiratory flow rate (PEFR) is an important test in the diagnosis and monitoring of respiratory conditions, especially asthma. PEFR measures the speed at which air is forcefully exhaled from full inspiration, expressed in litres per minute (L/min). It involves using a peak flow meter - a simple, affordable, portable and widely available device that can be used in clinic or home settings. Nurses obtaining a patient's PEFR must have the knowledge and skills required to do so safely and effectively and must work within their level of competence. • PEFR is a simple-to-obtain measure that records the maximal flow rate of air that can be achieved in one forceful expiration following a full inspiration. • Where possible, it is advisable that patients and/or carers learn how to perform the test themselves, so that they can self-manage and monitor conditions such as asthma and chronic obstructive pulmonary disease. • The procedure is simple to teach, but it is necessary to use the correct technique to achieve accurate results. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: • How this article might improve your practice when obtaining a patient's PEFR. • How you could use this information to educate nursing students or colleagues about the technique for obtaining an accurate PEFR.

Rationale and key points: A 12-lead electrocardiogram (ECG) is a painless procedure commonly undertaken in healthcare practice. An ECG machine uses cables or 'leads' attached with stick-on electrodes to specific parts of the body to create a series of ECG traces, which are then printed onto graph paper. This provides a recording of the cardiac electrical activity measured from different angles or perspectives. • A 12-lead ECG is a valuable diagnostic tool that has proven effective in detecting various cardiac abnormalities or enabling healthcare professionals to rule them out. • It is a cost-effective investigation that can be performed by any appropriately trained healthcare professional. • Careful preparation and correct electrode and lead placement are crucial to ensure accuracy when recording a 12-lead ECG.

Reflective activity: How to' articles can help to update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: • How this article might improve your practice when recording a 12-lead ECG. • How you could use this information to educate students or colleagues about the preparation and recording of a 12-lead ECG.

The sharp increase in the cost of living in the UK over the past few years has affected all populations, including higher education students. Many higher education students, including nursing students, are experiencing financial difficulties and concerns, which adversely affect their mental health and can cause them to consider leaving their course. This article reports the findings of an online survey undertaken in one university in Glasgow, Scotland, that aimed to explore the effects of financial stress on second and third-year nursing students. Most respondents had experienced financial worries since starting their preregistration nursing degree programme; many were concerned about the cost of living, and financial worries adversely affected their academic performance and clinical placements. The authors suggest there is a need for a collaborative partnership between universities and practice placement areas to adopt a student-centred approach to identifying solutions to nursing students' financial concerns as well as a review of the available funding for this cohort.

A priority in wound care is preventing wound infection, because this can cause delays in healing and increase the risk of hospital admission. Moreover, the diagnosis of a wound infection is not always straightforward, and the presence of biofilms may mean that an infection is particularly challenging to treat. This article outlines the main aspects of diagnosing, treating and preventing wound infections. It explains that treating wound infection is multifactorial and may include topical antimicrobials, antibiotics and wound bed preparation techniques. The author discusses various preventative measures that can support patients and healthcare organisations, while also contributing towards effective antimicrobial stewardship.

Nurses have an important role in providing high-quality care to meet the needs of diverse populations, including people with mental health issues. Developing rapport is essential for engaging with service users and promoting a person-centred approach in the context of mental health care. However, in practice this may not always come naturally to all nurses. In this article, the author discusses several evidence-based methods for effective communication with people who have mental health issues, such as making a good introduction, active listening, using open questions, using silence and being aware of body language. The author also explains how nurses can communicate compassionately, demonstrate cultural sensitivity and develop trust within a therapeutic relationship, thereby enabling them to effectively explore service users' thoughts, feelings and needs.

Rationale and key points: In hospitals and nursing homes, the maintenance of feeding tubes used in enteral nutrition, such as percutaneous endoscopic gastrostomy (PEG) (the placement of a feeding tube directly into the stomach through the abdominal wall), is often a nursing responsibility. Therefore, it is vital nurses understand how to care for this patient group safely and effectively. Incorrect PEG procedures, inadequate infection prevention and control practices, and a lack of appropriate stoma care, can negatively affect patient outcomes. Nurses administering enteral feeding via PEG must have the knowledge and skills required to do so safely and must work within their level of competence. • Enteral nutrition such as PEG aims to meet the nutritional requirements of patients who have an intact gastrointestinal (GI) tract but whose oral intake is inadequate. • Management of the PEG feeding tube and care of the stoma site are vital, and nurses should be able to recognise common complications of PEG feeding. • A non-touch technique should be used when administering enteral feed via PEG to reduce the risk of bacterial contamination. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: • How this article might improve your practice when administering enteral feed via PEG. • How you could use this information to educate nursing students or colleagues about safe enteral feeding with PEG.

Iron deficiency anaemia develops when there is not enough iron in the body to sustain normal red blood cell production. It is a major cause of morbidity worldwide and is linked to a range of comorbid conditions, including gastrointestinal cancer. In the UK, iron deficiency anaemia is the most common cause of anaemia identified in primary care and is estimated to affect 3% of men and 8% of women. Nurses can support the management of iron deficiency anaemia by identifying possible causes, ordering blood tests, advising on diet and iron supplementation, and referring patients for additional investigations as required. This article provides an overview of the pathophysiology, identification and diagnosis of iron deficiency anaemia, describes sources of dietary iron and factors influencing dietary iron absorption, and discusses patient management.