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

Portal hypertension is a condition that describes increased pressure within the portal vein, an important structure that drains blood from the gastrointestinal tract and conveys it to the liver. This article describes the normal structure of the liver and its circulation. It also explains how cirrhosis leads to the development of portal hypertension and varices, and considers the latest evidence and guidance for safe clinical management. As liver disease is a leading cause of morbidity and mortality, nurses commonly encounter patients experiencing the effects of portal hypertension in practice, and professional bodies have highlighted a need for increased foundational nursing knowledge to enable informed care and optimise patient outcomes. Therefore, this article aims to enhance nurses' knowledge of the underlying pathophysiology, clinical manifestations and recommended management of portal hypertension and varices in the context of end-stage liver disease, with specific consideration of the nurse's role.

Psychological safety refers to the belief that one will not be punished or humiliated for speaking up with ideas, questions, concerns or mistakes. It comprises elements such as open communication, candour and honesty, interpersonal risk-taking and a learning culture. This article discusses the importance of fostering psychological safety as part of effective leadership. It also explores the benefits of leading in a psychologically safe way, highlighting research and evidence on how this can enhance patient care and team performance. The author places psychological safety in context by explaining the links and overlaps between this concept and various leadership styles.

Advance care planning, which enables patients to make informed decisions about their care as they approach the end of their life, has been part of UK policy and strategy for almost two decades. Yet despite evidence of the benefits, advance care planning completion rates are low. This is due, in part, to healthcare professionals' lack of confidence in initiating such conversations and insufficient knowledge of the available advance care planning options. Moreover, although recognising when a patient is approaching end of life can provide nurses with an opportunity to initiate advance care planning discussions, predicting this life stage is inherently difficult. This article provides an overview of advance care planning and the challenges of predicting when someone is nearing end of life. The article also considers how nurses might approach advance care planning discussions with patients in a timely and sensitive manner and discusses some of the options available, such as an advance decision to refuse treatment or advance statements.

Peripheral vascular access devices (PVADs) are widely used in healthcare for short-term intravenous administration of fluids, medicines and blood products. However, the use of PVADs often leads to complications, notably an inflammation of the vein wall known as phlebitis. This article explores the causes and types of phlebitis and outlines the many risk factors for it, notably inadequate gauge size, long dwell time and potentially harmful infusate characteristics. The author reviews evidence-based strategies for preventing PVAD-related phlebitis and emphasises the need for standardised care protocols and ongoing staff training to support safer PVAD use and reduce the risk of phlebitis.

Evidence suggests that opioids are no longer appropriate for long-term use in chronic non-malignant pain, due to lack of efficacy and risks to patients such as increasing tolerance and dependency, multiple physical side effects, mental health issues or even death from accidental overdose. This article considers the evidence on the appropriate use of opioids, and ways to safely implement and manage their long-term use. The author details best practice for nurses on subjects such as the use of opioids in the treatment of various types of pain, the principles of opioid stewardship, optimising the effects of opioids, and the risk of tolerance, dependency and dose escalation.

Wound care is a complex and evolving practice. Despite a growing body of evidence on wound healing processes and wound infection management, misconceptions about wound care remain entrenched in nursing practice. These misconceptions can result in suboptimal patient outcomes and increase the economic burden on healthcare services. This article critically examines five common wound care myths - regarding moisture balance, wound sterility, wound swabbing, slough and dressing products - and provides guidance for nurses to support them to provide evidence-based wound care aligned with contemporary scientific understanding and principles of best practice.

Evidence demonstrates that trans patients and service users consistently experience poorer health outcomes compared with the general population across all aspects of healthcare provision, with one of the reasons for this being a lack of trans-inclusive education for healthcare professionals such as nurses. This article outlines some of the challenges experienced by trans people when accessing healthcare services, such as discrimination and stigma. The author also explores some of the educational resources that can assist nurses in all roles and fields of practice to improve care for trans patients and service users.

The concept of planetary health explains how human health and the health of the planet are intrinsically linked. As such, nurses have an important role in caring for the environment. Nurse leaders who consider the health of the planet alongside providing patient care can ensure that they offer effective leadership in a world threatened by growing environmental concerns. This article provides an overview of the concept of planetary health and examines the practical, ethical and relational dimensions of planetary health leadership in relation to nursing practice. The author also makes the case for broader action from healthcare organisations and leaders to contribute to the preservation of planetary health.

Nurses in all settings are frequently in contact with bereaved people, which places them in a unique position to offer emotional and practical support. However, nurses may feel unprepared to provide meaningful support to, or lack the confidence to initiate conversations with, bereaved people. This article describes theoretical models of grief and practical strategies that can inform and support effective and compassionate bereavement care. Applying these models and strategies can assist nurses in providing meaningful support to bereaved people and recognise when they may need additional, formal interventions from specialist services. The article also underscores the importance of organisational support and self-care to sustain the well-being of nurses delivering bereavement care.

Infective endocarditis is a serious and potentially life-threatening cardiac infection which affects the endocardial (inner) layer of the heart and primarily involves the heart valves. It is most often caused by a bacterial infection, with Gram-positive streptococci, staphylococci and enterococci being the most common pathogens. Where the condition is known to have been caused by bacteria, it is referred to as bacterial endocarditis. While it is still a relatively rare condition, the numbers of infective endocarditis cases and associated mortality have increased over the past 30 years, making it a global public health concern. This article provides an overview of the anatomy and pathophysiology, epidemiology, aetiology, diagnostic criteria, clinical presentation, treatment and management of bacterial endocarditis. The article focuses on bacterial endocarditis but uses the term infective endocarditis when discussing the condition in general.