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

Health inequalities between groups of people are often unjust and avoidable and are influenced by social determinants of health, the non-medical factors that influence health outcomes. Gypsy and Traveller communities experience significant health inequalities, including barriers to accessing healthcare services and suboptimal health outcomes compared with the general population. This article provides an overview of health inequalities in relation to Gypsy and Traveller communities and examines three social determinants of health - discrimination and racism, accommodation and access to healthcare - that influence these inequalities. The authors propose that accurate data collection as well as delivery of culturally competent health services and care may facilitate access to healthcare for Gypsy and Traveller communities and potentially reduce health inequalities.

A thorough, holistic wound assessment is essential to identify the aetiology of a hard-to-heal wound and formulate a diagnosis, which will underpin the treatment plan. This article describes the fundamental elements of assessing a patient with a hard-to-heal wound holistically, including taking a patient history, performing a clinical examination and investigations, and considering the patient's physical, psychological, spiritual and social needs. The author also outlines the aspects of the TIMERS (tissue, infection/inflammation, moisture, edge, regeneration and social factors) wound assessment tool in detail, and explains some of the challenges associated with accurately assessing a wound.

Makaton is a unique multimodal language programme that uses signs, symbols and speech. It offers a flexible communication system that can be used across settings with a wide range of people, including those with learning disabilities or communication difficulties. This article explains what Makaton entails and how it can be used to aid communication with service users. The authors suggest that Makaton should be integrated in preregistration nurse education for all fields of practice, particularly learning disability nursing. Effective communication skills are essential for all nurses and learning Makaton as part of their preregistration education programmes could improve their competence and confidence in engaging in meaningful dialogue with people who find it challenging to communicate verbally.

The prevalence of mental health issues among black women is high, but they are underrepresented among mental health service users. This article details a systematised review of the literature that explored black women's perceptions and experiences of, and barriers to, engaging with mental health services. A total of 16 articles from the UK and North America were included in the review. Four main themes were identified as presenting barriers to black women's engagement with services: mistrust; sociocultural factors; lack of awareness; and practical barriers. The intersection of gender and race was evident in the 'strong black woman' ideal, which may have hindered their recognition and disclosure of mental health conditions, as well as in practical barriers such as costs and caring responsibilities. Historical and cultural perceptions of mental health issues and healthcare services, alongside their previous negative experiences of services, may prevent many black women from accessing essential support. Nurses and other healthcare professionals have an important role in engendering trust, challenging racism and promoting positive mental health.

Dementia usually occurs as a result of brain disease and, while it is usually chronic or progressive in nature, it has not traditionally been conceptualised as a terminal or life-limiting syndrome. However, the median survival time for people with dementia is between 3.5 years and 4.5 years from symptom onset to death, although this varies depending at which stage the dementia is diagnosed and its cause. As such, it has long been recognised that people with dementia and their family carers have palliative care needs equal to those of patients with cancer. However, a palliative approach to dementia care requires both the dementia and palliative care workforces to fully understand the needs of people with dementia and their families towards the end of life. This article describes the development of a 'community of practice' where healthcare professionals from dementia and palliative care services shared their practice and learned from each other in a safe and supportive environment.

Blood component transfusions are a valuable clinical intervention and are widely used in healthcare. However, some patients may decline transfusion, for example if it conflicts with their religious beliefs or they are concerned about the associated risks. This article details a narrative review that was undertaken to identify what alternative patient management strategies can be used when allogeneic blood transfusion is not feasible, and to explore how these strategies can benefit individuals who decline transfusion and the broader patient population. Searches were conducted to identify articles published between 2013 and 2023. A total of 43 articles were included in the review and thematically analysed. Four main alternative approaches to transfusion were identified from the literature: blood management and conservation; early optimisation; use of synthetic compounds; and proactive management in emergencies. Applying these strategies could reduce risks and costs, enhance the overall use of blood components, and ensure a holistic approach to care and maintaining haemostasis for all patients.

Chimeric antigen receptor (CAR) T-cell therapy is a relatively new and innovative immunotherapy for haemato-oncological diseases. In the UK, CAR T-cell therapy can be used to treat some patients with relapsed or refractory acute lymphoblastic leukaemia or diffuse large B-cell lymphoma. However, CAR T-cell therapy can have side effects that have implications for patients' physical and psychosocial well-being and may induce adverse reactions that can cause life-threatening acute toxicities. Nurses may have a significant role throughout the CAR T-cell therapy process, including in supporting patient decision-making, administering infusions, monitoring patients, identifying and managing adverse reactions, and providing follow-up care. This article provides an overview of CAR T-cell therapy and describes some of its potential side effects and adverse reactions. The authors also consider the role of the nurse and the implications for the nursing workforce in terms of meeting the needs of the increasing numbers of patients who may become eligible for this treatment as it is extended to other cancer types.

Rationale and key points: This 'How to' article explains how to reflect on clinical practice using reflection-on-action and a reflective model to help ensure the nurse gains comprehensive learning from an experience or incident to enhance their professional development and patient care. • Reflection is a vital element of nursing practice and has a wide-ranging purpose including, for example, self-inquiry into experiences to find meaning, gain insight and prompt action, recognition of emotional responses to care situations and exploring wider issues, such as healthcare culture. • Reflection-on-action involves a retrospective critical exploration of an experience or incident to identify learning points and may be engaged in alone, with one other person, for example during clinical supervision, or in a group activity. • There are a range of reflective models that can be used to structure a reflection, the main components of which generally include a description of the event, reflection on its meaning and identification of learning. 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 using reflective techniques. • How you could use this information to educate nursing students or your colleagues on the appropriate methods for reflecting on clinical practice.

Eating is a distinct behaviour in humans, in that they must consume food to provide sufficient energy for the body to function and to ensure survival. Behaviours around food consumption can range from 'normal' to disordered, where some people may develop eating patterns that suggest a preoccupation with food or weight. This preoccupation can lead to inappropriate compensatory behaviours, such as purging or excessive exercise, or dysphoric mood following food consumption. This article discusses the continuum between 'normal' eating behaviours and eating disorders, with a focus on binge eating behaviour and binge eating disorder. The author also describes the use of a screening tool for identifying binge eating behaviour and suggests ways in which nurses might support patients in addressing disordered eating behaviours.

Imposter phenomenon is described as persistently doubting one's accomplishments, leading to an internalised fear of being exposed as a 'fraud'. This article identifies the nature and prevalence of imposter phenomenon among nursing students, newly registered nurses and senior nurses. It also explores the effects of this phenomenon for nurses and healthcare organisations, including its potential association with burnout, suboptimal performance and a lack of career development. Evidence suggests that addressing imposter phenomenon is not something individuals can accomplish by themselves, but that it requires system-level interventions from healthcare organisations and higher education institutions. This could raise awareness, promote recognition and improve resources and training to mitigate the detrimental effects of this phenomenon on healthcare provision.