British journal of nursing (Mark Allen Publishing)最新文献

Sam Foster considers the need to create an environment where nurses feel speaking up will lead to change.

Patient safety remains a critical concern in healthcare systems worldwide, particularly in acute settings such as stroke units, where multidisciplinary co-ordination is essential.

Method: This study explores the implementation and impact of a focused clinical daily safety huddle (FCDSH) as a non-technical intervention aimed at enhancing patient safety, reducing hospital-acquired pressure ulcers (HAPUs), and improving interprofessional collaboration. The project employed Kotter's eight-step change model to guide the implementation process and used Plan-Do-Study-Act (PDSA) cycles for iterative development. Stakeholder engagement, coaching leadership methodology, and a robust data collection process, including run charts, supported the intervention.

Results: The results demonstrated a significant increase in the number of days between reported pressure ulcers, with the ward achieving 142 days without an incident post intervention compared with a baseline average of 18.2 days. The findings highlight the effectiveness of FCDSHs in improving communication, fostering teamwork, and reducing preventable patient harm.

Conclusion: This service evaluation contributes to the growing evidence base for human factors approaches and non-technical skills in clinical practice.

Background: Elderly care nursing has problems such as staffing shortages, stress and limited career opportunities, which are prompting nurses to leave.

Aim: The aims of this service evaluation were to explore the factors contributing to high turnover of nurses in elderly care and propose retention strategies.

Design: A qualitative design was used.

Methods: Seven semi-structured interviews were conducted with nurses from six wards within the elderly care division.

Results: Three main themes emerged: staff and patient safety; lack of career progression; and training needs.

Conclusion: Nurses in elderly care face both personal and organisational challenges. Prioritising their development, safety and recognition is crucial for retention. Trusts should acknowledge and support these nurses' hard work and commitment. Recommendations include flexible working patterns, providing adequate skill mix on the wards and opportunities for career progression in elderly care.

Marika Nemeckova (marika2.nemeckova@northumbria.ac.uk), Alison Steven, Ian Joy and Linda Tinkler discuss alarm fatigue, the desensitisation of nurses and other clinical staff to alarm signals. It is a patient safety risk, a professional concern and a workforce issue to manage meaningfully, confidently and safely.

Heel pressure ulceration remains a significant and largely preventable cause of morbidity, yet it continues to pose complex clinical challenges. The heel's unique anatomical structure, limited soft-tissue padding and relatively poor vascular supply increase vulnerability to pressure, shear and friction, particularly among older adults and individuals with diabetes or peripheral arterial disease. This article synthesises the evidence surrounding the prevalence, risk factors and pathophysiology of heel pressure ulcers, highlighting their propensity for delayed healing, infection and limb-threatening complications. Despite their frequency and severity, current national guidelines provide limited heel-specific recommendations, resulting in variation in practice. The article discusses the importance of comprehensive risk assessment, early vascular evaluation, and implementation of evidence-based prevention strategies such as effective offloading. Key principles of local wound management, including debridement, infection control and appropriate dressing selection are outlined. By improving recognition of heel-specific risk and promoting consistent, multidisciplinary approaches, clinicians can reduce avoidable harm, enhance healing outcomes and support improved quality of life for patients with heel pressure ulceration.

Wound infection delays wound healing, which has a negative impact on patient wellbeing and treatment costs. This article outlines an evidence-based and person-centred approach to the assessment, management and reduction of bioburden and wound infection. It highlights that effective infection and inflammation control commences with prevention. Nurses are pivotal in this approach, optimising the environment and wound bed to reduce bioburden, and taking account of the patient's existing health conditions to enable an effective host response.

Oedema is a complex condition, and understanding its underlying causes is essential for safe and effective management. The most common aetiology is poor venous return, and venous disease develops when the veins are unable to withstand the hydrostatic pressure within them, leading to a cascade of tissue changes including lipodermatosclerosis, haemosiderin deposition and venous leg ulceration. The most disabling consequence is often secondary lymphoedema. Under normal circumstances, most interstitial fluid that is not reabsorbed at the venous end of the capillaries enters the lymphatic system and is transported back to the heart. When venous valves fail, hydrostatic pressure increases, overwhelming the lymphatic system. Excess fluid is forced into the interstitial space, and the result is oedema.

Upasana Rajagopalan reports on last year's Theatre Safety Club conference, chaired by BJN Editor in Chief Ian Peate, where speakers addressed the key topics of hand health, speaking up and deep vein thrombosis.

As the number of people living with dementia continues to rise, acute hospitals must explore innovative, person-centred strategies to support their needs. Hospital environments can be disorientating and distressing for people with dementia, contributing to increased agitation, anxiety and poorer outcomes. Music, a widely accessible and low-cost intervention, is increasingly recognised for its therapeutic potential in this context. This article explores the use of music as a non-pharmacological intervention in acute hospital settings, highlighting its potential to support cognitive function, psychosocial wellbeing, motor activity, and behavioural symptoms. Drawing on current evidence and practical examples, it outlines how tailored music activities, such as listening, singing, lyric writing, and movement, can enhance person-centred care, improve the patient experience, and reduce reliance on medication. The article also discusses implementation challenges, ethical considerations, and the need for further research to embed music more effectively within routine dementia care in hospitals.