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Putting it into practice

Do you know the signs of sepsis?

21 April, 2014 Posted by: -

Early identification and treatment of sepsis


McClelland H, Moxon A (2014) Early identification and treatment of sepsis. Nursing Times; 110: 4, 14-17.

Sepsis is a potentially fatal condition and is becoming increasingly frequent, yet health professionals are often unable to recognise its symptoms. It is the body’s exaggerated response to infection and, if left untreated, will lead to severe sepsis, multi-organ failure and death. Nurses play a vital role in identifying patients with sepsis and starting essential treatment. This article looks at how sepsis can be identified and effectively treated to improve survival.

  • This article has been double-blind peer reviewed
  • Figures and tables can be seen in the attached print-friendly PDF file of the complete article in the ‘Files’ section of this page


5 key points

  1. Sepsis is one of the leading causes of death in hospital patients worldwide
  2. Patients with severe sepsis will not respond to fluid replacement
  3. Sepsis can be identified during routine observations so nurses play a vital role in spotting symptoms
  4. All patients with sepsis should have a management plan that includes level of observation, review schedule and an escalation plan
  5. Clear guidance on identification and evidence-based interventions is available to support effective and safe care


After reading this article

  • List the signs of sepsis
  • Identify what groups are at particular risk of sepsis
  • Describe how sepsis is managed
  • Should patients with sepsis be given oxygen?
  • Why is it important to measure urinary output when monitoring patients with sepsis?

What is a patient group direction?

14 April, 2014 Posted by: -


Wat D et al (2014) Reducing admissions with patient group directions. Nursing Times; 110: 16, 18-20.

In times of financial restrictions and reform impediments, health services need to invest in resources that provide value for money and reduce hospital admissions. Improving disease management in the community is a primary target for those trying to reduce costs.

The second most common cause of emergency admissions to hospital is chronic obstructive pulmonary disease and it has been suggested that more effective treatments and better management of the condition would likely result in an estimated 5% fewer admissions to hospital, saving around £15.5m each year. This article discusses how savings could be made by improving care provided in the community.


Let’s discuss…

  • After reading this article, could you explain the advantages of using PGDs to supply medicines to patients who have had an exacerbation of COPD?
  • Do you think PGDs help to provide a more responsive service to patients?
  • Would non-medical prescribers be able to provide the same service?
  • What are the disadvantages of PGDs?


For more information about COPD visit our respiratory section.

Are your blood pressure measurements accurate?

31 March, 2014 Posted by: -


O’Connell S (2014) Assessing and managing primary hypertension. Nursing Times;110: 14, 12-14.

Hypertension is a major risk factor for coronary heart disease, stroke and heart failure. This article discusses treatments for interventions and drug therapy, and highlights the importance of accurate blood pressure measurement.


What do you think?

  • How would you explain blood pressure to a student nurse?
  • Do you measure blood pressure in both arms?
  • How does incorrect cuff size affect on BP measurement?
  • What dietary advice would you give a patient with hypertension?
  • What is the current recommended drug therapy for primary hypertension?
  • What are the complications of hypertension?

Further reading

Can interviews effectively judge whether a person has caring and compassionate values?

24 March, 2014 Posted by: -

Corder K et al (2014) How to recruit caring and compassionate HCAs. Nursing Times; 110: 13, 20-22.


“Heathcare organisations are faced with the challenge of recruiting staff who have caring and compassionate values, so need to ensure these can be identified at interview. We piloted multiple mini-interviews as a possible solution to recruiting healthcare assistants. This article outlines how these were implemented and highlights some of the pitfalls of using this approach. Although the work has not been evaluated formally we decided to share our early experiences of using this approach so others can learn from our practice.”


What do you think?

  • Can interviews effectively judge whether a person has caring and compassionate values?
  • What alternative recruitment methods have you found work well?
  • Can healthcare workers be trained to be compassionate?

Comments (16)

Should patients always be made aware they are nearing end of life?

10 March, 2014 Posted by: -

Richards NM et al
(2014) How do patients respond to end-of-life status? Nursing Times; 110: 11, 21-23.


UK palliative care policy and philosophy endorse open awareness, where all parties acknowledge that the patient’s death is approaching. Perceived benefits of making patients aware of their prognosis include being able to plan a variety of activities, so arguably death occurs more in keeping with their wishes.

To explore if and how information about a transition to palliative care was communicated to patients discharged from hospital who fulfilled standardised criteria for palliative care need.

Literature review
Despite evidence of a link between encouraging people to talk about dying and an improved dying experience, persistent barriers exist to entering a context of open awareness.

Semi-structured interviews were conducted with 15 patients and three family carers, 3-6 months after discharge from hospital. A thematic analysis was undertaken.

Despite indications that participants might be nearing the end of their lives, most were unaware of their prognosis and showed little insight into what they could expect from the trajectory of their disease.

Patients can be reluctant to gain knowledge that requires them to face the imminence of death. This can create tensions for nurses about how they relate to and communicate with patients facing incurable illnesses.

To ensure timely access to palliative care, new and innovative ways of delivering palliative care are needed, which do not rely on the ideologically based assumption that awareness can and should be encouraged in all cases.

What do you think?

  • This research found that most of the patients they interviewed were unaware of their prognosis, why do you think this is?
  • Should patients always be told that are nearing end of life? Are there some situations when this would not be appropriate?
  • How can a patient’s reluctance to accept that they are dying impact on the care they receive?

Comments (25)

Should families be present during resuscitation attempts?

3 March, 2014 Posted by: -

Jaques H (2014) Family presence at resuscitation attempts. Nursing Times; 110, 10: 20-21.



“UK resuscitation guidelines suggest that parents and carers should be allowed to be present during a resuscitation attempt in hospital but no guidance is available regarding family presence when resuscitation takes place out of hospital.

“A new research study has suggested that relatives who were offered the opportunity to witness resuscitation were less likely to develop symptoms of post-traumatic stress disorder than those who were not given the chance.

“This article summarises the results of this study and provides an expert commentary on its conclusions.”


What do you think?

  • Should families be present during resuscitation attempts?
  • Should children be allowed to be present?
  • What effect can witnessing an unsuccessful resuscitation have on a family member?
  • Can family members’ presence affect health professionals’ ability to do their job?

Comments (5)

Will recommendations for HCA training recreate the SEN role?

24 February, 2014 Posted by: -

Health Education England has launched a major consultation on ways to develop band 1 to 4 NHS staff, including increasing the number of healthcare assistants that move into nursing.

The Talent for Care document, which calls for the views of nurses and other healthcare professionals, highlights the plight of low-paid support workers, with wide variations in training opportunities across the country.

It also says there is a “mismatch” between the training and support NHS organisations claim to offer and the experiences of staff on the ground, which has contributed to “some serious failures in care”.

Feedback from the consultation will help create a national strategy for bands 1 to 4, which will include minimum training standards for HCAs, the development of formal career paths into band 5 posts and beyond, and more opportunities to access registered training courses like nursing.


News: Views sought on plans to boost HCA training and careers


Will these plans result in a second level nurse role?

What training and education should healthcare assistants receive before they have contact with patients?

What is your response to this consultation?

Comments (13)

How do patients feel about attending nurse-led, rather than consultant-led, services?

24 February, 2014 Posted by: -


Townsend A (2014) Patients’ views on a nurse-led prostate clinic. Nursing Times; 110: 9, 22-23.



“Nurse-led clinics are being established in a number of specialties including urology. Men attending a nurse-led clinic for suspected prostate cancer were surveyed to investigate their perception of and satisfaction with a nurse-led clinic and to establish whether this model of care met expectations.

“The results showed that patients were satisfied with the service. This adds to the growing body of evidence supporting nurse-led services.”


What do you think?

  • Should more services be nurse-led?
  • How do patients feel about attending nurse-led, rather than consultant-led, services?
  • What are the advantages and disadvatages of developing nurse-led services

Comments (2)

What problems can an ineffective handover cause?

17 February, 2014 Posted by: -


Collins G (2014) Using simulation to develop handover skills. Nursing Times; 110: 8, 12-14.


“This article outlines the potential impact of ineffective handover skills on nurses’ confidence, competence and coordination, as well as on patient safety.
It focuses on how student nurses can develop their communication skills, reporting on how the University of Derby used simulation to teach pre-registration student nurses effective handover techniques.”

Let’s discuss…

  • What problems can an ineffective handover cause?
  • What common mistakes do people make when handing over?
  • How can students develop their communication skills?

Comments (5)

Are e-cigarettes a safer alternative to smoking?

10 February, 2014 Posted by: -


Preston W, Ayre S (2014) Are e-cigarettes a safer alternative to smoking? Nursing Times; 110: 7, 20-21.


“The safety of electronic cigarettes has received considerable attention, as people appear to be increasingly using them as an alternative to tobacco.

“Electronic nicotine delivery devices (ENDDs) - commonly called e-cigarettes - are electronic devices that mimic real cigarettes. Operated using chargeable batteries, they deliver nicotine through vapour rather than smoke. They usually look like cigarettes, and reproduce the glowing light at the end of a cigarette when it is inhaled, and steam that mimics smoke when it is exhaled. The nicotine content varies and they are made in several strengths.”


What do you think?

  • Are e-cigarettes a safe alternative to smoking?
  • Can e-cigarettes encourage people to start smoking?
  • Are these devices effective in helping a person stop smoking completely?

Comments (1)

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