Putting it into practice
O’Connell S (2014) Assessing and managing primary hypertension. Nursing Times; 110: 14, 12-14.
5 key points
- Hypertension is a primary modifiable risk factor for the development of cardiovascular disease
- Accurate blood pressure measurement is essential
- All patients diagnosed with hypertension should be offered lifestyle advice
- ACE inhibitors are the first drug of choice in most patients aged under 55 years
- Calcium channel blockers are the first drug of choice in patients of African or Caribbean origin
How can you ensure your blood pressure readings are accurate?
Are automatic blood pressure monitors reliable?
Is a high blood pressure reading enough to motivate patients to change their lifestyle and behaviour?
Anderson P (2014) Reducing need to restrain vulnerable patients. Nursing Times; 110: 29, 24-25.
A multiprofessional consortium led by the Royal College of Nursing has developed guidance on reducing the need for restrictive interventions in hospitals and residential or care homes.
The guidance, published by the Department of Health this year, states that nurses and other staff must create therapeutic environments that promote wellness, and must use restrictive interventions only when there is a real possibility of harm to the person, staff or the public.
Staff must not restrain people in a way that affects their airway, breathing or circulation, and restrictive intervention must not include the deliberate application of pain. Interventions used must always be the least restrictive option to meet the immediate need.
- In what situation is restraint necessary?
- If you have ever restrained patients, could you ever have avoided this by responding differently?
Collins G (2014) Using simulation to develop handover skills. Nursing Times; 110: 8, 12-14.
This article is available in full to non-subscribers until 11 July, just register for free to access. Subscribers can all articles at any time.
“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 by looking specifically at how the University of Derby used simulation to teach pre-registration student nurses effective handover techniques.”
- Why do student nurses often lack confidence in giving handovers?
- What techniques have you found useful in building this confidence?
- What do you think of the SBAR approach to handovers?
Gary Rolfe is professor of practice development and innovation, College of Human and Health Sciences, Swansea University.
Rolfe G (2014) Advanced nursing practice 1: understanding advanced nursing practice. Nursing Times; 110: 27, 20-23.
Articles published in Nursing Times in 2012 presented the role of the advanced nurse practitioner as an extension into the territory of junior doctors in response to pressures in healthcare resources. This article traces the history of advanced practice and suggests that a more appropriate model, post Francis report, should focus on fundamental skills and core nursing values. Rather than attempting to plug a gap created by a shortage of doctors by developing medical skills, nurses should value and promote advanced nursing practice, which is driven by patients’ needs for the care that doctors are unable and unskilled to provide.
- The author suggests the current role of the advanced nurse practitioner developed in response to pressure on healthcare. What do you think of this theory?
- Following the Francis report and a call for a return to core skills, values and attitudes for nurses should we re-examine the role of advanced nursing?
- How would you define the roles and responsibilities of nurses undertaking advanced practice?
Part 2 of this series is published next week
McKenzie K (2014) Nurses’ intentions to give lifestyle support. Nursing Times; 110: 26, 20-22.
Models of behaviour change can help identify factors that influence health behaviours such as eating a healthy diet and physical activity. The Theory of Planned Behaviour has been shown to be relatively effective at predicting people’s intention to engage in health-related behaviours.
More recent research has explored whether it can help predict the intentions of one group of people to support another group to engage in healthy behaviour. This has implications for nurses, who are often facilitators of patient health. This article gives an overview of the model and discusses its potential implications for nurses.
- How much influence do nurses have over their patients’ lifestyle decisions?
- Do patients expect nurses to offer advice on health behaviours, such as diet and physical activity?
- Do you feel comfortable starting these conversations?
Markey L, Farvis R (2014) Reflective practice in an acute setting. Nursing Times; 110: 24, 16-18.
This initiative was undertaken to find a realistic and sustainable approach to reflective practice in an acute hospital ward. A questionnaire was distributed to staff on an oncology ward to discover their thoughts on finding an approach that could be used on a daily basis. The results were collated and a reflective tool was developed; a pilot study was carried out, which found the tool to be usable. Communication improved between staff and a more reflective culture began to develop.
- Is it possible to reflect on your practice on a daily basis?
- Is reflection a part of your normal work routine?
- How useful do you find clinical supervision?
- The research suggests that if staff feel valued, the quality of care improves. Do you find this to be the case?
Ashton S (2014) Leadership walkrounds in mental healthcare. Nursing Times; 110: 23, 21-23.
Patient safety leadership walkrounds are designed to assist healthcare leaders to improve patient safety. At 2gether Foundation Trust, walkrounds have been developed in mental health settings. They ensure that executives are informed first- hand about the safety concerns of frontline staff, while ensuring staff are listened to and supported when issues of safety are raised. Patient safety and quality improvements have been implemented over time through this process.
- How helpful would it be to have your chief executive visit your ward or unit?
- How often do hospital leaders visit your area of work?
- The article explains how walkrounds help hospital leaders to listen to the concerns of frontline staff working in mental health, could this be effective in other areas?
Solomon D et al (2014) Managing misuse of novel psychoactive substances. Nursing Times; 110: 22, 12-15.
“Misuse of novel psychoactive substances, also known as legal highs, is growing in the UK. These substances include more than 200 psychoactive chemicals and are associated with harm to physical and mental health, but are not controlled under the Misuse of Drugs Act 1971 or regulated as a medicine.
“This article reviews the evidence relating to psychosocial interventions for illegal substance misuse to identify how therapies could improve rates of abstinence and awareness in adults who are misusing novel psychoactive substances. The evidence is limited and there is a need for further research and increased awareness among health professionals and the general population of this growing problem.”
- Have you come across patients suffering adverse effects of “legal highs”?
- The use of NPS is associated with serious health risks as the drugs are not tested to ensure they are safe for human consumption. How can this be communicated to patients?
Kaur R et al (2014) Using face-to-face interpreters in healthcare. Nursing Times; 110: 21, 20-21.
This article discusses the use of professional interpreters in healthcare. Interpreters can improve clinical outcomes by bridging the gap in access to and quality of care between native and non-native speakers. The article also offers guidance on how to work with interpreters.
- How easy is it to access interpreter services?
- The article stresses the importance of healthcare professionals being adequately trained in how to work with interpreters. Is such training readily available?
- Why is it inadvisable to use the patients’ friends or relative as informal interpreters?
Drake R (2014) Five dilemmas associated with e-rostering. Nursing Times; 110: 20, 14-16.
Increased use of e-rostering is likely to benefit nurses and patients, but will also create dilemmas for staff. Rosters may not be flexible enough to accommodate day-to-day changes, and may also foster unfair treatment and disempower staff.
5 key points
- The government is tendering for a workforce management system for the NHS costing up to £1bn
- While manual rostering systems may be unsatisfactory, e-rostering brings new dilemmas
- Fairness is the most commonly cited objective of roster policies at NHS trusts, with productivity second
- Today’s e-rostering systems are the forerunners of more sophisticated systems that will change the way nurses work
- Employment contracts in future may specify a number of “on-call” hours to be worked at short notice
- Do you support the move to e-rostering?
- What dilemmas do you envisage e-rostering causing?
- What problems have you found with current rostering systems?