Lansley’s experiment with the NHS must never be repeatedNursing practice, clinical research
Nursing practice and peer-reviewed clinical research for all nurses
Latest practice
Helping survivors to adjust after cancer
As the number of people living with or beyond cancer is growing, nurses have a crucial role in helping them adjust to their new lives after their treatment
Leading change: 3 - implementation
How to pilot, implement and review a change and make sure it is sustainable
Electronic record system preparation
Nurse leaders may need to prepare for new electronic record systems. This article advises them on the questions they will need to ask to ensure sustainable benefits for patients
Skin reactions in radiotherapy
How a toolkit helped staff to assess and manage radiotherapy-induced skin reactions
"People with rare cancers get a raw deal in research and care"
People with rarer cancers deserve the same support and information as those with more common cancers
How to prevent the spread of norovirus
Norovirus has a significant impact on healthcare resources. Nurses can help to prevent its spread by maintaining good hand hygiene and infection control measures
When should peripheral venous catheters be replaced?
Catheter insertion is an unpleasant experience for patients. This Cochrane review assessed the effects of removing catheters when clinically indicated compared with doing so routinely
Leading change: 2 - planning
Change needs to be planned properly, objectives and timetables set, and resistance dealt with sensitively if you are to get people on board to implement change
Toilet privacy in hospital
An audit that collected the views of patients and nursing staff highlighted key points to improve patients’ privacy and dignity when they were using the toilet in hospital
"Beware the implications for nurses of assisted dying law"
While imminent changes to the law are unlikely, the issue of assisted dying is not going to go away
Intermittent self-catheterisation in MS
A review of the literature on the use of ISC in people with multiple sclerosis found significant support and follow-up may be required to ensure long-term use of this technique
Causes and strategies for moisture lesions
Moisture lesions often cause pain and distress. A number of strategies can be adopted to prevent and treat dermatitis associated with urinary or faecal incontinence
Foreign body ingestion in children
Gagging, choking, vomiting and refractory wheezes are classic signs that children may have ingested foreign bodies
Pressure ulcer risk assessment
Early detection and preventive action are vital to reduce avoidable pressure ulcers
Leading change: 1 - identifying the issue
Clinical staff can find themselves in a position where they can influence practice by leading on change. First, they need to be clear on exactly what needs to change
"If data isn't used, it just takes nurses away from the bedside"
Nurses need to find a balance between form filling and delivering care, and ensure that any data gathered on pressure ulcers is used to improve care
Using the 30º tilt to reduce pressure ulcers
There is confusion over methods and frequency of repositioning needed to prevent pressure ulcers, so this study compared a specific schedule with usual care
'Education and understanding are so important in this field because blood transfusion is all about patient safety'
We talk to Bev Ward, a nurse for 31 years, with experience as an Enrolled Nurse (Mental Illness), then as a Registered General Nurse, and now as a Transfusion Practitioner for Nottingham University Hospitals NHS Trust.
Preparing injectable medicines safely
Advice on minimising the risks to patients when preparing injectable medicines
Engaging staff with intentional rounding
Using intentional rounding on a medical assessment unit produced a drop in call bell frequency and improved patient experience. Staff buy-in was essential to the process
Do ward sisters have influence over care?
It is now claimed that the role of the ward sister is confused and without power. Can nursing traditions of the past offer guidance on reclaiming the position?
“Focus on the values of nursing to boost care – not checklists”
Nurses must ensure that ward rounds do not become tick-box exercises
Self-management of obesity
Obesity is a complex condition and nurses in the community must use various strategies to help patients achieve sustained weight loss
Antibiotics and antiseptics for venous leg ulcers
This review investigated whether antibiotics and antiseptics were more effective than usual care for healing venous leg ulcers and, if so, which antibiotic and antiseptic preparations worked the best
“Technology can transform the quality of clinical practice”
Nurses must embrace technology as part of ensuring high-quality care
Managing obesity in primary care
A nurse-led initiative used a holistic approach to encourage patients to improve health
Effect of recording site on pulse oximetry readings
An audit found clinically significant differences between ear and finger pulse oximetry readings during ambulatory oxygen assessments
Why do students fail to disclose health problems?
Many student nurses fear disclosing information about disability or health. This study explored their concerns and developed a web zone to improve knowledge
Dietary treatment for familial hypercholesterolaemia
This Cochrane review compared the effective cholesterol-lowering dietary interventions with other forms of dietary intervention in patients with familial hypercholesterolaemia
Developing evidence-based practice among students
Patient care must be based on the latest evidence-based practice. Student nurses should be introduced to the principles of this as part of pre-registration education
A tool to identify falling care quality
A safety trigger tool was developed so individual wards could anticipate where standards may start to deteriorate and therefore act to prevent care failures occurring
Little voice: giving young patients a say
How a patient experience questionnaire for young outpatients was developed
"At Christmas, making a stand against routine can be enough"
The value of nursing lies in the opportunity to affect individual lives and the personal rewards that this brings - especially at Christmas
Improving blood pressure control in hypertension
This review looked at how care for patients with hypertension should be delivered in the community to enhance blood pressure control
Perinatal support to protect maternal mental health
Mental illness during or after pregnancy is common. A project offering intensive support with befriending in the perinatal period was found to benefit mothers’ mental health
Can failure to rescue be a key indicator of patient safety?
A look at whether administrative data in English hospitals contain enough information to reliably report “failure to rescue” rates and to what extent they affect patient safety
"We need to do research and shout about it - or fall behind"
Nurses need to demonstrate their contribution to care by describing, measuring and comparing what they do at an international level
Broaching sexual health issues with patients
Sexual health problems are a public health issue. Nurses are often reluctant to discuss this topic with patients so advice is given on how to approach the subject
Evaluating a critical care course
A study looked at how final-year student nurses felt they benefited from taking part in a critical care course
How skill mix affects quality of care
The boundaries between different nursing roles have become increasingly blurred. Does care given by nurses differ from that by healthcare assistants and, if so, how?
Communication skills training in end-of-life care
A two-day training course in communication skills for end-of-life care gave healthcare assistants more confidence in discussing death and dying with patients and families
“Compulsory training would help every HCA spot moisture lesions”
Healthcare assistants need more training to distinguish between moisture lesions and pressure ulcers
Use of emollients in dry skin conditions
Emollient therapy can help to prevent skin breakdown in dry skin conditions
Educating patients to prevent diabetic foot ulceration
Foot ulcers are a common and serious complication of diabetes. A systematic review evaluated preventive patient education
Improving person-centred care in dementia
Failings have been identified in dementia care in acute hospitals; to address these nurses should take a person-centred, individualised approach to care
An infant with intussusception
Vomiting, abdominal pain and blood in stools are the classic triad that should alert nurses to the possibility of intussusception in a child
How urinary sheaths benefit quality of life
The first randomised, controlled trial compared how urinary sheaths with absorbent products affected quality of life in men with moderate to severe urinary incontinence
Behaviour change to treat overactive bladder syndrome
Nurses are ideally placed to offer patients who have overactive bladder syndrome behavioural treatments to help manage the problem and improve their quality of life
Faecal incontinence in critical illness
Nurses should not underestimate the value of supportive interaction with patients
"Why do nurses believe they are management material?"
Should nurses focus on nursing and leave management to the managers?
"Extending choice will let us set standards for children"
The new any qualified provider system aims to extend choice in continence services
Where does mental health nursing fit in primary care?
The Improving Access to Psychological Therapies model raises many questions for mental health nurses - including some around professional identity itself
Essential care for patients with stomas
Nurses in any clinical setting may see a patient who has a stoma, so they need a good understanding of the basics of stoma management to ensure they provide holistic care
Improving training in motivational interviewing
Practitioners from different clinical backgrounds can use motivational interviewing. A university set up a module on the technique for health and social care professionals
Diagnosis and management of colorectal cancer
A new NICE guideline on colorectal cancer is particularly relevant to nurses because of their role in maximising patients’ quality of life
“Bowel screening should be made part of mainstream care”
Health professionals must support the bowel cancer screening programme for it to succeed
Management of stoma complications
Most patients who have a stoma experience complications at some point. Nurses need to provide prompt assessment, advice and referral for specialist help if required
Acute traumatic stress treatment
This Cochrane review looked at early psychological interventions to manage and treat acute traumatic stress symptoms
Use of pharmacotherapy in smoking cessation
Nicotine replacement therapy, bupropion and varenicline are pharmacotherapies that are effective in people who want to stop smoking, doubling quit rates
Benefits of napping on night shifts
Napping on breaks during a night shift can boost nurses’ health and patient safety
Using IT to improve out-of-hours care
A trust used information technology to make its Hospital at Night service safer and more efficient while improving staff satisfaction
Smoking cessation buddies in COPD
A buddy-led smoking cessation clinic can help patients with COPD to quit
Peritoneal dialysis
A NICE guideline gives recommendations on using peritoneal dialysis to treat people with stage 5 chronic kidney disease
"We must look at our practices and attitudes about shift work"
Nurses need to look at how they can reduce the toll that night shifts can take on their health and wellbeing
“Nurses should defy the deeply embedded doctor-nurse game”
Nurses still need to push for equality with doctors
How to interpret spirometry results
The second in a two-part series on spirometry looks at how to interpret the test results and highlights possible reasons for abnormal results
Is the doctor-nurse game still being played?
The doctor-nurse game first described 40 years ago is still relevant to modern nursing, despite many changes to the profession. Is nursing partly to blame?
Designing wards to release time to care
Innovative ward layout can reduce wasted nursing time. A hospital designed three new wards to allow nurses to spend more of their shift providing direct patient care
Avoiding air embolism when removing CVCs
CVC removal is fairly straightforward but nurses should take essential steps to avoid complications
Developing an end-of-life benchmark in acute care
Measuring standards in end-of-life care to raise awareness of best practice across a trust
Reviewing home oxygen services
Demand for home oxygen therapy is growing. Carrying out an assessment and review of this service can result in financial savings and improve patient care
Managing COPD
A NICE guideline updates and adds recommendations on how to care for people with chronic obstructive pulmonary disease
Diagnosing and treating vocal cord dysfunction
Vocal cord dysfunction is often mistaken for asthma. Increasing staff awareness of the condition is essential to effective diagnosis and treatment
"I felt that my concerns were being pushed aside"
Jill McCormack’s son has asthma. Here she discusses her experiences of his care, contrasting community and hospital nursing
'A "Top Gear" approach to flu clinics must be quashed'
It’s that time of year again, to try and catch, bin and kill any chance of a day off over the next few weeks.
Understanding spirometry
The first in a two-part series explores the purpose and technique of the spirometry test
Using mealtime volunteers to support patients
Malnutrition is still a problem among patients in hospital. Mealtime volunteers can play an important role in helping people to eat, and supporting nursing staff at mealtimes
Administration of medicines via an enteral feeding tube
How to be safe when administering drugs to patients with an enteral feeding tube
A skills framework for sickle cell disease and thalassaemia
A competence framework for those nursing people with sickle cell disease and thalassaemia has been launched to help address variations in standards of care
“All nurses need to know about inherited blood disorders”
This year, the NHS Sickle Cell and Thalassaemia Screening Programme celebrated its 10th anniversary.
Guidance for feeding adults with swallowing disturbances
This Cochrane review compared the safety and efficacy of percutaneous endoscopic gastrostomy with nasogastric tube feeding for adults who have swallowing disturbances
Nasogastric feeding tube placement: changing culture
A multidisciplinary approach and a change in culture to recognise and act on the risks involved in placing nasogastric feeding tubes improved patient safety
Obstructive sleep apnoea: its link with diabetes
Health professionals need to make the connection between obstructive sleep apnoea and diabetes to ensure that patients receive the right care
Preventing cardiac death in diabetes
A study looked at how nurses record measures to reduce risks linked to diabetes and prevent premature death
How to manage hypoglycaemia
Hypoglycaemia affects the quality of life of patients with diabetes and can be fatal
Carbohydrate counting in diabetes
Teaching patients with type 1 diabetes to count their carbohydrates can help them to manage their insulin dose adjustment better and improve their quality of life
Assessing the value of electronic records
A project investigating whether electronic records can help nurses enhance patient involvement and care planning found a range of issues to be addressed
'Practice nurses should know about diabetes in pregnancy'
Obesity in the UK is rising to epidemic levels, with reports suggesting that, by 2025, four out of 10 people in the UK will be obese. Rising obesity is linked with an increase in adults with type 2 diabetes.
'If assisted suicide is legalised, are nurses best placed to do it?'
We have a strange relationship with death.
How to care for patients with chronic fatigue syndrome/ME
Managing CFS/ME promptly reduces the possibility of lasting impairment and disability
Complex febrile seizures in children
A thorough clinical examination and a detailed history are vital to ensure prompt support of children presenting with febrile seizures
Improving the hydration of hospital patients
A hands-free drinks system can help to reduce patient dehydration in acute settings
Implementing nurse-led discharge
Clinical areas must be prepared to embrace nurse-led discharge for it to succeed
Defibrillation 2: using defibrillators in hospital
The second in a two-part series discusses the use of defibrillators in hospitals
'Patient stories give another view of the world we work in'
Recently, I had the misfortuneof becoming a patient.
Attitudes towards Gypsy Travellers
Nurses need to recognise and overcome negative attitudes towards Gypsy Travellers to help address the health needs of this community
Treating TB in people with HIV
This review investigated whether preventive therapy for latent TB could reduce its active prevalence in people with HIV
'Pre-operative fasting guides can still fall short of the mark'
Mr Jones is on the surgical ward following an elective hemicolectomy.
Defibrillation 1: using an AED outside hospital
The first of a two-part series on defibrillation explores the use of automated external defibrillators outside hospitals, and explains why they can be used without training
Introducing Nursing Times Learning
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Practice comment
"People with rare cancers get a raw deal in research and care"
People with rarer cancers deserve the same support and information as those with more common cancers
"Beware the implications for nurses of assisted dying law"
While imminent changes to the law are unlikely, the issue of assisted dying is not going to go away
"If data isn't used, it just takes nurses away from the bedside"
Nurses need to find a balance between form filling and delivering care, and ensure that any data gathered on pressure ulcers is used to improve care
“Focus on the values of nursing to boost care – not checklists”
Nurses must ensure that ward rounds do not become tick-box exercises
“Technology can transform the quality of clinical practice”
Nurses must embrace technology as part of ensuring high-quality care
"At Christmas, making a stand against routine can be enough"
The value of nursing lies in the opportunity to affect individual lives and the personal rewards that this brings - especially at Christmas
"We need to do research and shout about it - or fall behind"
Nurses need to demonstrate their contribution to care by describing, measuring and comparing what they do at an international level
“Compulsory training would help every HCA spot moisture lesions”
Healthcare assistants need more training to distinguish between moisture lesions and pressure ulcers
"Why do nurses believe they are management material?"
Should nurses focus on nursing and leave management to the managers?
"Extending choice will let us set standards for children"
The new any qualified provider system aims to extend choice in continence services
“Bowel screening should be made part of mainstream care”
Health professionals must support the bowel cancer screening programme for it to succeed
"We must look at our practices and attitudes about shift work"
Nurses need to look at how they can reduce the toll that night shifts can take on their health and wellbeing
“Nurses should defy the deeply embedded doctor-nurse game”
Nurses still need to push for equality with doctors
'A "Top Gear" approach to flu clinics must be quashed'
It’s that time of year again, to try and catch, bin and kill any chance of a day off over the next few weeks.
“All nurses need to know about inherited blood disorders”
This year, the NHS Sickle Cell and Thalassaemia Screening Programme celebrated its 10th anniversary.
'Practice nurses should know about diabetes in pregnancy'
Obesity in the UK is rising to epidemic levels, with reports suggesting that, by 2025, four out of 10 people in the UK will be obese. Rising obesity is linked with an increase in adults with type 2 diabetes.
How it was fifty years ago
Watching some episodes of Melvyn Bragg’s series ‘Reel History’ on BBC television recently about the start of the NHS and the opening of the M1 Motorway, I was reminded of the time I was driven by ambulance on the newly constructed M1 Motorway from London to Birmingham when I was working as a staff nurse at the Bedford General Hospital in 1959.
'If assisted suicide is legalised, are nurses best placed to do it?'
We have a strange relationship with death.
'Patient stories give another view of the world we work in'
Recently, I had the misfortuneof becoming a patient.
The other side of the sheets: part one
The first in a three part series about what happens to a nurse the other side of the sheets.
'Pre-operative fasting guides can still fall short of the mark'
Mr Jones is on the surgical ward following an elective hemicolectomy.
NHS Evidence and the Principles of Nursing Practice: Getting to grips with evidence-based practice
Dr Jenny Gordon, Programme Manager for Evidence into practice - Royal College of Nursing (RCN) believes NHS Evidence provides an excellent resource for nurses to use in supporting ‘Principle F’ of the RCN Principles of Nursing.
“In the middle of a maelstrom, good nursing is everything”
I am no stranger to trauma and, having practised for over 20 years, I’m no stranger to nursing either. I thought I knew what good care meant and how to make a difference – now I really do.
'Staff need key competencies in infection prevention and control'
Infection prevention and control (IPC) is vital in quality improvement and patient safety agendas.
'Too much information can be dangerous, not empowering'
Patients now self-diagnose at the click of a mouse.
Upskill support workers to meet older people’s needs
In the 1980s, in response to demographic changes, older people were moved from the acute setting into an expanding private care home sector.
'Members of the public can help reduce cancer mortality'
Empowering the community and the general public is the most effective way to reduce cancer mortality, and improve health and wellbeing.
“Person-centred care is led by learning disability nurses”
No one who watched the Panorama documentary on the Winterbourne care home for people with learning disabilities could have felt anything but extreme distress and anger.
'Those with a rare disease often know more about it than we do'
It may seem an obvious thing to say but the problem with a rare disease is that it is rare.
'Respiratory strategy must be acted on if care is to improve'
The Department of Health’s publication of An Outcomes Strategy for Chronic Obstructive Pulmonary Disease(COPD) and Asthma in England last month is the culmination of several years’ persistent lobbying from health professionals and patient groups.
'We can consign this nasty infection to the history books'
The news that MMR uptake rates have improved, with 90% of two-year-olds in the UK having their first dose, is encouraging.
'A half-empty glass does not prove your patient can drink'
“Water, water everywhere nor any drop to drink,” wrote Coleridge in his epic poem The Rime of the Ancient Mariner.
'A plethora of job titles just serve to confuse our patients'
The burgeoning number of titles and roles for nurses and others in primary care may encourage choice and uphold the principles of skill mix, but can spell confusion for patients.
'Depression after stroke may be missed – nurses can spot it'
Stroke is the single largest cause of neurological disability in the UK. For some, the physical disability may not be as devastating as the emotional aspects
'We can read Nightingale as a credo for compassion today'
Compassion, or the lack of it, has been at the heart of nursing reform.
'Cottage industry could end delayed discharge misery'
Much has been written on the cost implications of delayed discharge of patients in acute settings.
'Despite progress, we still need to be vigilant about MRSA'
MRSA has become synonymous with media and public perception of “superbugs”. An explosion of news articles linked it to dirty hospitals in the early 2000s.
'We must recognise that we are role models to our patients'
In 2009, the Boorman report highlighted the importance of NHS staff health and wellbeing, not only for individual employees but also so they can delivery quality healthcare.
