Putting it into practice

Key points

• Nurses may benefit from specific training in the administration of medication to patients with dysphagia
• An individualised medication administration guide (I-MAG) can help nurses to administer medication to this group and increase safety
• Nurses often feel more confident in their practice when I-MAGs are in place
• Time and safety are nurses’ main concerns when administering medication to patients with dysphagia
• Research to determine the cost-effectiveness of I-MAGs is needed

Let’s discuss

• Think about a patient in your ward or unit who has dysphagia. What measures have you taken to ensure their drugs are administered safely?
• Why are patients with dysphagia more likely to suffer a medication administration error than those without swallowing difficulties? You should find this link useful.
• How can the risk of error be reduced?
• What information do you need to ensure safe drug administration for this group of patients?
• What should you consider before administering drugs via enteral feeding tubes? You should find this link useful.

Key points

• Policy is aiming to put service users at the heart of the healthcare experience
• Nurses are ideally placed to take compassionate, person-centred care forward
• Engaging service users in nursing education is crucial to developing nurses who are well prepared for practice
• Storytelling has provided insights into the healthcare experiences that professionals provide
• This patient story appears to have affected how students and mentors see their therapeutic relationships with service users

Let’s discuss

• Do our personal experiences of health care influence how we practice?
• Outline how you think patient stories can be used to inform practice?
• Describe the benefits of reflective practice?
• How can nurses use their personal experience of healthcare in learning situations with student nurses or their peers?

Key points

• Defining minimum nurse staffing levels could help to stabilise the nursing workforce, ensure safe levels of staffing and deliver care to an agreed standard.
• However, careful consideration needs to be paid to variations in patient needs and local clinical contexts, as well as the potential impact on patients.
• Setting a mandated minimum has major consequences not just in terms of investment required to set up and establish (and periodically recalibrate) levels, but also in terms of mechanisms needed to monitor compliance and deal with non-compliance.
• Ratios currently in use focus on numbers of nurses to patients. There is a need to look at overall staffing levels, and the skill mix of the nursing team.
• Ratios do not obviate the need for robust mechanisms for workforce planning locally, to ensure that the right staff with the right skills are in place to meet patient needs.

Let’s discuss

• Why is there a call of minimum staffing levels in the UK?
• Who should be involved in setting minimum staffing levels?
• What are the advantages and disadvantages of set minimum staffing levels?
• Think about patients in your ward or unit. Is nurse-to-patient ratios the best way of defining staffing levels?

Key points

• Action learning sets involve peer-discussion groups working to resolve individual workplace issues
• Benefits include enhancing communication skills and developing self-awareness and leadership skills
• ALS is a dynamic and evolving group process
• Similarities between clinical supervision and ALS suggest they are equally suited to developing professional standards in nursing
• ALS could be used as a supportive tool to empower nurses in today’s challenging healthcare arena

Let’s discuss

• How does you team receive clinical supervision?
• What opportunities does your team have to get together and discuss their working lives?
• After reading this article, describe how action learning sets could be used in your clinical area?
• What are the potential benefits for staff?
• Do you think there are barriers to using action learning sets? How could these be overcome?

Key points

• Environmental changes influence pollen seasons
• Rhinitis can be classified as allergic or non-allergic
• Symptoms are debilitating and limit activity
• Treatment should be started promptly
• Rhinitis and asthma often coexist

Let’s discuss

• Why are cases of allergic rhinitis increasing in the UK?
• What questions would you ask patients who you suspect have allergic rhinitis?
• How can allergic rhinitis affect performance at school and work?
• What advice would you give students who experience seasonal rhinitis at exam time?
• How would you explain the technique for using a nasal spray to patients?

Key points

1. Many assumptions about online delivery are not borne out in practice
2. Students need to be prepared for online study; this includes clarity about what is expected and required of them
3. Course designers should explore if online learning allows things to be done differently
4. Existing tutors should be involved in online course design
5. Online courses shoud be underpinned with sound learning and teaching principles

Let’s discuss

• What are the benefits of online learning?
• How would you prepare to for an online course?
• What support would you expect from lecturers providing an online course?
• Do students perform better in assessments following online or face-to-face courses?

THIS ARTICLE WILL TELL YOU ABOUT:

• The ways in which the NMC code is a tool for all nurses in all situations
• The key principles of the NMC code
• Areas of development of the code, including emphasising the need for critical thinking, technology and evidence-based practice skills in students

YOU WOULD BE LIKELY TO REFERENCE THIS ARTICLE IF YOU WERE RESEARCHING:

• The NMC code
• Guidance
• Professional conduct

IN WHAT SITUATIONS WILL THIS ARTICLE BE USEFUL TO ME?

The NMC code, the article explains, should be a framework for how nurses and midwives practise.  With its discussion of the key principles of the code and its five key points, this article makes the code more accessible.  You may also find the discussions of some of the specific guidances — like on the care of older people or on paper and electronic records — helpful.  

QUESTIONS FOR YOUR MENTOR/TUTOR:

• How do you understand the purpose of the NMC code? How do you apply it to your practice?
• How can I remind myself of the key principles of the code in caring for my patients?

STUDENT NT DECODER:

• Evidence-based practice: the approach to care used by health professionals, which is based on the idea that practice should be determined by what research supports.
• NMC Guidance: publications by the NMC on a specific concern that provide instructions on how to address that concern.  Examples include the guidance on record keeping and the guidance on the care of older people. 

OTHER ARTICLES YOU MIGHT FIND USEFUL:

• #NurChat - ‘Jedi’s have the force, nurses have the code’
• Developing Evidence-based practice among students
• Being professional - what it means for nurses

Key points

1. Remedial care aims to maximise recipients’ independence, autonomy, abilities and quality of life
2. The Caring For and Caring About model is weighted towards a remedial rather than protective approach
3. The quality of interaction between caregiver and recipient will determine how, what and in which timescale remedial care can succeed
4. Success depends on what the recipient and caregiver agree to commit to as an attainable improvement
5. The decision about the appropriateness of the approach involves taking an informed direction that is consistently thought through

Let’s discuss

• What are the main challenges to providing resident-centred care in residential and nursing homes?
• What barriers exist to changing practice?
• What leadership styles should care home managers adopt and why?
• How can care home managers involve staff in exploring how care could be improved?
• What strategies could care home staff use to change practice?

Key points

1. Skin tears usually occur in immature skin in neonates and in older people
2. Evidence on their prevalence and incidence is limited and generally dated
3. Nurses should be aware of the risk factors associated with skin tears and minimise risks to patients wherever possible
4. Prevention should start with early identification
   of those at risk
5. The most important aspect of assessment and management is to minimise further trauma and preserve viable tissue

Let’s discuss …

• Why are skin tears and increasing problem in tissue viability?
• How would you identify a patient who is at risk of skin tears?
• Think about patients you care for who are at risk of skin tears. How could you minimise this risk?
• How would you assess and manage a skin tear?

Key points

• Some 40,000 new cases of colorectal cancer are dignosed in the UK every year
• Risk factors for colorectal cancer include a high intake of meat and fat, smoking, lack of exercise and high alcohol consumption
• Most colorectal cancers develop from benign polyps or adenomas and so can be detected before they become malignant
• Accurate staging of the cancer will mean an appropriate treatment plan can be put together
• Colorectal cancer treatment includes surgery, radiotherapy and chemotherapy

Let’s discuss

• How do you ask patients about their bowel function when carrying out a routine assessment?
• What signs and symptoms would indicate a risk of bowel cancer?
• Patients aged 60-75 years are screened for bowel cancer every two years. How would explain the screening process to patients?
• A recent NHS campaign has focused on patients’ embarrassment when talking about bowel function with health professionals. Why are people embarrassed to talk about their bowels and how can you help your patients to overcome these barriers?

Key points

• There are complications and risks associated with traditional chest drainage systems
• Digital drainage systems offer more accurate monitoring and a more scientific rationale for removal
• Patient mobility is also improved due to the light weight of the drains
• Using digital drainage systems after thoracic surgery is becoming accepted as a safe method for draining air and pleural fluid
• Other patient groups may also benefit from digital drains

Let’s discuss

• What questions would you ask about a new product before using it with patients?
• How would you conduct a trial of a new product?
• How would you involve patients in trialling new equipment?
• How should you work with manufacturers and suppliers when you are considering new equipment?

Key points

1. People of South Asian origin are four times more likely to develop diabetes than other ethnic groups
2. Those with type 2 diabetes also have a greater risk of developing cardiovascular disease and renal problems
3. Nurses should not make assumptions about understanding among South Asian people with type 2 diabetes
4. Fatalism and strongly held cultural beliefs should not be seen as resistance to health education
5. It is important for nurses to understand other cultures and how individuals relate to their own culture

Let’s discuss

• Why are people with diabetes in South Asian community more likely to develop complications from their condition?
• Is culture specific care effective in improving management of diabetes in this population?
• How would you address commonly held beliefs that prevent South Asian people developing healthier lifestyles?

Imagine you need to organise a support group for people with diabetes from a South Asian community.

• Who should you involve in planning and setting up the group?
• How could you engage people and encourage them to attend?

Key points

1. Nurses have a responsibility to be well informed about research on all medications taken by patients, including licensed, pharmacologically prepared and illegal cannabis
2. Patients should be given information about the physical and psychological effects of illegal cannabis and how it may interact with prescribed medication
3. Nurses should ensure they document patients’ cannabis use, its effects and side-effects
4. They should ensure patients are aware of the Misuse of Drugs Act 1971 and of the penalties for using cannabis
5. Nurses should not get involved in supplying, funding, obtaining or preparing cannabis for patients even if the latter are unable to do this

Let’s discuss

• Do you think there is strong evidence to support the use of cannabis to control symptoms associated life limiting illness?
• What action should you take if a patient discloses they are using cannabis for symptom control? 
• It has been suggested that patients with specified medical conditions should be exempt from criminal prosecution if they grow cannabis for their own use. What are the arguments for and against this proposal?  
• Cannabis is available in a number of countries as a synthetic product. What are the advantages and disadvantages of using these synthetic products?

Key points

1. There is a pressing need to improve the sexual health of young people aged 16-24
2. Encouraging this group to take up screening remains a major challenge
3. Evidence suggests that engaging with young people encourages behaviour change
4. The experience of a specialist team in Nottingham shows that education encourages young people to take up sexual health screening
5. Opportunities to reach young people through existing channels using education combined with screening should be exploited

Let’s discuss

• Why do the under 25 age group have problems talking about sexual health and participating in screening for sexually transmitted infections?
• How can education be used as part of an STI screening programme?
• At what age is it appropriate to talk to school pupils about STIs?
• How would you introduce the subject of STIs to a group of school pupils?

Key points

Let’s discuss

• Why are care homes residents at increased risk of MRSA colonisation?
• Why is it important to screen care home residents for MRSA colonisation?
• How would you organise an MRSA education programme for care assistants in the residential/care home sector?
• Can you identify particular challenges in providing education programmes in care homes and strategies you could use to overcome these?
• What key messages would you include in your programme?

Key points

1. Clinical staff often show a lack of engagement or scepticism about using technology
2. Careful planning and involving nursing teams is vital when implementing electronic record systems
3. Nurse leaders need to consider whether IT systems fit with their professional values
4. The Caldicott guardian in each trust is a helpful resource
5. A team effort is crucial in reaping the benefits more quickly for patients and staff

Let’s discuss

Think about how you respond to new technology in the work place.

• Do you feel excited about it or does it make you feel anxious? Why?
• If technology makes you or one of your team anxious or worried list actions you could take to address these concerns?
• If you are using electronic record systems how is patient confidentiality assured?
• How could you measure the effect of new technology on patient care and the ward team?

Key points

• Dignity is about small things that are extremely important
• Concern is growing that inpatients’ expectations are not being met in terms of dignity, particularly for older people
• Without sensitive support, continence care can become undignified and impersonal
• Ensuring patients have privacy and dignity when using the toilet is crucial
• Privacy pegs and signs can help give patients more dignity

Let’s discuss

Think about patients on your ward who requires help with toileting.

• How could you measure whether their privacy and dignity is maintained during toileting?
• How often do you use a commode or bed pan rather than take a patient to the toilet?
• Are there environmental barriers that prevent you taking patients to the toilet?
• How could these be addressed?
• What other changes could you make to ensure privacy and dignity is maintained?

Key points

1. There is a pressing need for nurses to participate in or lead change management projects
2. Staff need to be encouraged to develop the knowledge and skills to influence change
3. The first step is to identify what exactly needs to change and why
4. Several tools exist to help this process, including root cause analysis and process mapping
5. Stakeholders need to be identified and involved in the process of change for it to be successful

Let’s discuss

The NHS Leadership Framework (NLC, 2011) recognises the potential of all staff to change practice. It is important that change is planned to ensure that it is effective and sustained.

Think about something in your clinical area that you would like to change.

• What process did you use to identify the problem?
• Are there barriers to making a change?
• How could these be overcome?
• Who should you involve in the process?

Key points

1. Intentional rounding involves nurses checking individual patients at set intervals to assess and manage their fundamental care needs
2. It places the patient at the heart of the ward routine
3. IR reduced the frequency of call bell use
4. Introducing IR requires a cultural change and staff need support to bring in the change
5. IR has a positive effect on patient experience

Let’s discuss

• How would you explain intentional rounding to staff at a team meeting?
• What benefits does intentional rounding offer patients and staff?
• How would you implement intentional rounding on your ward?
• What are the barriers to using intentional rounding? How can these be overcome?

Key points

1. Obesity is complex and diseases related to it place a large burden on the NHS
2. Its causes include genetic, social and environmental factors
3. A weight loss of 5-10% can have important health benefits
4. A flexible, structured, person-centred, holistic approach can result in good outcomes
5. Weight management should be a mandatory aspect of primary care services managing long-term conditions such as diabetes and heart disease

Let’s discuss

• How do you start discussions about weight loss with patients who are overweight?
• What barriers do patients describe when they are trying to lose weight?
• How can you incorporate the emotional and behavioural well being of patients, as well as diet and
  exercise advice in to care plans?
• How would you explain the health benefits of weight loss to patients who are obese?

Key points

1. One in six mothers is affected by perinatal mental health issues and stress
2. Early intervention is crucial to better relationships and child development
3. The Family Action perinatal support project complements the health visitor role
4. Volunteer befrienders can reduce anxiety and depression and improve mother-baby bonding
5. This approach is a cost-effective way to improve perinatal mental health

Let’s discuss

• How does stress and mental health problems during pregnancy and after child birth affect
  the relationship between the mother and child?
• What interventions can be used to ensure healthy attachment between the mother and
  child?
• If women feel depressed or unable to cope, what barriers prevent women asking for help?
• How can befriending scheme help support women during pregnancy and childbirth?

Key points

1. It is crucial to systematically question the quality and standards of care
2. The best hospitals monitor standards on a ward by ward basis
3. The QuESTT tool is effective in identifying the potential for falling standards in care given by a clinical or ward team
4. Ward leaders know how they are doing and can provide robust and reliable information from ward to board
5. Peer review is a critical part of the validation process

Let’s discuss

• How do you measure standards of care in your ward or department?
• How are the results of these measures fed back to staff?
• How are they used to review and change practice?
• Do staff have ownership of this information? If not how could this be improved?
• How could the Quality, Effectiveness and Safety Trigger Tool (QuESTT) described in this article be used in your clinical area?

Key points

1. Consider patients’ sexual health needs as part of a holistic approach to care
2. Be aware of your own assumptions, beliefs and values
3. Use neutral language such as “your partner”
4. Consider using the Ex-PLISSIT model of intervention to help open up discussions about sexual health with patients
5. Refer patients on for expert help if necessary

Let’s discuss

Think about your own attitudes towards sexual health and your patients and consider:

• Do you find it difficult to talk about sex? If so, think about why.
• Do you assume your patients are heterosexual?
• Do you make assumptions about the sexual behaviour of your patients? For example, do you think that because they have a long-term illness they are not interested in expressing their sexuality or in having sexual contact?
• If you know a patient’s sexuality, do you make assumptions about how they behave?
• Do you currently consider your patients’ sexuality and/or sexual health needs and if so how?

Key points

1. Healthcare assistants increasingly provide fundamental care
2. The nurses/ HCA boundary is blurring
3. The media has reported care failures as failures in nursing
4. There is a correlation between low nurse-to-patient ratios and high rates of mortality, morbidity and adverse events, but increasing ratios alone would not solve the problems
5. Hospitals with the right culture, workforce, and leadership improve patient satisfaction and save money by reducing adverse events

Let’s discuss

• Do we need an entirely registered nursing workforce?
• Do you agree tasks delegated from managers, doctors and others have an unintended consequence of reducing the perceived value of fundamental nursing care?
• What is the role of the clinical leadership in providing individualised care?
• How would you define safe, minimum staffing levels?

Key points

1. The number of people with dementia is expected to double in the next 25 years
2. UK ombudsman reports show shortcomings in dementia care
3. People with dementia should have their specific needs and preferences recognised
4. Nurses should identify and record causes and triggers that may result in distressed behaviours
5. Delirium can occur in up to half of all those aged 65 years or over who are admitted to hospital

Let’s discuss

• Why do people with dementia frequently become distressed when they are admitted to hospital?
• What strategies can you use to reduce this distress?
• Describe the difference between delirium and dementia?
• How would you explain these differences to a relative or carer?

Key points

1. The remit of Improving Access to Psychological Therapies (IAPT) is to provide timely and time-limited therapy
2. New roles in the IAPT framework mean nurses can access new training
3. Becoming part of the IAPT structure could give mental health nurses the opportunity to have their skills formally recognised
4. It is up to individual mental health nurses to decide whether they can work within an IAPT model
5. Nursing must fight to survive and establish its place within a changing healthcare environment

Let’s discuss

Improving Access to Psychological Therapies (IAPT) aims to reduce the state’s welfare bill by increasing the number of people returning to work after suffering common mental health problems such as depression and anxiety. The initiative has raised some fundamental questions for mental health nurses:

• With 10,000 new paraprofessionals working their way through waiting lists, is there still room for mental health nurses in primary care, or have they been sidelined?
• Is mental health nursing still a separate profession, with specialist skills and knowledge but with few clearly defined nursing roles left?
• Should mental health nurses develop into “psychological wellbeing practitioners”, “gateway workers” or “high-intensity therapists”?

Key points

1. Hospital at night (HaN) services provide cover for roughly 75% of a hospital’s working year and must adhere to the same clinical governance standards as core-time services
2. HaN practices using bleeps sap staff morale and put patients at risk
3. Hospitals can function safely out of hours with a small clinical team, but only with the aid of technology to support team processes
4. Appropriately introduced IT can increase safety and reduce costs
5. HaN coordinator roles can support ward staff and act as a hands-on nurse with supporting technology

Let’s discuss

The coordination of medical cover in hospitals at night presents a number of challenges.

• Is communication at night between medical staff and ward staff effective in your hospital?
• If there are problems how does this affect patient care and staff morale?
• How can these problems be addressed?
• What role can technology play in improving communication between wards and medical staff at night?

Key points

1. The doctor-nurse game says that doctors and nurses share a special relationship founded on role expectations based on power, influence and territory. The nursing role showed respect, acted passively and never disagreed with the doctor
2. In recent years, nursing has aspired to be a profession and take on greater responsibilities
3. By 1990, the author of the doctor-nurse game said it was no longer being played because nurses were no longer competing
4. Yet many of those working on the front line believe the doctor-nurse game is still being played
5. Nursing is more dependent on medicine than ever before and medicine still holds all the cards

“Nursing has been so intent and fixated in mirroring medicine that it has turned itself into little more than a clone.”

Do you agree?

To think about:

• Have doctors tactically delegated tasks to nurses so they can move onto more sophisticated aspects of care?
• Is it relevant to measure the progress made by nurses in terms of medical functions they undertake?

Key points

• Vocal cord dysfunction (VCD) is the abnormal closure of the vocal cords during breathing, most commonly during inspiration
• Symptoms are often misdiagnosed as asthma, meaning some patients suffer unnecessary treatment morbidity
• There is poor awareness and understanding on how to best manage VCD due to a lack of robust prospective research
• Diagnosis is typically based on case history and laryngoscopy, but pulmonary function tests, such as spirometry, can add further support
• Patients who have limited, inconsistent or unexpected relief from bronchodilators may have VCD rather than asthma

Let’s discuss

• Why is vocal cord dysfunction frequently misdiagnosed as asthma?
• What are the signs and symptoms of vocal cord dysfunction?
• How would you manage a patient with suspected vocal cord dysfunction?
• How would you explain vocal cord dysfunction to a patient?

Key points

• Over three million people in the UK are affected by malnutrition and the healthcare costs associated with that exceed £13bn annually
• In the past 10 years, the proportion of patients being discharged from English hospitals while malnourished has risen by 85%
• Malnutrition has clinical implications, such as delayed healing, development of pressure ulcers and prolonged hospital lengths of stay
• Nurse awareness of nutritional screening, as well as using protected mealtimes, can help to maintain the nutritional care of patients
• Mealtime volunteers can support patients by carrying out simple tasks such as completing menus, opening packaging and encouraging them to eat

Let’s discuss

Using volunteers for feeding

• Should volunteers feed patients?
• Are there safety issues and if so, how can these be addressed?
• What other nursing tasks could volunteers undertake on wards?

Key points

Let’s discuss

• How would you treat a patient who you suspect has hypoglycaemia but has lost consciousness?
• What advice would you give a patient who has repeated episodes for hypoglycaemia?
• Some patients have “hypoglycaemia unawareness” – they may lose consciousness without warning. How could you support a patient who is told they cannot drive because of this problem?
• What are the clinical signs of hypoglycaemia?

Follow the debate on Twitter #NTjournalclub

Key points

Let’s discuss

• How would you treat a patient who you suspect has hypoglycaemia but has lost consciousness?
• What advice would you give a patient who has repeated episodes for hypoglycaemia?
• Some patients have “hypoglycaemia unawareness” – they may lose consciousness without warning. How could you support a patient who is told they cannot drive because of this problem?
• What are the clinical signs of hypoglycaemia?

Follow the debate on Twitter #NTjournalclub

Key points

Let’s discuss

• What do the words “Gypsy” and “Traveller” mean to you?
• Where do your perceptions come from? For example, are they influenced by your personal experience of travellers or media stereotypes?
• If a nurse has negative perceptions of a particular group or community do you think this affects the care they give to people from that group?
• There is often a gap between personally held views and opinions and our public voice and professional practice. Is it possible to compartmentalise personal views from professional practice?

Key points

Let’s discuss

• What additional training do nurses need to carry our defibrillation?

You might like to consider:

• Does your current CPR training cover defibrillation and is this annual update adequate to ensure you are competent to carry it out?
• How can you identify ventricular fibrillation (VF) or pulseless ventricular tachycardia
  (VT)?
• Outline the procedure and safety precautions for defibrilliation.

Key points

Let’s discuss

• Why do you think ward using agency and bank staff have lower quality scores than wards with permanent staff only?

To think about:

• How do you introduce temporary staff to your ward? How do you know this is effective?
• What strategies could you use to ensure temporary staff understand their role and
  responsibilities in your ward team?
• If you work as a bank or agency nurse what advice would you give ward staff about
  introducing you to the ward and team?

Key points

1. The Health and Social Care Act (2008) requires healthcare providers to have a standardised aspetic technique in which education and audit can be demonstrated
2. Aseptic technique represents the last line of defence for patients from microorganisms during invasive clinical procedures
3. Aseptic Non Touch Technique is the de facto standard aseptic technique in the UK
4. Safe aseptic technique relies on effective staff training, safe environments and equipment that is fit for purpose
5. Basic infection prevention precautions, such as effective hand hygiene and glove usage also help to ensure asepsis

Let’s discuss

• What does the term “aseptic technique” mean?
• Why is non-touch technique important?
• How can you achieve a standardised approach to aseptic technique in your trust?
• Should registered nurses have their competency to carry out this procedure reviewed regularly?

Follow the debate on Twitter #NTjournalclub

Key points

• Leg ulcers are complex wounds and should be managed by skilled practitioners
• Factors such as age, obesity and co-morbidity can affect the effectiveness of treatment
• A better understanding of the benefits of different compression materials is needed
• Surgery may be appropriate for some patients
• Quality of life is an important issue and patients’ needs should be taken into account

Let’s discuss

• What is the role of obesity in the development of venous leg ulcers?
• How could you assess the impact of venous leg ulceration on a patient’s quality of life?
• What training and education do you think you need to manage venous leg ulcers effectively? When should you refer patients to a specialist service?
• Outline why is compression therapy used to treat venous leg ulcers?

Key points

• Patients’ perspectives on care are vital to improving the quality of NHS services
• Patients occasionally give feedback on the way student nurses have cared for them, but usually in an ad hoc way
• Developing a structured tool allows patients, carers and relatives to become part of the student nurse assessment process
• Patients can evaluate communication, comfort, and treating individuals with respect
• It is not appropriate to request feedback from some patients, for example those who are sedated or too ill

Let’s discuss

• How can structured patient feedback help in student assessment?
• How could patient feedback affect the relationship between the student and patient?
• What aspects of a student nurse’s care should patients assess?
• Could patient feedback be used to assess registered nurses performance?

• Poor physical and mental health is often related to modern lifestyles with a lack of exercise, poor diet, stress and isolation
• Outdoor activities can help people relax, reduce stress and instil a sense of wellbeing
• Exercising in a green space is more beneficial than forms that concentrate on exertion without considering the surroundings
• Promoting outdoor activity could save money through fewer medical interventions, prescription drugs and hospital admissions

• Do you agree outdoor activities should be a treatment option for some patients

Think about a patient you are caring for with a long-term condition:

• How would you explain the benefits of outdoor activities to them?
• What sort of activity would you encourage them to participate in?
• How could you evaluate whether the activity has had a positive impact on their health?

• The principles of the Mental Capacity Act 2005 should be followed by all staff caring for people who may lack capacity to make healthcare decisions
• Many people with learning disabilities can make healthcare decisions with support, such as the use of simple language and pictures, to communicate
• A mental capacity assessment must be carried out to determine whether individuals have the capacity to make adecision, and before any decisions can be made on their behalf
• The nurse or doctor is usually responsible for best-interests decisions, with input from patients’ families and carers
• Health professionals should try to limit restrictions on patients’ families and carers
• Health professinals shoult try to limit restrictions on patients’ rights nad freedoms y avoiding any form of restraint, unless it is in the patients’ best interests

• Do general nurses understand the needs of people with learning disabilities when they are admitted to hospital with health problems?
• In your experience, are people with learning disabilities are involved in decisions about medical treatment?
• How would you assess whether a patient with learning disabilities has the capacity to make a decision about their medical treatment?
• How would you explain a best interest decision to relatives and carers?

1. What problems do you have with traditional off duty? Think about incorporating requests, holidays, bank and agency staff.
2. How could e-rostering improve management of staff time in your clinical area?
3. How can e-rostering promote fairer off duty planning and improve staff morale?
4. How would you explain the benefits of e-rostering to your team?

• Evaluating the strengths and weaknesses of NHS workforce planning methods
• How do those charged with delivering safe care ensure safe staffing?
• How to manage the staff duty roster

• Since 2005-06, there has been a 465% increase in outpatient attendances at specialist nurse clinics – a rise of more 100,000 outpatients a year
• Patients appear to value the services provided by specialist nurses; they are consistently rated better than those of other health professionals
• The role and function of specialist nurses, services they provide and their effects should be described and measured accurately
• Specialist nurses need to ensure that they have evidence their services are cost-effective and improve patient safety and services
• The unique knowledge, skills and experiences of specialist nurses means they could play a vital role in commissioning

• What value do specialist nurses add to care of patients in your ward, department or team?
• What evidence could you use to demonstrate their value to managers or service commissioners?
• Do specialist nurses have appropriate business skills to justify the services they provide?
• Do you think specialist nurses are at greater risk of cuts in times of financial austerity than general nurses?

• Patients with urinary catheters are at high risk of infection.
• Catheters reduce the body’s natural ability to cleanse the urinary tract of micro organisms.
• Bacteria can be free floating or can colonise into biofilms that attach to the catheter surface and may cause catheter blockage.
• Biofilms can develop a resistance to antibiotics.
• Silver alloy urinary catheters can reduce biofilm formation and colonisation by releasing silver ions into the urinary tract.

• Why does catheter-associated urinary tract infection (CAUTI) remain a persistent challenge in healthcare?
• What strategies have you found to be effective in reducing CAUTI?
• Looking at the evidence in this article, do you think silver alloy catheters should be used routinely in clinical practice?

• Driving down catheter associated infection rates
• Urinary catheter use in end of life care

• Fluid balance is a term used to describe the balance of the input and output of fluids in the body to allow metabolic processes to function;
• To make a competent assessment of fluid balance, nurses need to understand the fluid compartments within the body and how fluid moves between these compartments;
• Dehydration is defined as a 1% or greater loss of body mass as a result of fluid loss. Physical symptoms of dehydration include impaired cognitive function, headaches, fatigue and dry skin. Severe dehydration can lead to hypovolaemic shock, organ failure and death;
• The three elements to assessing fluid balance and hydration status are clinical assessment, including vital signs, body weight and urine output, review of fluid balance charts, and review of blood chemistry;
• Fluid balance recording is often inadequately or inaccurately completed. Reasons identified for inappropriate completion of fluid balance charts include staff shortages, lack of training, and lack of time.

• Why are fluid balance charts notoriously difficult to maintain accurately?
• What role should healthcare assistants play in fluid balance monitoring and assessing patients’ hydration needs?
• In the clinical situation are signs of dehydration and fluid overload easy to identify? When do you find it challenging?

• Using red jugs to improve hydration
• What is the evidence for drinking eight cups of fluid a day?
• Ensuring hydration
• Campbell N (2011) Why is dehydration still a problem in healthcare? Nursing Times; 107: 22, early online publication.

1. Concerns about essential nursing care have refocused attention on the need to ensure fundamental aspects of care are delivered reliably
2. Intentional rounding involves health professionals carrying out regular checks with individual patients at set intervals
3. The approach helps nurses focus on clear, measurable aims for undertaking the round
4. It also helps frontline teams to organise workload on the ward
5. Rounding can reduce adverse incidents, offer patients greater comfort, and ease their anxiety

• How could you adapt intentional rounding for use on your ward or unit?
• The authors suggest “It may be possible that rounding might prove challenging for staff, because it leads them to encounter directly and personally some individuals’ painful circumstances via immediate, regular contact with patients as people”. What do you think?
• How can intentional rounding be used to improve the organisation of, and quality of, care?
• What are the benefits and potential pitfalls of implementing this approach in your place of work? How could the pitfalls be addressed?