Perfecting your practice

THIS ARTICLE WILL TELL YOU ABOUT

• Why public health is important
• How all nurses and midwives, including you, can influence public health
• The importance of evidence-based practice

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

How nurses can use their role to influence public health. This article also explains the evidence base for public health promotion.

IN WHAT SITUATIONS WILL THIS ARTICLE BE USEFUL FOR ME?

As this article states, public health can be promoted by all nurses. This article would be useful for you in any placement as it gives advice on small things you can do to help individuals and communities live a healthier lifestyle.

QUESTIONS FOR YOUR MENTOR/TUTOR

• How do you promote public health in this setting?
• What barriers might you come up against when trying to promote healthy lifestyle choices?

THIS ARTICLE WILL TELL YOU ABOUT

• Methods for collecting patient opinion
• Patient opinions on being placed on an enhanced recovery pathway
• Advice and guidance for using enhanced recovery pathways, particularly when working in perioperative care

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

The role nurses play in caring for patients immediately following surgery and during the recovery period. This article looks in particular at patient experience and could be referenced in essays that analysis how good nursing care impacts on recovery outcomes. This article would also be useful if you were researching the use of enhanced recovery in surgical settings.

IN WHAT SITUATIONS WILL THIS ARTICLE BE USEFUL FOR ME?

This article would be particularly useful if you were on placement, or considering working, in a perioperative setting. It gives guidance on this type of specialist care and on communicating with patients during the post-operative period. The article looks at ways of reducing the need for pain relief and of offering goal-orientated care.

It also gives broader guidance on using an enhanced care pathway, which could be relevant in a wide range of surgical settings.

QUESTIONS FOR YOUR MENTOR/TUTOR

• How is patient experience evaluated in this setting?
• How can the need for pain relief be reduced?

STUDENT NT DECODER

• Enhanced recovery

Enhanced recovery, often referred to as rapid recovery, is a new, evidence-based model of care that creates fitter patients who recover faster from major surgery (NHS Improvement).

• Hepatobiliary surgery

Surgery on the liver, gall bladder, pancreas and bile ducts.

Article

Liddle C (2013) Postoperative care 1: principles of monitoring postoperative patients. Nursing Times; 109: 22, 24-26.

Authors

Cathy Liddle is senior lecturer, school of professional practice, department of skills and simulation, Birmingham City University.

THIS ARTICLE WILL TELL YOU ABOUT

• The principles of postoperative care
• Reasons for vital signs monitoring
• Considerations for transferring postoperative patients

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

The guidelines, policies and evidence base behind postoperative care.

This article particularly focuses on a report by the National Confidential Enquiry into Patient Outcome and Death, and the recommendations for improving postoperative care that came from this report.

IN WHAT SITUATIONS WILL THIS ARTICLE BE USEFUL FOR ME?

This article gives useful guidance for those on placement in perioperative care. It explains nurses’ roles in recovery and in the care of patients for the first few days following surgery. It also gives good rationale for the policies and guidelines behind postoperative care and gives students a clear understanding of how they can assist qualified staff.

QUESTIONS FOR YOUR MENTOR/TUTOR

• Which early warning systems do you use?

STUDENT NT DECODER

Vital signs

Measures to assess basic body functions. Such as respirations, blood pressure, temperature or pulse.

Analgesia

Drugs that relieve pain, more commonly known as painkillers.

Anaesthesia

Anaesthesia means ‘loss of sensation’. Medications that cause anaesthesia are called anaesthetics. Anaesthetics work by blocking the signals that pass along your nerves to your brain (NHS Choices).

THIS ARTICLE WILL TELL YOU ABOUT

• The risks students undertaking placements abroad may face
• How to complete a thorough risk assessment before travel
• Steps to be taken to keep as safe as possible when doing an elective placement abroad

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

This article could be referenced in essays relating to placements aboard, such as reflective essays of your own practice. You could also use it when researching the role and responsibilities of practice nurses.

IN WHAT SITUATIONS WILL THIS ARTICLE BE USEFUL FOR ME?

This article would be useful when planning your own elective placement abroad. It gives a good indication of what vaccinations and precautions you need to be aware of and how you can keep yourself as safe as possible.

It may also help if you are on placement with a general practice nurse. The article provides a good understanding of how practice nurses should assess the risks associated with travel abroad.

QUESTIONS FOR YOUR MENTOR/TUTOR

• In your opinion, do students gain more benefit from undertaking placements in the UK or abroad?

STUDENT NT DECODER

Elective placement

A placement that students organise themselves. This tends to be an area or specialism they are particularly interested in, or somewhere they would like to find out more about. Many students use this placement as an opportunity to experience nursing in other countries.

Bloodborne viruses

A disease that can be spread through contamination with blood, such as HIV, hepatitis or viral haemorrhagic fevers.

THIS ARTICLE WILL TELL YOU ABOUT

• How research in to the Somali community in the UK was carried out
• The knowledge and attitudes about tuberculosis within the Somali community
• How nurses can tailor their practice around different ethnic minority groups to provide best possible care

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

How culture, beliefs and attitudes about disease and infection can affect individual’s willingness to engage with treatment providers. It also gives advice on how problems engaging with hard-to-reach groups can be overcome.

IN WHAT SITUATIONS WILL THIS ARTICLE BE USEFUL FOR ME?

As well as the above, this article could be useful to you in situations where you are required to deal with culturally sensitive issues.

It also gives factual information about tuberculosis and how it is transmitted, as well as providing an understanding of how the Somali community, in particular, view the disease.

QUESTIONS FOR YOUR MENTOR/TUTOR

• Are there any groups of patients that you find particularly difficult to engage with?
• Does stigma about diseases still exist in modern healthcare?

STUDENT NT DECODER

Tuberculosis

Also known as TB. An infectious disease that usually attacks the lungs, although it can affect other parts of the body. TB is an airborne virus and can only be spread in this way.

Can clinical governance act as a cultural barometer?

Authors:

Robert McSherry is professor of nursing and practice development at Teesside University; Wilfred McSherry is professor in dignity of care for older people at Staffordshire University; Paddy Pearce is an independent healthcare clinical governance consultant based in Yarm, Stockton on Tees.

THIS ARTICLE WILL TELL YOU ABOUT

• What is clinical governance
• How to identify where cultural change is needed
• How to implement changes to the culture

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

Clinical governance or how to implement change in a healthcare setting. This article could also be useful to reference in essays about effective leadership.

IN WHAT SITUATIONS WILL THIS ARTICLE BE USEFUL FOR ME?

This article could be useful for you when starting a new placement. It gives advice and recommendations for gauging the culture of healthcare settings. Although, as a student nurse, you may not be in a situation to change this culture, it is useful to have an understanding of the culture within healthcare teams and to be able to identify how this affects patient outcomes.

QUESTIONS FOR YOUR MENTOR/TUTOR

Have you ever had to escalate concerns?

Are there any barriers to doing so?

STUDENT NT DECODER

Clinical governance

A framework through which NHS organisations are accountable for continually improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish (Scally and Donaldson, 1998).

Escalation

In this situation, the word ‘escalation’ refers to staff raising concerns about patient care or colleagues’ practice with those higher up than themselves.

Mid Staffordshire public inquiry

The inquiry, led by Robert Francis QC, in to care failings at Mid-Staffordshire trust between January 2005 and March 2009. The subsequent report is known as “The Francis Report”. There is an earlier report which came out in 2010 which is also known as the Francis report which is Mr Francis’ report of an earlier independent inquiry held behind closed doors. This specifically looked at the failings of the trust.  The second 2013 report is the report of a public inquiry which does refer to some of the evidence gathered at the independent inquiry. The public inquiry was a wider far-ranging inquiry which put the failures in a wider NHS context.

THIS ARTICLE WILL TELL YOU ABOUT

• The Essence of Care benchmarking toolkit
• Advice for improving communication
• How to implement change on a mental health ward

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

The essence of care framework and how this is implemented in practice. This article also gives an insight in to mental health nursing, particularly the importance of communication and some of the literature behind the communication skills nurses are taught.

IN WHAT SITUATIONS WILL THIS ARTICLE BE USEFUL FOR ME?

It may be useful to read through this article before starting a placement on a mental health ward, as it contains a lot of information about how mental health wards work. The article gives guidance on how to improve communication that could also be useful in other health settings.

QUESTIONS FOR YOUR MENTOR/TUTOR

• Have you ever implemented change in practice? How did you do this?
• How can I improve my communication skills?

STUDENT NT DECODER

Essence of Care Benchmarks

A set of benchmarks developed by the Department of Health with the aim of helping healthcare practitioners take a patient-focused and structured approach to sharing and comparing practice.

Essence of Care Benchmarks

THIS ARTICLE WILL TELL YOU ABOUT

• Indications for digital removal of faeces and why this method is still used for some patients
• The risks associated with DRF and how it can cause autonomic dysreflexia
• What other bowel-emptying techniques are available and why different techniques are preferred by different patients

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

This article could be referenced in essays relating to continence or constipation. It may also be useful when writing about situations that patients, or even nurses, may find embarrassing.

IN WHAT SITUATIONS WILL THIS ARTICLE BE USEFUL FOR ME?

As above, this article will be useful when researching constipation and treatments. It may also help you if you witness DRF being performed on placement and want to find out more about it. As this type of technique is used rarely, it can be a shock to witness it being done or even asked to assist.

QUESTIONS FOR YOUR MENTOR/TUTOR

• Is DRF ever used in this area?
• Why might patients prefer to deal with constipation in this way rather than more modern methods?

STUDENT NT DECODER

Impaction

A solid mass of faeces in the rectum that cannot be easily moved. This can occur as a result of severe constipation.

Autonomic dysreflexia (AD)

A medical emergency most often seen in those with paralysis. AD occurs when something affects or overstimulates the involuntary nervous system (eg blood pressure, breathing, digestion). The nervous system will react to this by signalling to the brain to deal with the irritation, however in persons who are paralysed the damage to the spinal cord prevents this message from being passed on. This causes a rise in blood pressure.

Also known as autonomic hyperreflexia.

Cerebral haemorrhage

A bleed within the brain tissue itself. Symptoms vary depending on where in the brain the bleed has occurred. Cerebral haemorrhages are the second most common cause of stroke.

Also known as haemorrhage or intracerebral haemorrhage.

THIS ARTICLE WILL TELL YOU ABOUT

• What the Buteyko breathing technique is
• The evidence base for this complementary approach
• Key elements of the method

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

The Buteyko technique specifically and its evidence base. Alternatively, this article may be useful if you were looking more generally at treatment for respiratory disorders, or researching complementary therapies.

IN WHAT SITUATIONS WILL THIS ARTICLE BE USEFUL FOR ME?

This article could be useful if you are based on a respiratory clinic or ward – in this situation it may help you to teach your patients a technique they may not be aware of, complementary to the treatment they are receiving. Alternatively, your placement may already be using the technique and it would be helpful if you are already aware of how it works and why it is used.

QUESTIONS FOR YOUR MENTOR/TUTOR

• Have you ever used the Buteyko breathing technique with patients?
• What complementary treatments do you feel benefit patients the most?

STUDENT NT DECODER

Buteyko breathing technique

A system of breathing exercises and holistic advice that lower patients’ minute volume by reducing both respiratory rate and depth. In simple terms, this means learning to “breathe less”.

Hyperventilation

Breathing faster or deeper than normal. As more carbon dioxide is being breathed out than the body is producing, this can cause a decrease in the amount of carbon dioxide circulating (hypocapnia) so it is important that breathing is returned to normal as soon as possible.

Pulmonary rehabilitation

A programme of interventions, usually offered by a multidisciplinary team, to help control chronic respiratory conditions.

THIS ARTICLE WILL TELL YOU ABOUT

• What fishbone analysis is and how it works
• How you can apply this tool in clinical settings
• Advice on problem solving and team working

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

How change can be successfully implemented in health care settings.

IN WHAT SITUATIONS WILL THIS ARTICLE BE USEFUL FOR ME?

This article could be useful if you were researching management and delegation techniques and how teams can be persuaded to accept change. Alternatively, you may find it useful to teach you practical skills in working with others and implementing ideas.

QUESTIONS FOR YOUR MENTOR/TUTOR

• Do you use any tools to implement change?
• What problems have you come up against in trying to make changes in healthcare settings?

STUDENT NT DECODER

Root cause analysis

A method of examining what is causing a problem and how to address these causes in order to solve the problem.

Mid Staffordshire public inquiry

The inquiry, led by Robert Francis QC, in to care failings at Mid-Staffordshire trust between January 2005 and March 2009. The subsequent report is known as “The Francis Report”.