Perfecting your practice

THIS ARTICLE WILL TELL YOU ABOUT

• Common reasons for travel
• Factors about the patient and about the journey to consider during risk assessment
• Groups of individuals at higher risk for travelling
• Guidance for risk communication and planning an individual’s risk-management strategy

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

• Traveling
• Risk assessment
• Risk management

IN WHAT SITUATIONS WILL THIS ARTICLE BE USEFUL TO ME?

Since “about 57 million UK residents travelled abroad in the 12-month period to December 2011,” this article presents useful information for a significant portion of the population.  It is useful as a comprehensive introduction to risk assessment and management, especially as it focuses on guidance for health professionals in performing these processes in an individualised manner.

QUESTIONS FOR YOUR MENTOR/TUTOR

• What risk management strategies can I communicate to higher risk travellers like pregnant women, the elderly or young men?
• f a higher risk traveller expresses the desire to engage in high-risk activities, how can I communicate risk management in a non-threatening manner?

STUDENT NT DECODER

• Deep Vein Thrombosis: a common travel health risk in the elderly in which a clot forms in a deep vein.  This clot can become dislodged and travel to another part of the body, like the lungs. 
• Risk assessment: Risk assessment is the determination of the level of risk from a potential hazard.
• Expatriate: an individual who has decided to leave his or her country in order to live long-term in another country.

OTHER ARTICLES YOU MIGHT FIND USEFUL

• The travel vaccinations guide (NHS)
• Advising travellers with special risks
• Raising awareness of the risk of sexually transmitted infection among overseas travellers

Key points

1. Environmental changes influence pollen seasons
2. Rhinitis can be classified as allergic or non-allergic
3. Symptoms are debilitating and limit activity
4. Treatment should be started promptly
5. 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?

THIS ARTICLE WILL TELL YOU ABOUT:

• The symptoms of Parkinson’s disease
• Treatment options, including medication and deep brain stimulation (DBS)
• The role of a Parkinson’s nurse and advice for nurses on caring for Parkinson’s patients

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

• Parkinson’s disease
• Parkinson’s dementia
• Deep brain stimulation

IN WHAT SITUATIONS WILL THIS ARTICLE BE USEFUL TO ME?

Knowledge of the symptoms of Parkinson’s, the treatment options and the possible side-effects of treatment, like involuntary movements and impulsive and compulsive behaviour, is important for caring for patients with Parkinson’s. The discussion of the roles of specialist Parkinson’s nurses and the advice on caring for Parkinson’s patients may be useful for both students and general nurses.

QUESTIONS FOR YOUR MENTOR/TUTOR:

• What are some common signs of impulsive or compulsive behaviour?
• What types of movement problems should I look for because they could lead to malnutrition?

STUDENT NT DECODER:

• Idiopathic – meaning, from an unknown source. According to the article, idiopathic Parkinson’s is the most common form of the disease, meaning that, in most cases, there is no clearly definable cause.
• Dementia – the condition of a loss of brain functioning, more than that which is naturally the result of age.  Some symptoms are forgetfulness, hallucinations and slowness of thought. 

OTHER ARTICLES YOU MIGHT FIND USEFUL:

• Pallative care in Parkinson’s disease
• Parkinson’s stem cell research shows promise
• Dementia: time to make room for hope

THIS ARTICLE WILL TELL YOU ABOUT:

• The definition and symptoms of chronic heart failure (CHF)
• How the heart functions normally and how the body responds to CHF
• Statistics on prevalence and cost
• How CHF is diagnosed as well as pharmacological and non-pharmacological treatment

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

• Chronic heart failure
• Coronary heart disease
• Dyspnoea

IN WHAT SITUATIONS WILL THIS ARTICLE BE USEFUL TO ME?

This article provides a comprehensive overview of CHF, including its definition, symptoms, signs and diagnosis methods, treatment options, prevalence and cost. It will be useful in helping you understand one of the most common conditions. The discussions on how the heart functions normally, how CHF alters the bodies functioning, and non-pharmacological strategies for treatment will be especially useful in the education of patients.

QUESTIONS FOR YOUR MENTOR/TUTOR:

• What are some practical strategies for helping a patient with CHF make needed lifestyle changes?
• How can I best present to a patient what CHF is and how it affects the body?

STUDENT NT DECODER:

Dyspnoea: shortness of breath, generally; includes orthopnoea, which is dyspnoea that occurs when lying down, and paroxysmal nocturnal dyspnoea, which refers to dyspnoea attacks at night. In all forms, dyspnoea is a symptom of CHF.

Epidemiology: the study of the occurrence of a condition within a certain group of people

Myocardial Infarction: known commonly as a heart attack

Oedema: collection of fluid beneath the skin that creates swelling

OTHER ARTICLES YOU MIGHT FIND USEFUL:

• Assessment and nursing care of the patient with dyspnoea
• Pharmacological interventions to manage coronary heart disease
• Acute coronary syndromes: identification and patient care

THIS ARTICLE WILL TELL YOU ABOUT:

• Leg ulcer aetiology and comorbidity in diagnosis and treatment
• Process and strategies for effective leg ulcer assessment and treatment
• Effects of leg ulcers on patients’ well-being

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

• Leg ulcers
• Wound assessment
• Comorbidity

IN WHAT SITUATIONS WILL THIS ARTICLE BE USEFUL TO ME?

This article emphasises the importance of considering all the factors that contribute to a patient’s health when assessing and treating leg ulcers. Guidance on wound assessment—based on the TIME model and other tools—is especially useful. The author also describes the appearance of venous and arterial ulcers but urges that they be used in context of the larger picture of wound assessment.

QUESTIONS FOR YOUR MENTOR/TUTOR

• What strategies would you suggest for more accurate diagnosis of leg ulcer aetiology and comorbidities if the patient cannot communicate well?
• Can you tell me more about managing pain in compression bandaging?

STUDENT NURSING TIMES DECODER

• Aetiology: causation
• Comorbity: when a condition exists independently of and at the same time as another condition. While the two will combine to affect the overall well-being of the patient, neither is considered to be caused by the other. For example, asthma is a comorbidity in elderly patients with leg ulcers.
• Ischaemia/ischemia: occurs when a tissue receives inadequate blood, resulting in too little oxygen and glucose for proper functioning
• Oedema: collection of fluid beneath the skin that creates swelling

OTHER ARTICLES YOU MIGHT FIND USEFUL

• Developments in venous leg ulcer management
• The elements of wound assessment
• Preventing, assessing and managing skin tears

THIS ARTICLE WILL TELL YOU ABOUT:

• The current statistics about falls in UK hospitals
• Major risk factors of falling.
• How a trust designed and implemented a plan to reduce falls, and the results.

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

• Inpatient falls
• Fall prevention
• Risk assessment

IN WHAT SITUATIONS WILL THIS ARTICLE BE USEFUL TO ME?

Preventing falls at home and in hospital is one the High Impact Actions for Nursing andMidwifery. The statistics about inpatient falls in the UK and the discussion of major risk factors are a useful education resource. The risk assessment care plan, used successfully by an acute trust to reduce patient falls, provides additional risks to look for in your patients.

QUESTIONS FOR YOUR MENTOR/TUTOR:

• What can I do to reduce patients’ risk of falls?
• Why is reducing falls so important?
• What does a fall rate indicate about the quality of a service?

STUDENT NT DECODER:

• Risk assessment: risk assessment is the process of looking at a situation in order to determine what risks are present. Risk assessment is done with the purpose of decreasing risk. In the case of reducing inpatient falls, the risk assessment plan determined the risk for each patient based on their history of falling, medications, and other factors.
• Multifactorial assessment: an assessment of a range of different factors.
• Modifiable risk factors: risk factors which can be acted on and the risk lessened.

OTHER ARTICLES YOU MIGHT FIND USEFUL:

• Developing an evidence based approach to falls risk assessment
• A guide to risk assessment
• The impact of accurate patient assessment on quality of care

THIS ARTICLE WILL TELL YOU ABOUT:

• How Transcutaneous Electrical Nerve Stimulation (TENS) works
• Some of the evidence supporting and not supporting its use, and why there is a lot of debate
• How to prevent habituation in patients using TENS
• In what situations TENS should and should not be used

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

• Non-pharmacological methods of pain relief
• Gate-control theory
• Habituation

IN WHAT SITUATIONS WILL THIS ARTICLE BE USEFUL TO ME?

This article looks at a popular method of pain relief.  It will be useful in helping you understand how it works and when it should and should not be used. The discussion on the quality of the evidence can help you understand why there is so much debate about the effectiveness of TENS. Practically the discussion on habituation will be helpful to you with tips on how to maximise the effectiveness of TENS.

QUESTIONS FOR YOUR MENTOR/TUTOR:

• When I use TENS, how should I vary the location of electrodes and the electrical settings?
• If I am asked to use TENS to patients with decreased sensitisation, infection or epilepsy, how can I decrease the chance of side effects?

STUDENT NT DECODER:

• Transcutaneous Electrical Nerve Stimulation (TENS): an electrical analgesic—that is, a pain reliever that works by electrical impulses. Since these impulses pass through the skin, they are “transcutaneous”. TENS works by hindering the transfer of pain impulses in the nerves and by stimulating the release of endorphins. Experts suggest there are no direct side effects, but TENS can make certain conditions, like epilepsy, worse. Most evidence about TENS is inconclusive so it should be used with caution and in combination with other pain relievers.
• Habituation: the process by which pain relievers become less effective with long term use. Habituation to TENS can be decreased by managing time between sessions, rotating electrode locations and changing electrical settings.
• Level A and level B evidence: In the UK, evidence is rated from levels A-D according to how authoritative it is.  This rating is based on a number of qualifications, including the type of trial and the range of the population that was tested.  Level A evidence is the most authoritative evidence; level B is the next most. 

OTHER ARTICLES YOU MIGHT FIND USEFUL:

• Do not turn into the pain police
• Strange Clues to Pain Perception
• Investigation and pain management guidelines

THIS ARTICLE WILL TELL YOU ABOUT:

• Why proper technique for insulin injection is important
• Practical instructions for good technique
• Complications of poor technique
• Principles to teach patients

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

• Insulin administration
• Injection techniques
• Lipohypertrophy
• Patient education

IN WHAT SITUATIONS WILL THIS ARTICLE BE USEFUL TO ME?

This article is practical and will help you to develop good insulin injection techniques and guide you in your role as patient educator. The information will help you when injecting insulin, when educating patients about proper injection, and in understanding how improper techniques can result in harmful glucose levels. Specific techniques mentioned include managing insulin suspensions, skin folding, angle of insulin injection, site rotation and the disposal of sharps.

QUESTIONS FOR YOUR MENTOR/TUTOR:

• What strategies can I use for communicating proper insulin injection techniques to patients?
• How can lipohypertrophy be treated?

STUDENT NT DECODER:

• Hyperglycaemia: the condition in which the blood contains a higher than normal concentration of glucose
• Hypoglycaemia: the condition in which the blood contains a lower than normal concentration of glucose
• Lipohypertrophy: the accumulation of fat under the skin which can result from over injecting in one site

OTHER ARTICLES YOU MIGHT FIND USEFUL:

• Tackling insulin maladministration
• Safety when giving insulin in hospital
• How to manage hypoglycaemia

THIS ARTICLE WILL TELL YOU ABOUT:

• The current debate on decriminalisation of illegal drugs
• The attitude of nurses in treating drug misuse and how that attitude affects care
• Complications in care and special care needs for drug users
• Opinions of experts, like the Royal College of Psychiatrists and the RCN

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

• Decriminalisation versus legalisation
• Patient care of drug users
• Stigma of drug misusers
• Illegal substance misuse

IN WHAT SITUATIONS WILL THIS ARTICLE BE USEFUL TO ME?

This article presents the current discussion on the decriminalisation of drugs with an emphasis on how health care professionals view drug misuse.  It offers the opinions of experts so will be helpful to you in understanding the debate on decriminalisation.  The article can also help shape the way you view and treat drug misuse, because it emphasises the consequences of nurses’ attitudes toward drug users.  It also refers to some of the practical aspects of treatment of drug misuse. 

QUESTIONS FOR YOUR MENTOR/TUTOR:

• How do you approach the treatment of drug users if your personal views on drug misuse conflicts with the attitude and actions required by the professional code of conduct?
• Do you think that decriminalisation will result in a decrease in drug misuse?

STUDENT NT DECODER:

• Decriminalisation: the process where drug misuse shifts from a criminal action to a social and health issue according to the law.  Decriminalisation is not, and does not require, legalisation of drugs.
• Legalisation: the process whereby drug misuse is no longer punishable by the law.  While legalisation will remove the association of criminality, it will not necessary address the social and health issues that come with drug misuse. 

OTHER ARTICLES YOU MIGHT FIND USEFUL:

• Would decriminalising drugs improve care?
• Therapeutic use of cannabis
• Undergraduate nursing students perceptions of substance use and misuse
• 20% of nurses may abuse substances

THIS ARTICLE WILL TELL YOU ABOUT:

• The main symptoms of osteoarthritis (OA):  pain, stiffness, fatigue, depression and anxiety; as well as other resulting symptoms such as loss of function
• Pharmacological management and non-pharmacological management
• Specific medications used, their side-effects and their risks, and combining this information with research findings to show reasoning behind prescriptions
• Portenoy’s criteria for addiction in people with chronic pain

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

• Osteoarthritis
• Pharmacological treatment for OA
• Non-pharmacological treatment for OA
• Addiction, especially to opioids

IN WHAT SITUATIONS WILL THIS ARTICLE BE USEFUL TO ME?

This article will be useful to you in understanding the possible strategies for treating OA by giving you greater insight into effective and non-effective prescriptions.  In particular, the differences between pharmacological and non-pharmacological options— what symptoms they expect to treat, which medicines are recommended, what side-effects are likely—will be helpful in advising patients. 

QUESTIONS FOR YOUR MENTOR/TUTOR:

• How should pharmacological and non-pharmacological approaches be combined for the most effective treatment?
• How should I best advise patients to manage side-effects that may arise from pharmacological treatment?

STUDENT NT DECODER:

• Pharmacological Management: management of symptoms through the use of medication. 
• Non-Pharmacological Management: management of symptoms without the use of medication such as in this example of OA with exercise, weight loss and acupuncture.   

OTHER ARTICLES YOU MIGHT FIND USEFUL:

• Osteoarthritis 1:  physiology, risk factors and causes of pain
• How should I address risk factors when discussing osteoarthritis prevention with patients?
• Pharmacology
• Establishing a Diagnosis for Problematic Drug-Related Behaviour

This article will tell you about:

• What osteoarthritis (OA) is, its prevalence, and risk factors for development
• Diagnosis of OA based on its effects on bone, cartilage and other components of synovial joints
• The physiological process by which inflammation and pain are created
• The roles of specific neurotransmitters in the pathophysiology of OA

You would be likely to reference this article if you were researching:

• Osteoarthritis
• Neurotransmitters and processes of pain and inflammation
• Central sensitisation

In what situations will this article be useful to me?

This article will be useful to you in understanding osteoarthritis. You may care for patients specifically because of their OA or it may be additional to the condition that they are being treated for. This article covers a wide range of topics, including diagnosis, causes of pain, and chemical mediators. An understanding of the pathophysiology (pain, inflammation) presented will be important in treating patients. Discussion of risk-factors and prevalence with patients could also be useful in decreasing the chance of developing and controlling symptoms.

Questions for your mentor/tutor:

• How can an understanding of the pathophysiology of osteoarthritis improve my ability to care for patients?
• How should I address risk factors in discussion with patients for the prevention of osteoarthritis?

Student NT Decoder:

Osteoarthritis (OA): a synovial joint disorder involving cartilage, bone and the synovial membrane. Diagnosed from a persistent history of pain, stiffness and loss of function. OA is different from Rheumatoid arthritis (RA), and one key distinguishing factor is the degree of inflammation. In OA, inflammation is generally less. Both OA and RA affect synovial joints.

Neurotransmitter: a chemical signal that transmits a message from one neuron to a target cell across a synapse (for example glutamate).

Nociceptor: a sensory nerve receptor that responds to damaging or potentially damaging stimulation (chemical, thermal or mechanical).

Synovium: also known as the synovial membrane. It is a layer of tissues a few cells thick that lines the joint and the tendon sheath. It protects the joint by acting as a selective barrier and produces lubrication for the joint.

Other articles you might find useful:

• Rheumatoid arthritis 1: background, symptoms and ensuring prompt diagnosis and treatment
• The management of osteoarthritis and rheumatoid arthritis
• New guidance on osteoarthritis focuses on patient education

This article will tell you about:

• What a cancer survivor is
• The consequences of cancer treatment
• How nurses can help and support cancer survivors

You would be likely to reference this article if you were researching:

• Cancer
• Cancer survivors
• Cancer treatment
• Treatment effects

In what situations will this article be useful to me?

This article will be useful as you will come into contact with patients who have previously been treated for cancer. Although they are now being treated for another condition, their history of cancer treatment will still be impacting on them. They may have a number of long-term issues including health and psychological from their treatment. This article details the wide range of issues from altered body image to employment that are involved.

Questions for your mentor/tutor:

• How can I integrate my knowledge about cancer survivors into my care of patients?
• How will cancer survivorship impact on my care of patients in the future?

Student NT Decoder:

Cancer survivor - these are people who have completed cancer treatment and those who are undergoing treatment.

Fatigue - this is one of the most common effects of cancer treatment. Cancer fatigue can come and go in its intensity but it can impact significantly on daily activities. Symptoms can include muscle tiredness, shortness of breath on exertion and a general lack of energy.

Other articles you might find useful:

• Cancer survivorship 1: how services need to change for those living with and beyond cancer
• Cancer survivorship 2: providing advice and support to those living with and beyond cancer
• A review comparing the effectiveness of nurse led follow-up for cancer with conventional care

This article will tell you about:

• How to identify, prevent and treat moisture lesions
• The causes of incontinence
• Different methods for managing incontinence

You would be likely to reference this article if you were researching:

• Incontinence and its causes
• Management of incontinence
• Moisture lesions
• Incontinence-associated dermatitis

In what situations will this article be useful to me?

This article would be useful for those treating patients with incontinence. They are at risk of developing moisture lesions also known as incontinence-associated dermatitis. This expert article advises on treating and managing incontinence as well as how to prevent incontinence-related lesions. It also gives advice on how to care for and treat those already suffering from the condition.

Questions for your mentor/tutor

• What tools are used on this unit for identifying moisture lesions?
• How do you prevent incontinence-related lesions occurring?

Student Nursing Times Decoder

Moisture lesions - also known as incontinence-associated dermatitis. They are sore and inflamed areas of skin which have been in contact with urine and faeces.

Transepidermal water loss - this is when moisture is lost from the skin and is increased and aggravated by the inflammation caused by moisture lesions. Excoriation - wearing and abrasion of the skin.

Other articles you might find useful

• Understanding the differences between moisture lesions and pressure ulcers
• “Compulsory training would help every HCA spot moisture lesions”
• The high impact actions for nursing and midwifery 4: your skin matters

This article will tell you about:

• How to identify which patients are most at risk of developing pressure ulcers
• What factors affect the likelihood of developing pressure ulcers
• The tools available to help you do this, their benefits and drawbacks
• How you can reduce risk
• How to identify early warning signs of an ulcer developing
• Obstacles that may prevent you from stopping pressure ulcers developing

You would be likely to reference this article if you were researching:

• Causes of pressure ulcers
• Pressure ulcer prevention and treatment
• Why government targets are focusing on avoidable pressure ulcers

In what situations will this article be useful to me?

Anyone working with patients who have restricted movement, lack sensation or fall in to the risk category for developing pressure ulcers for any other reason, may find this article helpful. The article explores early warning signs to be aware of and how skin can be assessed to identify the likelihood of an ulcer developing. It also gives advice on how to reduce the risk and the reasons behind these methods.

Questions for your mentor/tutor

• What tools are used to prevent pressure ulcers?
• How is tissue viability assessed?
• What is in place to reduce the risk of pressure ulcers developing?

Student Nursing Times Decoder

• Compromised vascular supply: This means that blood supply to a localised area is reduced, which it could be for a number of reasons.
• Hypovolaemic shock: Severe blood or fluid loss prevents the heart from being able to pump enough blood around the body.
• Tissue hypoxia: This refers to an area of the body being deprived of an adequate oxygen supply.

Other articles you might find useful

• Using the 30º tilt to reduce pressure ulcers
• Using the SKIN Bundle to prevent pressure ulcers
• Exploring pressure ulcer prevalence and preventative care

 This article will tell you about

• How student nurses experience the transition from student to qualified nurse
• How having more responsibility and being accountable impacted on them
• The debate about preceptorship being mandatory
• How you can grow in confidence once qualified

You would be likely to reference this article if you were researching

• Newly qualified nurses
• Preceptorship
• Professional issues

In what situations will this article be useful to me?

This article would be useful if you are researching the areas above and also if you are in your final year and preparing to qualify as a nurse. It will alert you to the possible areas of difficulty on qualifying. This analysis of the research on newly qualified nurses details how they found the increased responsibility and being accountable stressful.  For example the responsibility  of drug administration  was  identified  of particular concern.

Questions for your mentor/tutor

• How can I be properly prepared for qualifying as a nurse?
• How can I access support if needed?
• How can I gain more experience in the areas that this article highlights as problematic such as drug administration and prioritising care for patients?

Student Nursing Times Decoder

• Preceptorship: This is a structured programme that supports newly qualified nurses to develop their confidence and grow into their role as a qualified nurse. It is currently recommended but not mandatory.
• Accountability: This means that you can be called to account for your actions and are responsible for your own actions.

 Other articles you might find useful

• What are the factors that affect band 5 nurses’ career development and progression?
• Preceptorship framework to ‘be completed by end of year’
• Preceptorships remain at whim of trusts

This article will tell you about

• What intentional rounding is and how the concept was developed
• Benefits of intentional rounding and how it impacts on quality of care
• How it delivers essential care needs
• How it is implemented in practice

You would be likely to reference this article if you were researching:

• Quality standards
• Intentional rounding
• Nurse Quality Forum Group
• Essential care

In what situations will this article be useful to me?

• Intentional rounding is suggested as one of the ways to improve care in the measures announced by the Prime Minister last week to address current concerns about care, particularly of the elderly. Intentional rounding is a system where patients are checked regularly to ensure their care needs are being met. The system originated in Kentucky, US and the intention is for nurses to have clear aims which are measured. Reading the article will update you on this care approach and how it is implemented and the benefits it can produce.

Questions for your mentor/tutor

• How would intentional rounding work in practice?
• How does it fit in a historical context?

Student Nursing Times Decoder

Intentional rounding

• Intentional rounding is a process where nurses and support staff carry out regular checks with
  individual patients at set intervals. Having checked on the patient, the check is ended by the patient
  being asked: “Is there anything else I can do for you - I have time”. This encourages patients to
  express their needs even when staff are busy.

Other articles you might find useful

• Exploring how to measure patients’ experience of care in hospital to improve services
• Exploring how to improve patients’ experience in hospital at both national and local levels
• Exploring how to enable compassionate care in hospital to improve patient experience

This article will tell you about

• How a group of second year students and recently qualified nurses performed when doing drug calculations
• Which type of calculation nurses found more difficult
• What can be done to improve nurses’ skill in drug calculations

You would be likely to reference this article if you were researching:

• Prescribing
• Drug calculations
• Medicines management

In what situations will this article be useful to me?

This research study tested 229 second year student nurses and 44 registered nurses on key calculation skills such as addition, subtraction, multiplication, division, fractions, decimals, percentages and conversions. And it tested them on the main types of drug calculations such as dosage calculations for solid and liquid oral medication and injections, and intravenous fluids. This study showed that both students and nurses were able to perform calculations for solids, oral liquids and injections more easily than calculations for drug percentages, drip and infusion rates. This article highlights the need for regular practice in drug calculation to maintain skills.

Questions for your mentor/tutor

• What are the range of skills that I need for drug calculations?
• How can I best practise my drug calculations skills?
• How can I get more practice?

Student Nursing Times Decoder

• Numerical testing: This assesses your skills on the use of numbers including adding, subtraction, multiplication, division, fractions, decimals and  percentages.
• Drug calculation testing: This assesses your skills on how you calculate correct doses of medications in a range of formats including  solid and liquid oral medication and intravenous therapy.

Other articles you might find useful

• Poor numeracy skills must be tackled to cut medication errors
• How to avoid drug errors
• Alarm over hospital medication errors

This article tells you about:

• The importance of patient feedback
• What ‘patient experience’ is
• How children can have a say in their care

You would be likely to reference this article if you were researching:

• Patient experience
• Patient feedback
• Children’s nursing

In what situations will this article be useful to me?

It will increase and cement your knowledge of the importance of patients being able to feedback their experiences of healthcare services. Listening to patients and actively seeking their feedback is gradually becoming ingrained in healthcare delivery. It is fundamental to a service being able to meet the needs of its users. It is difficult to get the views of patients who are in minority or vulnerable groups. This articles looks at how to ensure the views of children are heard in the planning and delivery of services.

Questions for your mentor/tutor

• Why is patient feedback important?
• Why did we not listen to patients in the past?

Student Nursing Times Decoder

• Patient experience: This is how patients have experienced healthcare. It includes how they feel about their treatment and about  their interaction with health professionals including nurses. Patient experience can be both positive and negative and we can learn from both in shaping and delivering care.

This article tells you about:

• What ‘failure to rescue’ is
• What are the potential points of failure
• How failure to rescue rates are compared between hospitals

You would be likely to reference this article if you were researching:

• failure to rescue
• deteriorating patient
• patient observations

In what situations will this article be useful to me?

Nurses have a responsibility to identify when a patient’s condition is deteriorating through taking, recording and interpretation of patient observations. If a patient dies when their condition was treatable this is referred to as ‘failure to rescue’ (FTR). This article explains how the rates of FTR can be used as indicators of the quality of care and compared between hospitals.

Questions for your mentor/tutor

• What are other indicators of quality of care?
• What are the difficulties in comparing indicators of care quality?

Decoder

• Failure to rescue
• Failure to rescue is when a patient who has had a surgical procedure dies from a cause that was preventable.

Early warning scores

Early warning scores use physiological measurements such as pulse and blood pressure recording to help identify patients who are, or who may become, critically ill. A combination of patient observations gives a score which can provide an early indication of deterioration.

Other articles you might find useful

• Simulation: can it eliminate failure to rescue?
• Are early warning scores the only way to rapidly detect and manage deterioration?
• Implementing the Patient Safety First intervention to reduce harm from deterioration

This article tells you about:

• What eczema is and what it looks like
• How to manage this common skin condition
• How it affects patients psychologically

You would be likely to reference this article if you were researching:

• dermatology
• eczema
• practice nursing

In what situations will this article be useful to me?

It will prove useful if you are nursing patients who have this common skin condition.

Patients admitted with other medical conditions or for surgery may have eczema which will need treatment and management during their admission. Eczema is common in young children who may have it sufficiently severely to require hospital admission. You may also meet this condition on your community placement as eczema is commonly managed within general practice.

Questions for your mentor/tutor

• How can you find out more about how to correctly apply creams and ointments for skin condition?
• What is the nurse’s role in the management of eczema?

Student Nursing Times decoder

Atopy

Atopy is when you are more likely to have an allergic response to common antigens such as pollen, different foods or chemicals. Atopy is hereditary. As a result atopic eczema is caused by an allergic reaction which runs in families

Emollients

These are skin preparations that moisten and lubricate the skin. They are the mainstay of treatment for eczema and come as ointments or creams. As a general rule they need to be applied in greater quantity that you would first assume.

Pruritus

This is the medical term for itching which is a symptom of eczema. Scratching skin made sore by eczema aggravates and worsens the condition. Part of the nurse’s role in eczema, particularly in children, is to discourage scratching of the skin.

Other articles you might find useful

• Use of emollients in dry skin conditions
• The importance of emollients in treating the increasing incidence of atopic eczema
• Raising the profile of skincare among health professionals

This article tells you about:

• How to assess patients with faecal incontinence
• How to manage the skin in this situation
• How to help patients cope psychologically

You would be likely to reference this article if you were researching:

• faecal incontinence
• critical care
• skin care

In what situations will this article be useful to me?

This article will be useful if you are nursing patients with faecal incontinence in an acute setting. When patients are critically ill, fundamental care such as managing incontinence can seem less of a priority. But it is an essential element of care preventing skin damage, pressure ulcers and infection.

Questions for your mentor/tutor

• What assessment tools would be useful in managing faecal incontinence?
• Is there a tissue viability specialist at the hospital who can be consulted for advice and support?

Student Nursing Times decoder

• Faecal management systems: a faecal management system is a fully closed system that collects and contains liquid or semi-liquidstools, helping to protect the skin and prevent faecal contamination of the environment.
• Barrier cream: skin preparations applied to exposed areas of the skin to protect skin cells from exposure irritants such as loose stools.
• Excoriation: damage to the surface of the skin from abrasion or contact with urine or stools, for example.

Other articles you might find useful

• Managing faecal incontinence: a joint approach to guideline development
• Best practice: guidelines for managing faecal incontinence
• A personal account of living with faecal incontinence

This article tells you about:

• The main types of stoma
• Common reasons that patients need stomas
• How to care for patients with stomas

You would be likely to reference this article if you were researching:

• Stoma care
• Colostomy, urostomy or ileostomy
• Stoma appliances

In what situations will this article be useful to me?

• Most patients with stomas receive specialist care from stoma clinical nurse specialists. However, they may present in any clinical setting for health problems either related to their stoma or not. In these situations non-specialist nurses need to be able to understand the basics of stoma management to ensure they provide holistic care, and know when to seek help from the stoma care nurse.

Questions for your mentor/tutor

• Is a stoma care nurse specialist available to offer stoma care help and advice in your place of
  work?
• Do nursing staff need training in basic stoma care?
• Does your workplace need to develop a stoma care policy or guideline?

Student Nursing Times decoder

• Colostomy: a stoma formed from the large bowel or colon
• Ileostomy: a stoma formed from the small bowel or ileum
• Urostomy: a stoma formed using a segment of bowel to allow the passage of urine
• Peristomal skin: Skin surrounding a stoma

Other articles you might find useful

• Management of stoma complications
• Older people should be given practical support to effectively manage their stomas
• Nutrition for people with Stomas 1: overview of issues
• Nutrition for people with stomas 2: An overview of dietary advice
• Sexuality Following Stoma Formation 1: Background
• Sexuality Following Stoma Formation 2: Nursing Care

This article tells you about:

• How to reduce tiredness on nights
• Benefits of napping at night when working shifts
• Recent research into advantages of restorative napping

You would be likely to reference this article if you were researching:

• Shift work
• Night nursing
• Sleep

In what situations will this article be useful to me?

• It will be useful for you in two ways. First, from a personal point of view as you will be working night shifts as part of your training. The article confronts the issue of tiredness, its impact on how you work and offers strategies to limit fatigue.
• Second, it will be useful to you if you are doing an assignment on night nursing or the issue of shift work.

Questions for your mentor/tutor

• Should you talk to the hospital about introducing restorative napping?
• How would it work in practice? What facilities are needed?

Student Nursing Times decoder

• Restorative napping: a brief sleep which reduces feeling of fatigue and improves performance.
• Cognitive impairment: this is when mental functions such as memory, understanding, and judgment are affected. This can be from a variety of causes - tiredness is one of them.

Other articles you might find useful

• ‘We must look at our practices and attitudes about shift work’
• Why nurses need to unwind from work

This article tells you about:

• New guidance on managing chronic obstructive pulmonary disease (COPD)
• The role of NICE guidelines
• The key priorities in managing this condition

You would be likely to reference this article if you were researching:

• COPD
• Respiratory conditions
• NICE guidance

In what situations will this article be useful to me?

• If you are caring for patients with chronic obstructive pulmonary disease (COPD) either in hospital or out in the community. It will provide a picture of the care that would ensure that patients with this condition have optimal symptom control and quality of life.
• It is also useful background when working with patients who are smokers to achieve behaviour change. 

Questions for your mentor/tutor

• What relevance does NICE guidance have to nurses?
• What are the benefits of pulmonary rehabilitation?

Student Nursing Times decoder

• COPD: Chronic obstructive pulmonary disease (COPD) is a long-term chronic lung condition. It is characterised by narrowing and inflammation of the airways. Its main symptoms are cough and breathlessness. Its main cause is smoking and the lung damage cannot be reversed.

Other articles you might find useful

• Exploring the outcomes and implications of the latest national COPD audit
• Developing self management plans to help people with COPD to control their condition

This article tells you about:

• What spirometry is and why it is used
• How to decide whether a patient is suitable for spirometry testing
•  How to perform spirometry
• What the results show
• Which patients are not suitable for spirometry

You would be likely to reference this article if you were researching:

• Respiratory nursing
• Chronic obstructive pulmonary disease
• Lung function
• Asthma
• Cystic fibrosis

In what situations will this article be useful to me?

If you are caring for a patient who is experiencing respiratory problems that are undiagnosed or with a diagnosed respiratory disorder that needs to be monitored. Spirometry is considered to be the “gold standard” method of assessing lung function. It should be used:

• For patients presenting with undiagnosed respiratory symptoms such as wheeze, cough and dyspnoea (difficulty in breathing or in catching the breath)
• For patients with suspected COPD
• To monitor patients with diagnosed long-term respiratory conditions

 Questions for your mentor/tutor

• How do I perform a spirometry test?
• What should I do with the results?

Student Nursing Times Decoder

• Spirometry: A method of measuring the speed and volume of air expelled from the lungs
• FVC: Forced vital capacity – the amount of air that can be forcibly expelled from the lungs after maximum inspiration
• FEV₁: Forced expiratory volume in one second - the volume of air exhaled during the first second of a forced expiration
• FEV₁/FVC ratio: The percentage of the FVC expired in the first second of a forced expiration
• VC:Vital capacity – the total volume of air expelled in a forced expiration after maximum inspiration
• PEF:Peak expiratory flow – the highest flow achieved during a forced expiration, measured in litres per minute

Other articles you might find useful

Best practice: Carrying out accurate spirometry testing - part 2

Guidance: The use of diagnostic spirometry in primary care

Interstitial lung diseases 1: Diagnosis and investigation

An overview of acute exacerbations of COPD

Using action plans for COPD patients

Reducing COPD admissions with a specialist chronic disease management team

This article tells you about:

• Using the correct equipment for this procedure
• Safe practice when giving medicines  via enteral feeding tubes
• Giving the correct dose at the right time
• How delivering medicines via enteral feeding tubes differs from other routes
• How to manage tube blockages

You would be likely to reference this article if you were researching:

• Enteral feeding
• Drug administration
• Nutrition
• Nasogastric feeding
• Patient safety 

In what situations will this article be useful to me?

• If you are caring for patients who are being fed through enteral feeding tubes who require medication. Patients require enteral feeding for a range of conditions. For example they are used for critically ill patients, those who have had recent surgery and those with swallowing difficulties. Enteral feeding is most commonly given via a nasogastric tube or a percutaneous endoscopic gastrostomy (PEG) feeding tube direct into the stomach.

Questions for your mentor/tutor

• How do I prepare medications for administering via an enteral feeding tube?
• How do you manage timing of enteral feeding and the giving of medication?

Student Nursing Times Decoder

• Enteral feeding: Enteral feeding is the giving of a nutritionally complete feed directly into the stomach, duodenum or jejunum via a feeding tube.
• Nasogastric tube: his is the most commonly used method of enteral feeding. The tube goes does through the nose and into the stomach. Nasogastric tubes can become displaced from position and end up in the lungs. Care  needs to be taken to ensure they are in correct place as giving a feed into the lungs is potentially fatal.
• Percutaneous endoscopic gastrostomy (PEG) feeding tube: These are used for longer-term enteral feeding. Often known as a PEG tube they are inserted directly into the stomach with an upper gastrointestingal endoscopy. They need to be monitored carefully for infection.

Other articles you might find useful

• Nutritional support: how to reduce the risk of harm
• Nasogastric tubes 1: insertion technique and confirming position
• Nasogastric tubes 2: risks and guidance on avoiding and dealing with complications
• Administration of drugs 2: non-oral

This article tells you about:

• Hypoglycaemia
• Its signs and symptoms
• What causes it to occur
• How to manage it

You would be likely to reference this article if you were researching:

• Diabetes
• Glycaemic control
• Hypoglycaemia

In what situations will this article be useful to me?

• If you are caring for patients with diabetes. Hypoglycaemia is much more common in type 1 diabetes but it can occur in patients with type 2 diabetes. Patients may be admitted for treatment of their diabetes or may be in hospital for another reason.
• If  their diabetes is not the primary reason for their admission you will still need to be aware of their diabetes, especially as they will be out of their normal routine and this will make it more difficult for them to control their blood glucose levels.

Questions for your mentor/tutor

• What advice should I be giving to a patient after a hypoglycaemic episode?
• Should I assume that all patients with diabetes understand hypoglycaemia?

Student Nursing Times Decoder

• Blood glucose: This is the level of blood glucose  in the blood. A normal level would be between 3.9-7.2 mmol/L
• Hypoglycaemia: This is when the blood glucose level falls to below 4mmol/L.
• Sulphonylureas: A group of oral drugs that are used in type 2 diabetes to stimulate the pancreas to produce insulin.

Other articles you might find useful:

• Hypoglycaemia
• Diabetes, type 1
• Diabetes, type 2

This article tells you about:

• This ethnic group
• Health problems of Gypsy Travellers
• Negative attitudes and bias towards this group
• How you can overcome negative attitude and bias 

You would be likely to reference this article if you were researching:

• Ethnic minority groups
• Prejudice
• Stereotyping

In what situations will this article be useful to me?

• It will help you to explore your own perceptions of this group
• It will help you to offer health care without bias

Questions for your mentor/tutor

• How can I ensure that I am not biased towards this group?
• What should I do if I notice prejudice from other health professionals?

Student Nursing Times Decoder

• Minority ethnic group: a group that has different national or cultural traditions from the majority of the population
• Gypsy travellers: Romany Gypsies and Irish Travellers are legally recognised as ethnic groups.   In terms of health and education, they are one of the most deprived groups in the Britain.
• Racial discrimination: this is when an individual or a group is treated less favourably on racial grounds than others in similar circumstances.

Other articles you might find useful

• Stamping out stigma in HIV
• How the Equality Act affects you