Perfecting your practice

THIS ARTICLE WILL TELL YOU ABOUT

• The difficulties of identifying substance misuse problems in older people
• The importance of screening and assessment to prevent further harm
• How to carry out a brief opportunistic screening
• The nurse’s role in intervention strategies

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

• Older people
• Substance misuse
• Drugs
• Alcohol

IN WHAT SITUATIONS WILL THIS ARTICLE BE USEFUL TO ME?

Substance misuse in older people often goes under recognised. This article will help you to appreciate this problem in the older age group and outlines a brief screening tool that can help to identify those affected. It also details possible intervention strategies.

QUESTIONS FOR YOUR MENTOR/TUTOR

• What steps should I take if I suspect one of the patients has a problem with substance misuse?
• Why would a patient be reluctant to admit to such a problem?
• What do I do if the patient sees their problem as ‘normal’?

STUDENT NT DECODER

Substance misuse: Substance misuse is defined as intoxication by or regular excessive consumption of substances that have an effect on the brain. The most commonly misused drug is alcohol.

Psychoactive substances: a drug affecting the mind

Detoxification: Medical treatment generally involving abstention from drink or drugs until the bloodstream is free of toxins.

Brief intervention: This is an intervention designed to promote behaviour change which is offered opportunistically and takes a short period of time i.e. 10 minutes and can be offered by a non-specialist.

OTHER ARTICLES YOU MIGHT FIND USEFUL

• Types of substance misuse and risk factors
• How to diagnose and manage physical complications related to alcohol misuse
• An alcohol withdrawal tool for use in hospitals
• Ensuring integrated treatment for people with mental health and substance use problems

THIS ARTICLE WILL TELL YOU ABOUT

• The different kinds of stigma people with mental illness face
• Ways in which the public discriminate against those with mental illness
• How this affects the lives of those with mental illness
• How nurses can help combat this

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

• Mental illness
• Stigma
• Discrimination

IN WHAT SITUATIONS WILL THIS ARTICLE BE USEFUL TO ME?

This article will be useful to help you understand how much the discrimination of mental illness can affect patients, and what you can do to help reduce this stigma.

QUESTIONS FOR YOUR MENTOR/TUTOR

• How can we help those affected by stigma overcome it?
• How can we help change the attitude of the public towards those with mental illness?

STUDENT NT DECODER

• Stigma: A mark of disgrace associated with a particular circumstance, quality, or person: “the stigma of mental disorder”. This can result in social distancing from others.
• Self-stigma: This is when people take the stereotyped view of themselves, the stigma, and internalise it making an assumption that others will distance themselves. This can prove very isolating

OTHER ARTICLES YOU MIGHT FIND USEFUL

http://www.nursingtimes.net/home/clinical-specialisms/mental-health/challenging-misconceptions-about-mental-health-nursing/5046812.article

http://www.nursingtimes.net/whats-new-in-nursing/stigma-attached-to-mental-health-problems/1790099.article

http://www.nursingtimes.net/nursing-practice/clinical-specialisms/substance-misuse/drug-abuse-stigma-sets-back-rehabilitation/5018665.article

THIS ARTICLE WILL TELL YOU ABOUT

• The causes of cellulitis
• How the condition is diagnosed and treated
• Other skin conditions that increase the risk of recurrent cellulitis

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

• Skin infections
• Assessment of skin conditions affecting the lower limb
• Dermatology

IN WHAT SITUATIONS WILL THIS ARTICLE BE USEFUL TO ME?

Cellulitis is an acute spreading bacterial infection of the connective tissue, dermis and subcutaneous layers of the skin. It is an “opportunistic” infection commonly occurring through breaks in the skin. It is important to understand the presentation of cellulitis as is often confused with other dermatological condition such as venous stasis eczema.

If you are working in primary care you may see patients with signs and symptoms of cellulitis associated with minor cuts and wounds. Sometime patients require admission to acute care if they have developed serious complications including necrotising fasciitis, osteomyelitis and bacteraemia so accurate assessment and diagnosis is vital.

QUESTIONS FOR YOUR MENTOR/TUTOR

• Which patients are most at risk of cellulitis?
• When should a patient with cellulitis be referred to acute care?

STUDENT NT DECODER

Lymphangitis - Infection of lymph vessels. This may be present in more severe cases of cellulitis, appearing as a red line originating from the cellulitis and leading to tender swollen lymph glands draining the affected area (for example, in the groin with leg cellulitis).

Venous stasis eczema (varicose eczema) – This is a common inflammatory condition affecting the lower limbs and often coexists with varicose veins. Clinical signs include inflamed red eczematous skin, itch, scaling, sometimes weeping crusting skin, pigmentation (haemosiderin deposit), hardened skin, tight red/brown skin/tissues (lipodermatosclerosis - vulnerable to ulceration), atrophy blanching.

Secondary lymphoedema This is caused by damage or disruption to the lymphatic system as a result of an infection, injury, trauma or cancer.

OTHER ARTICLES YOU MIGHT FIND USEFUL

• Multidimensional leg ulcer assessment
• Early diagnosis of lymphoedema helps to reduce its psychological and social impact