The 100 most-cited articles in Nursing Standard, 2016

What was the nature of the CPD activity, practice-related feedback and/or event and/or experience in your practice? The CPD article introduced the revised format of the British National Formulary (BNF) and explained how the information it contains may be accessed. It discussed the importance of developing healthcare professionals' knowledge and understanding of the BNF to enable safe and effective prescribing, dispensing, administration and monitoring of medicines.

This is the first article in a series of 11 that will offer guidance to new and existing mentors and practice teachers to enable them to develop in their role and help them to gather a portfolio of evidence that meets the Nursing and Midwifery Council's Standards to Support Learning and Assessment in Practice (SSLAP). This article provides background to the development of the standards and outlines the SSLAP, including the four main stages of the framework, the eight domains and outcomes, and the five principles required for the roles of mentor, sign-off mentor and practice teacher. The requirements for maintaining the mentor and practice teacher roles are explored.

Essential facts Anxiety is the feeling of fear that occurs when faced with threatening or stressful situations. It is a normal response when confronted with danger, but, if it is overwhelming or the feeling persists, it could be regarded as an anxiety disorder. The Royal College of Psychiatrists says anxiety disorders, including panic disorder, post-traumatic stress disorder and social anxiety disorder, affect about one in ten.

Patients with fibromyalgia experience chronic widespread pain, with associated symptoms of fatigue, sleep disturbance and memory problems. There are many therapies which may be helpful in managing the symptoms of fibromyalgia; however, these often require a process of trial and error to establish optimum management using a combination of pharmacological and non-pharmacological approaches. Nurses can support patients with fibromyalgia using a biopsychosocial approach to symptom management. Understanding the nature of fibromyalgia and management options will enable nurses to deliver holistic patient-centred care.

The Nursing and Midwifery Council (NMC) requires that nurses and midwives use feedback as an opportunity for reflection and learning, to improve practice. The NMC revalidation process stipulates that practitioners provide examples of how they have achieved this. To reflect in a meaningful way, it is important to understand what is meant by reflection, the skills required, and how reflection can be undertaken successfully. Traditionally, reflection occurs after an event encountered in practice. The authors challenge this perception, suggesting that reflection should be undertaken before, during and after an event. This article provides practical guidance to help practitioners use reflective models to write reflective accounts. It also outlines how the reflective process can be used as a valuable learning tool in preparation for revalidation.

The report on mental health nurse shortages (News, February 3) shows just how much pressure staff are under.

Adverse drug reactions (ADRs) are increasingly common and are a significant cause of morbidity and mortality. Historically, ADRs have been classified as type A or type B. Type A reactions are predictable from the known pharmacology of a drug and are associated with high morbidity and low mortality. Type B reactions are idiosyncratic, bizarre or novel responses that cannot be predicted from the known pharmacology of a drug and are associated with low morbidity and high mortality. Not all ADRs fit into type A and type B categories; therefore, additional categories have been developed. These include type C (continuing), type D (delayed use), and type E (end of use) reactions. Susceptibility to ADRs is influenced by age, gender, disease states, pregnancy, ethnicity and polypharmacy. Drug safety is reliant on nurses and other healthcare professionals being alert to the possibility of ADRs, working with patients to optimise medicine use and exercising vigilance in the reporting of ADRs through the Yellow Card Scheme.

Aim To present a narrative review of the empirical literature on the use of horticultural therapy in dementia care. Method A comprehensive literature search, conducted in December 2014, resulted in the selection of 15 primary research articles for review. Of these, three used qualitative methods, five used quantitative methods and seven used mixed methodology. The articles were critically appraised, and the narrative synthesis used a thematic approach whereby prominent themes from the articles were grouped to form representative themes. Findings Three main themes emerged from the narrative synthesis: the emotional health of people living with dementia, their perceived self-identity and their levels of engagement. Conclusion Horticultural therapy can be beneficial. At a macro-level, it is an inexpensive therapy that does not require specialist training to deliver. At a micro-level, it enhances the wellbeing of people living with dementia. Recommendations are made to promote access to appropriate horticultural therapy for people living with dementia, and for further research in this…

This article aims to enhance nurses' understanding of nursing care plans, reflecting on the past, present and future use of care planning. This involves consideration of the central theories of nursing and discussion of nursing models and the nursing process. An explanation is provided of how theories of nursing may be applied to care planning, in combination with clinical assessment tools, to ensure that care plans are context specific and patient centred.

As the population ages and the incidence of chronic diseases and lifestyle-related conditions rises, nurses are increasingly required to provide care for people with a range of chronic (long-term) conditions. The healthcare needs of patients are often complicated by comorbid conditions. Nurses deliver healthcare in the context of the patient's medical conditions, treatment regimens, the healthcare system, and the individual's socioeconomic, personal and family factors, which may include the challenges of social isolation and geographic distance. In such complex circumstances, patients may be perceived as 'difficult' or 'challenging', however, the challenge is not the patient themselves, but the relationship between the nurse and the patient. Communication difficulties can occur between nurses and patients, which may affect the therapeutic relationship and the quality of care provided. This article discusses the communication skills that nurses require to interact effectively with patients who have complex and chronic comorbid conditions. It focuses on therapeutic communication…

Accurate and considered wound assessment is essential to fulfil professional nursing requirements and ensure appropriate patient and wound management. This article describes the main aspects of holistic assessment of the patient and the wound, including identifying patient risk factors and comorbidities, and factors affecting wound healing to ensure optimal outcomes.

Identifying your preferred learning style can be a useful way to optimise learning opportunities, and can help learners to recognise their strengths and areas for development in the way that learning takes place. It can also help teachers (educators) to recognise where additional activities are required to ensure the learning experience is robust and effective. There are several models available that may be used to identify learning styles. This article discusses these models and considers their usefulness in healthcare education. Models of teaching styles are also considered.

Risk management for people with dementia has traditionally focused on preventing physical harm. However, research has demonstrated that focusing on the physical safety of people with dementia may result in their social and psychological wellbeing being overlooked - the very aspects that are necessary to achieve person-centred care. This article discusses the main challenges for practitioners caring for people with dementia in various settings, and encourages a care approach which enables appropriate risk taking as a way of promoting person-centred care.

Changes in healthcare organisations are common, and their implementation is often complex and challenging. Change is often implemented suboptimally, and can have several negative effects on staff turnover, patient care and budget targets. To minimise and avoid negative outcomes, a systematic three-stage change process that comprises preparing for change, implementing change, and evaluating and sustaining change can be followed. In the first stage, before commencing any change activities, time and attention should be given to conducting detailed analyses and preparatory work to establish the foundation for the implementation phase. In the second stage, a clear set of multiple implementation tactics are used to ensure the change process is effective. In the final stage, an evaluation of the success of the change is undertaken and measures are put in place to ensure it is sustained over time. It is only by following a methodical change process such as this that changes can be implemented effectively in healthcare organisations.

Aim To explore baccalaureate nursing students' perspectives of the influence of nursing staff on their learning and experience in the clinical setting. Method A qualitative description approach was used. Thirty nursing students were interviewed individually or in focus groups. Data were analysed using content analysis. Four researchers analysed the data separately and agreed on the themes. Findings Nursing staff had positive (enabling) and negative (hindering) effects on students' clinical learning and socialisation to nursing. Nursing staff may encourage and excite students when they behave as positive mentors, facilitators and motivators. However, their actions may also have a negative effect on students, decreasing their confidence, learning and desire to continue in the profession. Conclusion Nursing staff influence student learning. Their actions, attitude and willingness to teach are influential factors. The findings have implications for patient safety, nurse retention and recruitment, and preparing students for professional practice.

Situation awareness describes an individual's perception, comprehension and subsequent projection of what is going on in the environment around them. The concept of situation awareness sits within the group of non-technical skills that include teamwork, communication and managing hierarchical lines of communication. The importance of non-technical skills has been recognised in safety-critical industries such as aviation, the military, nuclear, and oil and gas. However, health care has been slow to embrace the role of non-technical skills such as situation awareness in improving outcomes and minimising the risk of error. This article explores the concept of situation awareness and the cognitive processes involved in maintaining it. In addition, factors that lead to a loss of situation awareness and strategies to improve situation awareness are discussed.

The terms palliative and end of life care are often used interchangeably and healthcare practitioners may perceive that palliative care is only appropriate during the terminal stages of an illness. This article, the first of two parts, provides healthcare practitioners with an overview of the concept of palliative care. It explains how this can be differentiated from end of life care and how it should be commenced in a timely manner, so that people who are living with dementia can contribute to the planning of their future care and death. The policies and tools used in the provision of palliative and end of life care are discussed, including advance care planning and The Gold Standards Framework. The article is framed in a care home context; there is little research about how to optimise palliative care for people living with dementia in care homes. The second part of this article will discuss end of life care and the best practices for providing end of life care, including nutrition and hydration, oral hygiene, pain management and spiritual care.

The need to obtain research ethical approval is common to all research involving human participants. This approval must be obtained before research participants can be approached and before data collection can begin. The process of ethical review is one way that research participants can be confident that possible risks have been considered, minimised and deemed acceptable. This article outlines some of the main issues researchers should consider when planning an application for research ethical approval by answering the following six questions: 'Do I need research ethical approval?', 'How many applications will I need to make?', 'Where should I apply for research ethical approval?', 'What do I need to include in my application?', 'What do research ethics committees look for?' and 'What other approvals might I need?' Answering these questions will enable researchers to navigate the ethical review process.

Spiritual care is an essential aspect of caring for people with dementia. It can improve their quality of life and give them the strength to cope with living with their condition. However, spirituality is a poorly understood concept and healthcare practitioners often lack confidence in assessing and meeting spiritual needs. Therefore, the spiritual needs of people with dementia are often overlooked, which can result in spiritual distress. This article provides an overview of spirituality and spiritual needs. It discusses the potential causes of spiritual distress in people with dementia and provides examples of spiritual care strategies.

Polypharmacy refers to the prescribing of many medicines for one individual. Polypharmacy is increasingly common as a result of the rise in multimorbidity, use of evidence-based clinical guidelines and care pathways, and a focus on disease prevention. Polypharmacy can be justified and appropriate, but it may also be inappropriate and associated with suboptimal health outcomes and mortality. Polypharmacy is associated with adverse drug events such as drug-drug interactions and adverse drug reactions (ADRs). Taking multiple medicines can adversely affect adherence, resulting in lost opportunities for health gain and wasted medicines. Older people, and particularly those who are frail, are susceptible to the adverse effects of polypharmacy. Medication reviews should be undertaken regularly in older people with polypharmacy. Medicines management systems, research, and education are essential to improve safe practice in the management of polypharmacy.

Self-harm is a public health issue that accounts for thousands of presentations at hospital each year. Self-harm commonly involves self-injury by cutting, burning or poisoning. The incidence of self-harm is increasing in the UK, particularly in young people. Research suggests that people who self-harm experience negative attitudes from healthcare staff, including nurses, on presentation to healthcare services. This is an ethical issue in nursing practice that has implications for the quality of care provided. Nurses with a lack of mental health training provide care for patients who self-harm in emergency departments and acute medical settings. This article presents a literature review exploring the factors affecting nurses' attitudes towards patients hospitalised for self-harm and makes recommendations for improving practice. The article identifies requirements for nurse education and training in mental health and effective provision of care for patients who self-harm and present at the emergency department.

Cohesive interprofessional teamwork is essential to successful healthcare services. Interprofessional teamwork is the means by which different healthcare professionals - with diverse knowledge, skills and talents - collaborate to achieve a common goal. Several interventions are available to improve teamwork in the healthcare setting. This article explores the role of care pathways in improving interprofessional teamwork. Care pathways enhance teamwork by promoting coordination, collaboration, communication and decision making to achieve optimal healthcare outcomes. They result in improved staff knowledge, communication, documentation and interprofessional relations. Care pathways also contribute to patient-centred care and increase patient satisfaction.

Aim The aim of this literature review was to explore the reasons why some patients are not suitable for discharge following day surgery. Method A pragmatic, mixed-methods approach was used to undertake a critical evaluation of the literature and current practice to determine what is already known about discharge following day surgery. Thematic analysis was used to identify the main themes and issues, enabling recommendations to be made to reduce the incidence of patients unable to be discharged following day surgery. Findings The main themes or reasons for delayed discharge following day surgery identified from the literature review were: post-operative nausea and vomiting, post-operative pain, going late to theatre and social factors. These themes were supported by the findings of an unpublished audit carried out in one day surgery unit in an NHS healthcare organisation in the south of England between June and August 2014, which indicated that 54 out of 1,180 day surgery patients required an overnight stay during this 12-week period. The audit also showed that a patient going late…

Essential facts Breast cancer is the most common cancer in the UK, with around 60,000 new cases diagnosed each year, according to the charity Breast Cancer Care. Over a lifetime, women have a one in eight risk of developing it.

The Mental Capacity Act 2005 is used to assess a person's decision-making ability and to make a best interests decision where the individual lacks the capacity to do so. The act was considered to have the potential to maximise the autonomy of individuals with mental or cognitive impairments, but this has not been fully realised. Since the act came into force, the United Nations Convention on the Rights of Persons with Disabilities has challenged many of the principles underpinning the act. That challenge and how existing provisions in the act can be implemented to increase autonomy and control for people with cognitive or mental impairments are discussed. The principles of the convention are described and potential future amendments to the law are identified.

This article describes the basic principles of evaluation, focusing on the evaluation of healthcare services. It emphasises the importance of evaluation in the current healthcare environment and the requirement for nurses to understand the essential principles of evaluation. Evaluation is defined in contrast to audit and research, and the main theoretical approaches to evaluation are outlined, providing insights into the different types of evaluation that may be undertaken. The essential features of preparing for an evaluation are considered, and guidance provided on working ethically in the NHS. It is important to involve patients and the public in evaluation activity, offering essential guidance and principles of best practice. The authors discuss the main challenges of undertaking evaluations and offer recommendations to address these, drawing on their experience as evaluators.

Essential facts There are two types of stroke - around 85% are ischaemic and 15% are haemorrhagic. According to the Stroke Association's State of the Nation report, published in January 2016, stroke occurs around 152,000 times a year in the UK. It is the fourth largest cause of death in the UK and one of the largest causes of disability.

Aim The physical health of people with mental health conditions is often suboptimal, and in many cases this may be related to their prescription medicines. One issue is that patients are monitored inconsistently for adverse drug reactions (ADRs). The aim of this study was to explore whether the nurse-led West Wales Adverse Drug Reaction (WWADR) Profile for Mental Health Medicines could improve recognition and management of ADRs in a crisis resolution home treatment service. Method The WWADR Profile was implemented in addition to usual care, in a one-group 'before and after' comparison study (n=20). The study took place from October to November 2013. Results The WWADR Profile identified previously unreported physical health problems for all participants in the study, including two potentially life-threatening conditions: cardiac arrhythmia, chest pain plus breathlessness, and valproate-induced pancreatitis. In total, four participants' medicines were discontinued, three were referred to a consultant psychiatrist, three were referred to GPs, one was referred to an electrocardiogram…

Dyslexia is one of the most commonly declared disabilities in higher educational institutions in the UK. This article explores the effects of specific learning difficulties, in particular dyslexia, on pre-registration nursing students on practice placements in clinical environments. The author proposes use of the OPEL model, which provides a simple, structured framework for supporting nursing students with specific learning difficulties in practice placements. This model could be applied to clinical situations where constructive support is necessary to enable the student to achieve the standards and requirements set by the Nursing and Midwifery Council.

Compression therapy is an effective and common approach to the management of lymphoedema, a chronic condition requiring long-term treatment. Lymphoedema is caused by the accumulation of fluid in soft tissue, resulting in swelling of the affected limb or area. Lymphoedema may be primary, as a result of a genetic abnormality, or secondary, as a result of injury, including non-accidental injury, or following treatments such as radiotherapy and/or surgery. The condition is characterised by a high protein oedema and secondary skin changes. This article outlines features of the various types of compression therapy used to treat patients with lymphoedema, including details of their application, effectiveness, indications and contraindications.

Aim To explore baccalaureate nursing students' perceptions of what makes an effective tutor in problem-based learning courses, and the influence of effective teaching on students' learning and experience. Method Students enrolled in all four years of a baccalaureate nursing programme completed online surveys (n=511) and participated in focus groups (n=19). Data were analysed and combined using content analysis. Findings The data were summarised using five themes, the '5 Ps' of effective teaching in problem-based learning. Nursing students perceived effective problem-based learning tutors to be prepared with knowledge and facilitation skills, person-centred, passionate, professional and able to prepare students for success in the nursing programme. Effective tutors adjusted their approaches to students throughout the four years of the nursing programme. Conclusion Effective teaching in problem-based learning is essential and has significant effects on nursing students' learning, motivation and experience. Important attributes, skills and strategies of effective problem-based learning…

Non-suicidal self-injury is a common behaviour in adolescents and young adults, and may be associated with mental health disorders, risk of suicidal behaviour (ideation and attempts), and a need for clinical services. Nurses, in particular those working in emergency departments and mental health settings, have a crucial role in the assessment, treatment and care of individuals who have self-injured. It is essential for nurses to assess an individual's risk of more serious harm or accidental death, regardless of intent. It is also important to understand the variations in non-suicidal self-injurious behaviour in terms of its presentation, features and functions, to provide appropriate person-centred care. Nurses should assist individuals in identifying the triggers or cues for their behaviour, exploring treatment options, and monitoring their behaviour and risk in the long term. This article describes the profile of people who self-injure, and the issues related to assessment and management of such patients presenting in emergency departments. A description of who self-injures and…

Dementia is a neurodegenerative disorder that can have a severe effect on the quality of life of individuals with the condition, and can place considerable strain on informal carers and healthcare systems. Research is required to identify ways to prevent or delay the onset of dementia. The government is committed to dementia research, yet funding for dementia research is eclipsed by funding for research into other conditions. Moreover, dementia research can only progress if individuals with the condition participate in research studies. This article discusses barriers associated with research into dementia and describes a UK government initiative, Join Dementia Research, which supports research participation for people with dementia.

Aim To conduct a scoping project to identify perceived barriers to UK nurse registration as experienced by internationally educated nurses working as healthcare assistants in the UK. Method Eleven internationally educated nurses working as healthcare assistants in two London hospitals attended two facilitated focus groups. Qualitative thematic analysis was used to analyse the data. Findings Study participants articulated frustration with UK English language testing requirements and a sense of injustice and unfairness relating to: double standards for nurses educated within and outside of the European Union (EU) and European Economic Area (EEA); and what was perceived, by some, as arbitrary English language testing with unnecessarily high standards. Differences among study participants related to issues of competency and accountability regarding English language skills and passing English language skills tests, with many feeling they were playing 'a game' where the rules kept changing. Conclusion Language testing barriers are impeding UK nurse registration for some internationally…

Chronic pancreatitis is a complex inflammatory condition characterised by irreversible damage to the pancreas. This article explores the pathophysiology of this condition and its effects on pancreatic function. It outlines the causes and presenting features of chronic pancreatitis, as well as its effect on patients' quality of life and the changes to their lifestyle that are likely to be required. Chronic pancreatitis cannot be cured; therefore, treatment aims to control pain, manage problems associated with malabsorption, and assess and manage long-term complications that may develop, such as insulin dependence.

This free app from the charity Action on Hearing Loss is a quick way to check users' hearing. Each section provides well laid-out information with links to further content.

Clinical practice placements are an essential component of pre-registration nursing programmes. Integration into a new team in an unfamiliar setting, which has its own values, practices, culture and language, can be stressful for nursing students. This article presents and discusses students' reflections on preparing for, entering and leaving practice placements. Ten students who participated in fortnightly group reflective sessions, discussed and analysed their learning experiences while on practice placements in an acute hospital. The challenges the students encountered were deconstructed using a group narrative approach. The students experienced ethical dilemmas around patient dignity, consent and advocacy as well as factors external to the practice setting, such as navigating systems and processes to access information before starting practice placements, managing household duties and academic workloads while working long shifts, and managing fatigue and loneliness. The students devised recommendations for other students to enable them to navigate their practice placements…

People with learning disabilities, particularly Down's syndrome, are at increased risk of dementia. At present, services and care tailored to people with both dementia and a learning disability are unsatisfactory. This article reviews the literature specific to dementia in people with learning disabilities, including: comprehensive screening, diagnosis, management, environmental considerations, end of life care and training issues for nursing staff. Recommendations for best practice and service improvement are made to improve the quality of life for individuals with dementia and learning disabilities, pre and post-diagnosis.

Falls are the most frequent adverse event reported in hospitals, usually affecting older patients. All hospitals in NHS organisations develop risk prevention policies that include falls risk assessment. Falls risk assessment involves the use of risk screening tools, aimed at identifying patients at increased risk of falls, and risk assessment tools, which identify a patient's risk factors for falls. Various risk screening tools have been used in clinical practice, but no single tool is able to identify all patients at risk of falls or to accurately exclude all those who are not at risk of falls. Guidelines recommend that patients aged 65 years and over who are admitted to hospital should be considered at high risk of falls and that a multifactorial falls risk assessment should be performed. Therefore, falls risk assessment tools should be used to identify the risk factors for each inpatient aged 65 years or over, in order to determine the most appropriate care plan for falls prevention and to maximise patient mobility and independence.

RATIONALE AND KEY POINTS: This article aims to provide an overview of the technique for applying vacuum-assisted closure therapy (V.A.C. therapy), using the example of one of the most basic dressing types: V.A.C. GranuFoam, a black polyurethane foam. Practitioners should refer to the manufacturer's instructions for application of other dressing types. ▶ V.A.C. therapy is used to apply negative pressure to the wound bed to promote wound healing. ▶ V.A.C therapy promotes perfusion, reduces oedema, draws the wound edges together and stimulates the formation of granulation tissue. ▶ The correct technique for applying V.A.C. therapy is essential to ensure patient safety and optimum wound healing outcomes. REFLECTIVE ACTIVITY: Clinical skills articles can help update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: 1. How you think this article will change your practice. 2. How the use of V.A.C. therapy might affect the patient's experience.

Dementia is a life-limiting condition that is largely a disease of ageing. However, older people in general, and older people with dementia in particular, have not always had equal access to effective palliative and end of life care. As a result, people with dementia at the end of life often receive aggressive and burdensome interventions, or inadequate assessment and management of their symptoms. Patterns in how people with dementia experience and present symptoms as they near the end of life can indicate when the goals of care should change and a palliative approach should be adopted.

Manual handling injuries can occur almost anywhere in a healthcare environment, and most staff perform a variety of moving and handling tasks every day. Heavy lifting, awkward posture, and previous or existing injury can increase the risk of musculoskeletal disorders. A healthcare professional's involvement in moving and handling is more widespread than it might appear, and their actions and understanding of techniques, legislation and guidelines have a direct effect on patient care. Every situation that involves the handling, or partial handling, of a person presents varying levels of risk to the patient and the carer. Maintaining a good level of patient mobility and independence is an essential part of care delivery and can reduce the risk of long-term physical and psychological effects. Delivery of care should focus on the individual's capacity, not their incapacity, to ensure that they are treated with dignity and respect.

Rationale and key points Eye drops and eye ointment are the mainstay of treatment of ocular conditions. Failure to prioritise administration of these medicines can prolong the condition and may present a risk to the patient's vision. ▶ Eye drops and eye ointments are used to treat acute and chronic conditions of the eye and surrounding structures. Eye drops must be instilled before applying eye ointment, since the ointment will affect the absorption of the eye drop. ▶ Nurses require knowledge of the technique, side effects and potential interactions associated with systemically or topically applied medicines to the eye to ensure patient safety and optimum outcomes. Reflective activity Clinical skills articles can help update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: 1. How this article will change your practice. 2. How you intend to develop your knowledge and skills regarding treatment of ocular conditions. Subscribers can update their reflective accounts at rcni.com/portfolio.

Rationale and key points Tracheal suction involves the removal of pulmonary secretions from the respiratory tract using negative pressure under sterile conditions. Practitioners should be aware of the indications for, and risks associated with, open tracheal suction via an endotracheal tube. ▶ Respiratory assessment of the patient should be carried out to identify when tracheal suction is required. ▶ A suction pressure of 80-120mmHg is recommended, and suction should last no longer than 15 seconds. ▶ Reassurance and support should be given to the patient to minimise any discomfort and distress that might result from tracheal suction. Reflective activity Clinical skills articles can help update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: 1. How you think this article will change your practice when performing open tracheal suction via an endotracheal tube. 2. How you could use this resource to educate your colleagues. Subscribers can upload their reflective accounts at: rcni.com/portfolio .

What was the nature of the CPD activity, practice-related feedback and/or event and/or experience in your practice? The article explored different learning styles and outlined some of the models that can be used to identify them. It discussed the limitations of these models, indicating that although they can be helpful in identifying a student's preferred learning style, this is not 'fixed' and might change over time. Learning is also influenced by other factors, such as culture and age.

AIM: To assess the relative clinical efficacy of different forms of non-pharmacological prophylaxis, intermittent pneumatic compression and graduated compression stockings in reducing the incidence of venous thromboembolism (VTE) in patients hospitalised following acute stroke. METHOD: This was a thematic synthesis of literature retrieved from a structured bibliographic search of: Medline, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Summon, British Nursing Index, NHS Evidence, Internurse.com, PubMed, Ovid and the websites of other health information resources, such as the Nursing and Midwifery Council, National Institute for Health and Care Excellence and the World Health Organization. Citations were also searched for using: Web of Science, Google Scholar, the Cochrane Central Register of Controlled Trials, Current Controlled Trials, Stroke Trials Registry and Clinical Trials. FINDINGS: Intermittent pneumatic compression (IPC) showed a small but statistically significant (P = 0.001) reduction in rates of deep vein thrombosis (DVT), in both symptomatic and…

Healthcare professionals in all settings increasingly encounter people with diabetes. Suboptimal control of diabetes may have harmful effects on multiple systems in the body and can result in life-changing and life-threatening complications. Therefore, it is crucial that all healthcare professionals have an understanding of diabetes. This article considers the increase in people developing diabetes worldwide. It defines type 1 and type 2 diabetes and discusses the associated pathophysiology and predisposing factors. The article outlines the basis for the development of the typical signs and symptoms associated with high blood glucose levels. Current guidelines for diagnosing a person with diabetes are considered.

Rationale and key points This article explores the process of introducing yourself to patients. This is an essential interaction because it forms the basis of the therapeutic nurse-patient relationship. ▶ Effective communication skills are essential to foster therapeutic nurse-patient relationships based on mutual trust and respect. ▶ It is important to consider both verbal and non-verbal communication in patient interactions. Reflective activity Clinical skills articles can help update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: 1. How this article will change your practice when meeting patients for the first time. 2. How you could use this article to educate your colleagues. Subscribers can upload their reflective accounts at: rcni.com/portfolio .

Nurse-led clinics are a vital part of UK health care. They are diverse and are therefore hard to define, but they involve nurses having their own patient caseload and increased autonomy, often using advanced clinical skills such as physical assessment, diagnosis and medicines management.

An integrated care organisation requires a flexible workforce with a variable skill mix in all care settings. Organisations should ensure that education and training are maintained to support safe, high quality care that provides value for money, promotes flexibility, and increases workforce participation in achieving organisation objectives and the expansion of services. Peripherally inserted central catheter (PICC) care was identified as a challenging area for the nursing workforce in acute care and community services, following the integration and service enlargement of the Whittington Health NHS Trust. This article describes the evaluation of a new PICC care training programme that was developed and implemented to increase knowledge and awareness. The evaluation provides the clinical education team with information to help identify additional training needs to facilitate the integration of care.

Concerns about inadequate patient hydration and suboptimal monitoring of fluid balance have been documented in recent reports. The Fluid Balance Improvement Project at Central Manchester University Hospitals NHS Foundation Trust was undertaken to identify risk factors influencing hydration and to implement a revised process to manage these risks, resulting in the development of a hydration pathway. This new approach to monitoring patient hydration, together with staff education and support, has resulted in improved compliance with fluid balance monitoring standards, as well as significant improvements in identifying patients at risk of dehydration, and an increase in patients with acute kidney injury commencing appropriate fluid balance monitoring.

Rationale and key points This article explains intentional silence, which can provide a therapeutic nursing presence that demonstrates compassion and respect for the patient. » Intentional silence can enhance the therapeutic relationship between the nurse and patient. » Intentional silence can be used to reduce the patient's emotional lability by ensuring that they feel listened to. » It is important that nurses are able to respond therapeutically to rhetorical statements and/or those concerning serious or severe clinical circumstances. » The nurse can use intentional silence to support the patient in acknowledging, processing and reflecting on changes in their health. Reflective activity 'How to' articles can help to update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: 1. How this article will change your practice. 2. How you could use this article to educate your colleagues. Subscribers can upload their reflective accounts at rcni.com/portfolio.

Rationale and key points A nasogastric tube (NG tube) can be used to aspirate stomach contents or to administer feed, medication or fluid into the stomach. ▶ A blind technique is used to insert the NG tube through the nostril, along the nasopharynx, through the oesophagus and into the stomach. ▶ It is important for nurses to be able to recognise problems that may arise when inserting a NG tube blindly, and to know what actions to take if it is suspected that the distal tip of the NG tube is not sitting in the stomach, or they are unable to identify its location. ▶ Misplacement and subsequent use of a NG tube to administer feed, medication or fluid is a 'never event' ( NHS England Patient Safety Domain 2015 ). Reflective activity Clinical skills articles can help update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: 1. How you think this article will change your practice. 2. How you could use this resource to educate your colleagues. Subscribers can update their reflective accounts at…

The NHS is under pressure to increase its effectiveness and productivity. Nurses are tasked with delivering effective and efficient care, as well as improving patient safety, experiences and results. The reduction of waste in service delivery, care and treatment can release time and resources for nurses to engage in direct patient care. Nurses have an important role in reducing waste and influencing other professionals in the healthcare environment to increase their efficiency and productivity.

The previous article in this series of 11, Facilitation of learning: part 1, reviewed learning theories and how they relate to clinical practice. Developing an understanding of these theories is essential for mentors and practice teachers to enable them to deliver evidence-based learning support. This is important given that effective learning support is dependent on an educator who possesses knowledge of their specialist area as well as the relevent tools and methods to support learning. The second domain of the Nursing and Midwifery Council's Standards to Support Learning and Assessment in Practice relates to the facilitation of learning. To fulfil this domain, mentors and practice teachers are required to demonstrate their ability to recognise the needs of learners and provide appropriate support to meet those needs. This article expands on some of the discussions from part 1 of this article and considers these from a practical perspective, in addition to introducing some of the tools that can be used to support learning.

Mobility is important to older people in nursing homes and residential facilities since it contributes to their health and quality of life. Many residents in such facilities require some form of assistance to move and accomplish activities of daily living. Therefore, nurses and healthcare assistants should have the knowledge and skills to provide effective mobility care. This article discusses three important aspects of mobility care: safety, mobility optimisation and person-centred approaches to care. Safety is important as residents and staff are at risk of injury during mobility care. Mobility optimisation is essential to ensure residents maintain their independence. Person-centred approaches to care are central to providing an integrated approach to mobility care.

Compassionate care is a priority in current healthcare policy. However, its definition is amorphous, leading to difficulties standardising it in practice. This article discusses how nursing theory is central to the delivery of compassionate care. It emphasises the need to develop a theoretical framework that reflects the eclectic and pragmatic nature of nursing practice, and the importance of using patient feedback as an indicator of the quality of care and as a basis for adapting theoretical hypotheses.

Planning for patient discharge is an essential element of any admission to an acute setting, but may often be left until the patient is almost ready to leave hospital. This article emphasises why discharge planning is important and lists the essential principles that should be addressed to ensure that patients leave at an optimum time, feeling confident and safe to do so. Early assessment, early planning and co-ordination of all the teams involved in the patient's care are essential. Effective communication between the various teams and with the patient and their family or carer(s) is necessary. Patients should leave hospital with all the information, medications and equipment they require. Appropriate plans should have been developed and communicated to the receiving community or non-acute team. When patient discharge is effective, complications as a result of extended lengths of hospital stay are prevented, hospital beds are used efficiently and readmissions are reduced.

Acute pulmonary oedema is a distressing and life-threatening illness that is associated with a sudden onset of symptoms. For the best possible patient outcomes, it is essential that nurses in all clinical areas are equipped to accurately recognise, assess and manage patients with acute pulmonary oedema. This article outlines the pathophysiology of acute cardiogenic and non-cardiogenic pulmonary oedema, and suggests a systematic approach to the recognition and management of its most serious manifestations. Long-term care and symptom recognition are discussed and suggestions for ongoing patient self-management are provided.

The approach to nursing in long-term care settings for people living with dementia continues to evolve from a traditional, task-oriented culture to one that is person-centred. Such change can be difficult to manage and may encounter considerable opposition; having an understanding of change management and leadership styles may help to make this transition easier. This article discusses the differences between task-oriented and person-centred care, theories of management, motivation and leadership styles, and focuses on those that are most appropriate for this type of change. An improved understanding of these theories will enable nurses to support others in the delivery of person-centred care.

Diabetes is an increasingly common life-long condition, which has significant physical, psychological and behavioural implications for individuals. Self-management of type 1 and type 2 diabetes can be complex and challenging. A collaborative approach to care, between healthcare professionals and patients, is essential to promote self-management skills and knowledge to help patients engage in shared decision making and manage any difficulties associated with a diagnosis of diabetes.

Health policy and healthcare professional guidelines promote patient and carer involvement, which includes working in partnership with service users in all aspects of healthcare provision, research and education. This article explores the expectations for nurses to work in partnership with patients and carers, examines the definitions and theories of working in partnership and related concepts, as well as considering examples of partnership working in nursing practice.

This article, the tenth in a series of 11, discusses the importance of effective leadership in nursing and how it can enhance the provision of high quality care. Recent findings regarding suboptimal care practices in nursing have demonstrated the need for effective leadership in healthcare settings. Mentors and practice teachers are required to demonstrate leadership as part of their nursing role and their role in facilitating student learning. In addition, mentors and practice teachers are responsible for developing effective leadership skills in students, who will be expected to demonstrate these skills when they become registered nurses or midwives. Guidance for mentors and practice teachers is provided in relation to the eighth domain and outcomes of the Standards to Support Learning and Assessment in Practice on leadership.

Rationale and key points Choking, or foreign body airway obstruction, is a common, yet treatable, cause of accidental death. This article aims to provide an overview of the skills required when faced with this emergency in adults, including how to recognise this emergency, the immediate management and treatment required, and the necessary aftercare. » Choking usually occurs when a person is eating or drinking. » An obstruction may classified as mild or severe. » For a severe obstruction in a conscious person, it may be necessary to administer back blows and/or abdominal thrusts to remove the obstruction from the airway. Reflective activity 'How to' articles can help to update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: 1. How this article might change your practice when managing adults who are choking. 2. Positive elements of your current practice and those that could be enhanced.

Essential facts Nearly one third of children aged 2-15 in England are overweight or obese. Younger generations are becoming obese at earlier ages and staying so for longer. Reducing obesity levels is a major public health challenge as the condition doubles the risk of dying prematurely. Obese adults are more likely to develop health conditions such as heart disease, type 2 diabetes and depression. Treating conditions related to obesity is a major financial burden on the NHS, costing more than £5 billion a year.

Intravenous cannulation is becoming one of the most common procedures in healthcare as increasing numbers of patients are treated for acute and chronic illnesses. The use of an intravenous cannula is not without risk, so it is essential that the healthcare practitioner can justify why the patient requires cannulation, as well as being able to safely manage and provide ongoing care for patients with the device. This article provides an overview of intravenous cannulation, including the selection of appropriate cannulation sites, identification of the different types and sizes of cannula used, and cannula maintenance. Specific complications related to intravenous cannulation are discussed and guidance is given on how to recognise and avoid potential complications to ensure that practice is safe and effective.

This article reviews contemporary primary research studies to establish the evidence supporting the use of barrier products and evaluate practice regarding their use in the acute hospital setting. Six primary research studies investigating the use of barrier products for preventing and managing incontinence-associated dermatitis were reviewed. The aim was to identify the most effective treatments for incontinence-associated dermatitis to enhance the quality of life of patients. The studies identified that there is no significant difference in efficacy between petrolatum, zinc oxide oil and a polymer-based barrier film, and that a polymer-based barrier film is more cost-effective than petrolatum or zinc oxide. However, further robust research studies are required to inform practice. The efficacy and cost-effectiveness of barrier products can be enhanced by providing education in clinical practice on consistent skin care regimens and effective use of barrier products.

Hay fever, or seasonal allergic rhinitis, is a common condition that affects one in four people in the UK. It is characterised by cold-like symptoms that may include a runny nose, itchy eyes, sneezing and nasal congestion or blockage. Patient education is important in improving patient concordance with treatment regimens and effectively managing hay fever symptoms, and may include advice on ways to avoid pollen. Encouraging patients to start treatment in advance of pollen dispersal, before they experience symptoms, enables optimum management of seasonal allergic rhinitis. Adjunctive treatment, using a nasal douche before applying a nasal corticosteroid spray, is recommended as an aid to nasal hygiene, to improve the efficacy of medication and to reduce allergic inflammation. Often a nasal corticosteroid spray is applied using an incorrect technique, rendering it ineffective. It is important for patients to understand how a nasal corticosteroid spray works and the need for continuous daily treatment using a correct application technique for maximum efficacy of the medication…

Medicines optimisation is promoted in a guideline published in 2015 by the National Institute for Health and Care Excellence. Four guiding principles underpin medicines optimisation: aim to understand the patient's experience; ensure evidence-based choice of medicines; ensure medicines use is as safe as possible; and make medicines optimisation part of routine practice. Understanding the patient experience is important to improve adherence to medication regimens. This involves communication, shared decision making and respect for patient preferences. Evidence-based choice of medicines is important for clinical and cost effectiveness. Systems and processes for the reporting of medicines-related safety incidents have to be improved if medicines use is to be as safe as possible. Ensuring safe practice in medicines use when patients are transferred between organisations, and managing the complexities of polypharmacy are imperative. A medicines use review can help to ensure that medicines optimisation forms part of routine practice.

With an increasing focus on evidence-based practice in health care, it is important that nurses understand the principles underlying systematic reviews. Systematic reviews are used in healthcare to present a comprehensive, policy-neutral, transparent and reproducible synthesis of evidence. This article provides a practical overview of the process of undertaking systematic reviews, explaining the rationale for each stage. It provides guidance on the standard methods applicable to every systematic review: writing and registering a protocol; planning a review; searching and selecting studies; data collection; assessing the risk of bias; and interpreting results.

Irritable bowel syndrome (IBS) is the most common cause of non-organic recurrent abdominal pain in children. IBS is a clinical diagnosis, which is based on the Rome IV criteria for functional gastrointestinal disorders in children, as well as the patient's history. The diagnosis of IBS is established following the exclusion of organic causes of recurrent abdominal pain. Staggered investigations should be avoided because they might increase the child's and family's anxiety in the absence of an organic diagnosis. In most cases, providing a positive diagnosis of IBS and explaining the current understanding of the functional pathophysiology of the condition and management strategies gives reassurance to the child and their family. Management is based on dietary, pharmacological and biopsychosocial interventions. IBS can be a debilitating condition, with effects on activities of daily living, education and social interactions. Nurses working in various clinical settings will encounter children with IBS and have an important role in the management of children with this condition.

Rationale and key points This article assists nurses to use the acronym PRICE (protection, rest, ice, compression and elevation) to guide the treatment of patients with uncomplicated soft tissue injuries to their upper or lower limbs. » Treatment of soft tissue injuries to limbs is important to reduce complications following injury, alleviate pain and ensure normal limb function is restored promptly. » Nurses should have an understanding of the rationale and evidence base supporting PRICE treatment of soft tissue injuries. » Providing accurate information to patients and carers about the management of soft tissue injuries and anticipated recovery time is an important aspect of treatment. » Further research is required to develop best practice in the treatment of soft tissue injuries. Reflective activity 'How to' articles can help you update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: 1. How this article might change your practice when managing patients with soft tissue injuries to upper or lower…

Essential facts Haematological malignancies are a diverse group of cancers that affect the blood, bone marrow and lymphatic systems. The main categories are lymphoma, leukaemia, myeloma, myelodysplastic syndromes and myeloproliferative neoplasms. In addition, there are subtypes of lymphoma and leukaemia, as well as more rare haematological cancers that have their own categories. There are also borderline conditions such as aplastic anaemia and other non-malignant bone marrow failure syndromes. The charity Bloodwise says 38,000 people in Britain are diagnosed every year with blood cancer or a related disorder, making it the country's fifth most common cancer.

This article discusses gastrointestinal (GI) healthcare in older people. It outlines the physiological changes that occur in the GI tract as a result of ageing, and discusses common GI disorders in older people. These GI disorders include dysphagia, gastrointestinal reflux disease, colorectal cancer, diverticular disease, constipation and anaemia. Healthcare professionals should be aware of the factors that may influence gastrointestinal health in older people, including nutrition, hydration and alcohol use, which are important considerations when delivering person-centred care.

Medication errors are one of the most common causes of preventable harm to patients, and result in a financial burden on the NHS.

Rosacea is a chronic inflammatory skin condition that predominantly affects the central face. It is characterised by a variable range of symptoms, including erythema, telangiectasia, papules, pustules and changes in skin texture. Rosacea may be transient, recurrent or persistent. Because it affects the most visible part of the body, the psychosocial effects of this condition can be significant. This article describes the features and management of the condition.

This article provides a comprehensive overview of the risks associated with the administration of chemotherapy, monoclonal antibodies and targeted or biological therapies in the management of solid tumours. The main physiological actions of these agents are discussed, with reference to the immediate infusion-related side effects and complications that may arise from an extravasation injury. The article focuses on the identification and early recognition of these risk factors to implement preventive measures and appropriate management strategies.

The author presented a model in the 1990s to explain altered body image, which has been used to characterise the difficulties encountered by patients who experience body change as a result of illness, injury or disability. However, it remains a challenge for nurses to establish care plans that can assist patients to manage the psychological adjustments associated with disfigurement. This article presents some simple questions to help patients narrate their psychological experiences and needs, and proposes a model of psychological change, based on the work of Kübler-Ross, to enable nurses to anticipate patient requirements that might arise at different stages of the individual's recovery and rehabilitation. Body-image rehabilitation may be protracted. Therefore, it is essential for nurses to understand what the patient is thinking and feeling throughout the rehabilitation process and which stage of psychological change the patient is working through.

Just 13% of nurses feel prepared to meet the needs of their transgender patients, according to a survey by the RCN. The UK-wide research involving more than 1,200 nursing staff found this could be due to lack of training, despite more than three quarters encountering transgender patients in their work, and 56% caring for them directly.

Essential facts About 200,000 people in the UK have ankylosing spondylitis, and there are around 2,300 new diagnoses each year in England and Wales. A form of arthritis, the chronic condition causes inflammation in the spine and other areas of the body. It is about three times more common in men than in women.

Essential facts Non-Hodgkin's lymphoma (NHL) is a cancer of the lymphatic system. According to Cancer Research UK, it is the sixth most common cancer in the UK, with 13,413 new cases diagnosed in 2013. There were 4,801 deaths from NHL in 2014. The disease has many subtypes, with two main broad categories: high-grade or aggressive and low-grade or indolent.

This article, the ninth in a series of 11, provides guidance for new and established mentors and practice teachers on evidence-based practice, the seventh domain of the Nursing and Midwifery Council's Standards to Support Learning and Assessment in Practice (SSLAP). Evidence-based practice is an important aspect of contemporary healthcare and is central to student preparation programmes for nursing, midwifery and specialist community public health nursing (SCPHN). The article describes evidence-based practice, discussing the importance and implementation of an evidence-based approach in the context of role development for mentors and practice teachers in the preparation of nursing, midwifery and SCPHN students.

Developed by charity Alzheimer's Research UK, and guided by people living with different forms of dementia, this app aims to give an insight into the everyday life of people suffering from dementia.

Poverty is a global issue that affects the health and quality of life of millions of people. It predisposes people to many health conditions, including sight loss or blindness as a result of the immune system becoming compromised. Blindness is common in areas of the world where there is extreme poverty. In the UK, poverty has become a major social issue, contributing to many health problems, including eye conditions. These eye conditions can result in sight loss if they are not managed effectively. Psychosocial care is an essential aspect of patient care, because poverty and sight loss are interrelated. Healthcare practitioners have a significant role in the management and prevention of blindness. Blindness caused by poverty is largely preventable, and health promotion is an important strategy in care management.

This article, the second of two, provides healthcare practitioners with an overview of best practice in palliative and end-of-life care, including nutrition, hydration, oral hygiene and pain management. Communication and spiritual care are discussed, as well as care after death. Providing support and education for families is an important aspect of palliative and end-of-life care. Care home nurses should ensure that the person living with dementia is at the centre of decision making, and provide care that is inclusive of their needs and wishes. The article is framed in a care home context; there is little research about how to optimise palliative care for people living with dementia in care homes.

Essential facts Jaundice is one of the most common conditions affecting newborn babies. It is estimated that 6 out of every 10 babies develop jaundice, with even higher rates for premature babies. Caused by increased levels of bilirubin in the blood, jaundice is generally harmless, and resolves without treatment by 2 weeks of age. However, high levels of bilirubin can be harmful if not treated and need to be identified quickly.

Essential facts Systemic lupus erythematosus (SLE) is a rare, chronic autoimmune disease that causes inflammation in various parts of the body. Its annual incidence is estimated at one in 20,000. Although there is no cure, early diagnosis and appropriate treatment can help to control the symptoms, preventing damage to vital organs. In addition, there are other types of lupus that affect the skin, including discoid lupus erythematosus and subacute cutaneous lupus erythematosus.

Essential facts Prostate cancer starts in the prostate gland, at the base of the bladder in men. It surrounds the first part of the urethra, which carries urine from the bladder. The prostate gland helps in the production of semen, which is also carried in the urethra. It is the most common cancer in men - one in eight will develop it during their lifetime.

Rationale and key pointsThis article provides nurses with information about how to care for a patient after death and support their family in the hospital setting.▶Care after death involves supporting the family and significant others, and providing personal care to the patient.▶Staff undertaking care after death should be offered appropriate support.▶Local and national guidelines should be followed.Reflective activityClinical skills articles can help update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of:1.How you think this article will change your practice.2.How this article could help you to consider the support mechanisms in your practice setting for the provision of care after death.Subscribers can upload their reflective accounts at: rcni.com/portfolio.

RATIONALE AND KEY POINTS: This article aims to help nurses to perform first aid in a safe, effective and patient-centred manner. First aid comprises a series of simple, potentially life-saving steps that an individual can perform with minimal equipment. Although it is not a legal requirement to respond to an emergency situation outside of work, nurses have a professional duty to respond and provide care within the limits of their competency. First aid is the provision of immediate medical assistance to an ill or injured person until definitive medical treatment can be accessed. First aid can save lives and it is essential that nurses understand the basic principles. REFLECTIVE ACTIVITY: Clinical skills articles can help update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: 1. Your skill in performing first aid and any areas where you may need to extend your knowledge. 2. How reading this article will change your practice. Subscribers can upload their reflective accounts at: rcni.com/portfolio .

Rationale and key points Eye care is an important aspect of the nursing management of patients who are critically ill. All patients in acute care settings with absent or compromised eye defence mechanisms are at risk of eye complications and ocular surface disease. This article aims to assist nurses to care for the eyes of patients in critical care settings to enable early detection and routine management of ophthalmic issues, thereby avoiding visual compromise on patient discharge from critical care settings. » Corneal exposure is reported to occur in many patients who are critically ill. » Incomplete eyelid closure and lack of lubrication are the main mechanisms that underlie the development of corneal damage in patients who are critically ill. » Unconscious, sedated and/or paralysed patients and those with a reduced Glasgow Coma Scale score depend on healthcare professionals to maintain their ocular surface to prevent complications such as corneal abrasion, infection and ulceration, perforations and blindness. » Meticulous nursing care is required to prevent ophthalmic…

AIM: To assess family satisfaction with care provided to patients in critical care units in Islamabad. METHOD: A descriptive cross-sectional study was conducted in 11 medical and surgical critical care units at two private hospitals in Islamabad, Pakistan. The purposive sample consisted of 323 immediate family members and other relatives and friends (referred to as family members in this article) of 323 patients admitted to the critical care units for at least 24 hours. The revised Critical Care Family Satisfaction Survey was used for data collection. Descriptive statistics were used for data analysis. FINDINGS: A total of 149/323 (46%) family members were 'very satisfied' with the honesty (openness) of staff in explaining the patient's condition, and 137/323 (42%) family members were 'very satisfied' with the nurses' availability to speak to them. A total of 143/323 (44%) family members were 'satisfied' with the honesty (openness) of staff in explaining the patient's condition, and 131/323 (41%) were 'satisfied' with the nurses' availability to speak to them. A few family members…

A public health nurse at Oxford Health NHS Foundation Trust developed the Let's Talk FGM app using funding from her Mary Seacole Leadership Award.

Essential facts Skin cancer can be split into 2 groups: malignant melanoma, which can be fatal; and non-melanoma, such as squamous cell carcinoma and basal cell carcinomas, which are rarely lethal. In 2013 there were 14,509 new cases of malignant melanoma in the UK and, in 2014, 2,459 people died from the disease. Non-melanoma skin cancers are more common; 72,100 new cases were diagnosed in the UK in 2013.

Overactive bladder in women is a common chronic condition of urinary storage, affecting a significant proportion of the population. It is defined as a symptom diagnosis that indicates lower urinary tract dysfunction, in which patients experience urinary urgency, with or without urge incontinence, usually accompanied by frequency and nocturia. The diagnosis and treatment of overactive bladder are straightforward and systematic in line with national and international guidelines. However, women are required to disclose their bladder symptoms, and be motivated to make changes to their lifestyle to see improvements. This article focuses specifically on idiopathic detrusor overactivity; its diagnosis, treatment and psychological effects on women. Healthcare professionals require an understanding of the pathophysiology and treatment rationale for the condition to ensure appropriate management strategies for patients presenting to primary and secondary care are implemented.

Nursing students, nurses and other healthcare professionals involved in prescribing, dispensing, administration and monitoring of medicines should be able to navigate and use the British National Formulary (BNF) effectively. Recent changes to the structure of the BNF have resulted in new symbols, additional sections in drug and drug-class monographs, and a reduction in the amount of cross-referencing between chapters. This article explores how healthcare professionals can access the information in the BNF to ensure that medicines use is optimised, therapeutic effects are maximised, and adverse drug reactions and drug interactions are minimised.

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Pathological changes in the circulation reduce the blood supply to major organs, causing them to fail. This may lead to death, therefore rapid recognition and treatment of sepsis is vital. Sepsis research has focused on patients in acute hospital settings. However, most cases of sepsis originate in the community, suggesting that the identification of sepsis and delivery of timely care is necessary before hospital admission. Therefore, it is essential that nurses practising in the community are provided with appropriate sepsis guidelines that can be implemented immediately. The UK Sepsis Trust has developed the General Practice Sepsis Decision Support Tool, which has been designed specifically for use in the community. This article provides an overview of how the tool is used in the community and how it works in conjunction with the 'Sepsis Six' care bundle and care bundles for hospital settings. Changes to the terminology used in relation to sepsis and recent guidelines are also…