The 100 most-cited articles in Nursing Standard, 2017

This book is a guide to planning health promotion programmes using interventional mapping, which is a protocol for developing effective behavioural change.

Spirituality is a complex concept that has different meanings for different people. Spiritual care is a fundamental aspect of nursing and attending to the spiritual needs of patients may improve their health outcomes. This article, the first in a series of three, explores various definitions of spirituality, and the importance of spirituality and spiritual care in healthcare settings. The second article of this series provides an in-depth exploration of the assessment of patients' spiritual care needs, and the third and final article in this short series discusses spiritual care nursing interventions.

Establishing positive and trusting therapeutic relationships with patients has long been recognised as an essential component of nursing practice and is important for effective care. There are various challenges in clinical practice that make it increasingly difficult to deliver effective care centred on such relationships. Understanding and addressing these challenges is crucial to ensure a positive experience of care for patients, families, carers and nurses. This article outlines how nurses can use a framework to develop therapeutic relationships with patients and use the best available evidence to deliver effective care. It also explores the challenges in developing effective therapeutic relationships with patients at the healthcare system level, and considers how these challenges can be addressed.

This informative, comprehensive, up-to-date book encompasses all aspects of sleep medicine. Written by a world authority and scientific expert, it explains in simple terms but with interesting detail the different stages of sleep, how they change throughout life, and why each one is important.

Patients who deteriorate without recognition or timely interventions are at risk of critical care admission and increased morbidity or mortality. This article outlines the systematic ABCDE (airway, breathing, circulation, disability, exposure) approach to patient assessment, which enables healthcare practitioners to identify and respond to life-threatening conditions in order of priority. The patient's vital signs should be measured as part of the ABCDE assessment and recorded using a track and trigger tool to enhance recognition of physiological abnormalities that signal deterioration. To optimise communication and escalation of deteriorating patients, healthcare practitioners should report ABCDE assessment findings using a structured communication tool.

The NHS in the UK is under increasing pressure as a result of financial and recruitment issues, as well as an ageing population. Nursing has continued to adapt to this challenging time. Over the past few years, the advanced nurse practitioner (ANP) role has been implemented widely in primary and secondary care. However, the ANP role has lacked consistency in scope of practice, training and regulation. This article summarises the development of the ANP role in the UK and internationally, and issues relating to regulation. Globally, ANPs are regulated by one of three different bodies: nationally by central government or a professional body, or locally by employers. In the UK, the role is regulated by local procedures, relying on employers to make decisions about the scope and preparation for practice. Some of the challenges in the UK in relation to ANP regulation are discussed, including variations in scope, organisational constraints and lack of support. These challenges are exacerbated by a lack of role clarity, thereby indicating there is a need to improve regulation of ANPs. The…

Assessing spirituality and the spiritual needs of patients is fundamental to providing effective spiritual care. This article, the second in a series of three, discusses the assessment of patients' spirituality and spiritual needs in healthcare settings. Several formal spiritual assessment tools are available to assist nurses to identify patients' spiritual needs and to determine whether they are experiencing spiritual distress. However, it may be more appropriate to assess patients' spirituality informally, by asking open questions about their spiritual beliefs and needs. It is important for nurses to be aware of the limits of their competence in undertaking spiritual assessment and providing spiritual care, and to refer patients to the healthcare chaplain or other spiritual support personnel where necessary. The third and final article in this series will discuss spiritual care nursing interventions.

Nurses are often asked to think about leadership, particularly in times of rapid change in healthcare, and where questions have been raised about whether leaders and managers have adequate insight into the requirements of care. This article discusses several leadership styles relevant to contemporary healthcare and nursing practice. Nurses who are aware of leadership styles may find this knowledge useful in maintaining a cohesive working environment. Leadership knowledge and skills can be improved through training, where, rather than having to undertake formal leadership roles without adequate preparation, nurses are able to learn, nurture, model and develop effective leadership behaviours, ultimately improving nursing staff retention and enhancing the delivery of safe and effective care.

Rapport is established at the first meeting between the patient and nurse, and is developed throughout the therapeutic relationship. However, challenges can arise during this process. Initially, nurses can establish trust with the patient through the questions they ask, however, as care progresses, the nurse will be required to demonstrate a commitment to maintaining the patient's psychological well-being. When the therapeutic relationship ends, the nurse should assist the patient to assess progress and plan the next stage of recovery. This article provides three reflective exercises using case study examples to demonstrate how rapport is developed and sustained. Evidence is provided to identify why challenges arise in the therapeutic relationship and how the nurse can ensure they provide care that the patient regards as genuine.

Modern healthcare environments are becoming increasingly complex. Delivering high-quality fundamental care in these environments is challenging for nurses and has been the focus of recent media, policy, academic and public scrutiny. Much of this attention arises from evidence that fundamental care is being neglected or delivered inadequately. There are an increasing number of standards and approaches to the delivery of fundamental care, which may result in confusion and additional documentation for nurses to complete. This article provides nurses with an approach to reframe their thinking about fundamental care, to ensure they meet patients' care needs and deliver holistic, person-centred care.

This article, the third and final in a series of three, discusses the implementation of spiritual care interventions by nurses. It describes how nurses can use clinical reasoning and the nursing process to implement appropriate spiritual care for patients, and outlines the competencies necessary to identify spiritual distress and meet the spiritual needs of patients. Spiritual care interventions are discussed as part of a multidisciplinary team approach to the provision of holistic care.

The number of people with dementia is expected to increase globally. People with dementia are not affected in isolation and any intervention should also support their families and carers. Intervention is best delivered using a relationship-centred approach and a case management model. Case management has an established and successful history in supporting people with long-term conditions and those with a diagnosis of severe mental illness. This article, the last in this dementia series, discusses the Admiral Nursing case management approach to supporting patients and families affected by dementia, and provides recommendations for establishing a gold standard model of case management.

Research suggests that the development of mindfulness and self-compassion may help to improve the well-being and resilience of professionals and students in the healthcare setting. This is reflected in the growth of mindfulness training for these individuals. Mindfulness is an important aspect of self-compassion, and healthcare professionals should be aware of the need to care for themselves when caring for others. This article explores the concepts of mindfulness and self-compassion and their relationship with, and ability to enhance, compassionate care.

Duty of care is a fundamental aspect of nursing, and many nurses consider this to be an important part of their professional duties as a nurse. However, the legal underpinnings of duty of care are often overlooked, and, as such, nurses may be unsure about when to act if they encounter emergency situations or serious incidents, especially when they are off duty. This article examines the legal, ethical and professional aspects of duty of care, what these mean for nurses in practice, and how duty of care is intrinsically linked with standards of care and negligence.

The mission of the Cochrane Nursing Care Field (CNCF) is to improve health outcomes through increasing the use of the Cochrane Library and supporting Cochrane's role by providing an evidence base for nurses and healthcare professionals who deliver, lead or research nursing care. The CNCF produces Cochrane Corner columns, summaries of recent nursing-care-relevant Cochrane Reviews that are regularly published in collaborating nursing-related journals. Information on the processes CNCF has developed can be accessed at: cncf.cochrane.org/evidence-transfer-program-review-summaries. This is a Cochrane review summary of: Lodi G, Franchini R, Warnakulasuriya S et al ( 2016 ) Interventions for treating oral leukoplakia to prevent oral cancer. Cochrane Database of Systematic Reviews. Issue 7. CD001829. doi: 10.1002/14651858. CD001829.pub4.

The medicines refrigerator is a common piece of equipment found in clinical areas. It is used to ensure specific medicines are safely stored within a narrow temperature range in line with manufacturers' instructions; this is usually between +2˚C and +8˚C, and ideally +5˚C. Drugs stored in the medicines refrigerator include: vaccines; insulin; chemotherapy drugs; topical preparations, such as some types of eye drops; and other treatments such as glucagon, which is used to manage severe hypoglycaemia. This article reviews the function of the medicines refrigerator and the checks required by healthcare practitioners to ensure that medicines remain safely stored and their effectiveness is maintained. It also outlines the medicines refrigeration procedure known as the 'cold chain', which includes the use of cold boxes or vaccine carriers to maintain the required temperature of medicines during transport from the manufacturer to user, or between healthcare departments.

This article encourages nurses to explore the concept of leadership in the constantly changing field of health and social care. All nurses have an important role in leadership, and they should consider what type of leader they want to be and what leadership skills they might wish to develop. This article examines what leadership might involve, exploring various leadership styles and characteristics and how these could be applied in nurses' practice. A core component of nursing and nursing leadership is the ability to provide compassionate care. This could correspond with the idea of servant leadership, an approach that moves the leader from a position of power to serving the team and supporting individuals to develop their potential.

Ensuring and maintaining patient safety is an essential aspect of care provision. Safety is a multidimensional concept, which incorporates interrelated elements such as physical and psychosocial safety. An effective nurse-patient relationship should ensure that these elements are considered when planning and providing care. This article discusses the importance of an effective nurse-patient relationship, as well as healthcare environments and working practices that promote safety, thus ensuring optimal patient care.

Red eye is a common ocular presentation in primary care, and there are several challenges that healthcare practitioners may encounter when caring for such patients. The main ocular conditions that can give rise to red eye are: primary acute angle closure glaucoma, acute iritis, dry eye, blepharitis and conjunctivitis. Red eye can be classified as sight-threatening or non-sight-threatening. Many patients presenting with painless red eye and normal vision usually recover well. However, when red eye is associated with pain, photophobia, watering and blurred vision, it is potentially sight-threatening and must be addressed urgently. Therefore, it is vital for healthcare practitioners to be able to undertake a careful assessment of the patient and make an accurate diagnosis early. This article provides an overview of the common causes of red eye encountered in general practice or an eye clinic. It discusses the nurse's role in the care and management of patients with red eye, with reference to patient assessment, the skills required to make an accurate diagnosis, treatment and health…

Compassionate care is a fundamental aspect of nursing, and is an important value that is embedded in nurses' professional standards and codes of practice. However, nurses may experience several challenges in their practice that can impede their ability to provide compassionate care. This article aims to support and guide nurses in developing their capacity to be compassionate. It explores concepts related to compassion, including compassion satisfaction, fatigue, literacy and self-compassion, and outlines strategies that nurses can implement to promote compassionate care. This article encourages nurses to identify their personal and professional values, to understand how these can influence their attitudes and behaviours. By raising awareness of these concepts, as well as the challenges and changing nature of compassion, it is hoped that nurses' capacity to provide compassionate care will be enhanced.

The burden of chronic illness is increasing globally as a result of increased life expectancy, unhealthy lifestyles, and advances in medical interventions and treatments. Therefore, people living with chronic conditions, and their families, will have to assume greater responsibility in managing such conditions. However, to do so they require appropriate support from healthcare services. This article explores some of the tensions that hinder the self-management of chronic conditions. It emphasises the importance of individuals and their families having the desire, and being enabled, to assume an active and decisive role in the management of chronic conditions. Nurses have a role in enabling patients to optimise their self-management skills, but organisational constraints in healthcare services, as well as constraints in nurse training and nursing roles, may mean that nurses are unable to fulfil this role. This article considers some of the factors that may limit the development of patient and nursing roles in relation to self-management of chronic conditions.

Aim The aim of this research was to explore how newly qualified nurses learn to organise, delegate and supervise care in hospital wards when working with and supervising healthcare assistants. It was part of a wider UK research project to explore how newly qualified nurses recontextualise the knowledge they have gained during their pre-registration nurse education programmes for use in clinical practice. Method Ethnographic case studies were conducted in three hospital sites in England. Data collection methods included participant observations and semi-structured interviews with newly qualified nurses, healthcare assistants and ward managers. A thematic analysis was used to examine the data collected. Findings Five styles of how newly qualified nurses delegated care to healthcare assistants were identified: the do-it-all nurse, who completes most of the work themselves; the justifier, who over-explains the reasons for decisions and is sometimes defensive; the buddy, who wants to be everybody's friend and avoids assuming authority; the role model, who hopes that others will copy…

First-year university students often embark on university life with excitement. In addition to experiencing greater freedom, they begin to take responsibility for their lives. However, it can be challenging for students to balance their studies with their new self-care responsibilities, while forming peer relationships. Some students may eat a suboptimal diet, for example they may regularly consume 'fast food' rather than healthier alternatives. Their physical activity may also decrease, as a result of time constraints and/or lifestyle choices. A suboptimal diet and reduction in physical activity, combined with possible stress associated with this life transition, can result in adverse health effects, for example weight gain and mental health issues. This article aims to support nursing students to adopt a practical approach to maintaining their health and well-being as they adjust to university life.

Healthcare is a complex area with significant potential for service improvement despite the effects of increasing economic and social pressures on the quality and safety of patient care. As the largest group of healthcare professionals in direct contact with patients, nurses are well positioned to contribute to improvements in healthcare services and to the development of new policies. To influence healthcare improvements and policies effectively, nurses require leadership skills. Historically, it was thought that only nurses in management roles required leadership skills; however, the ability to influence change is a requirement at all levels of clinical practice. Transformational leadership competencies provide nurses with the skills to contribute to improvements in the quality and safety of patient care, while enhancing their career satisfaction. This article examines how nurses can apply transformational leadership to their practice. It also informs nurses how to conduct an initial self-assessment of their leadership skills and to formulate a transformational leadership…

Robots, along with sensors and telemedicine, have been identified as technologies that can assist and prolong independent living for older people, with robots especially being used to help prevent social isolation and depression.

STATEMENT: The mission of the Cochrane Nursing Care Field (CNCF) is to improve health outcomes through increasing the use of the Cochrane Library and supporting Cochrane's role by providing an evidence base for nurses and healthcare professionals who deliver, lead or research nursing care. The CNCF produces Cochrane Corner columns, summaries of recent nursing-care-relevant Cochrane Reviews that are regularly published in collaborating nursing-related journals. Information on the processes CNCF has developed can be accessed at: cncf.cochrane.org/evidence-transfer-program-review-summaries. This is a Cochrane review summary of: Estcourt LJ, Desborough M, Brunskill SJ et al ( 2016 ) Antifibrinolytics (lysine analogues) for the prevention of bleeding in people with haematological disorders. Cochrane Database of Systematic Reviews. Issue 3. CD009733. doi: 10.1002/14651858.CD009733.pub3.

A vast and increasing scientific literature is published each year, including books, journals, research articles and reviews. One approach to determining the value of an academic publication involves measuring how often other academic writers or researchers refer to or cite it. This is the essence of bibliometrics. This article examines how bibliometrics has developed. It describes how analysing citations provides a measure of the influence of specific articles (individual article citations), to compare different journals (journal impact factor) and to examine the output and impact of individual academics (the h-index). Particular reference is made to nursing. Using citations should not be the only way that the value of scholarly work is judged, because there are limitations in using this method. However, bibliometrics provides an important, feasible and systematic means of reaching judgments about the importance of published works. As a result, it can be useful for examining the productivity and influence of individuals and institutions and for comparing different disciplines and…

statement The mission of the Cochrane Nursing Care Field (CNCF) is to improve health outcomes through increasing the use of the Cochrane Library and supporting Cochrane's role by providing an evidence base for nurses and healthcare professionals who deliver, lead or research nursing care. The CNCF produces Cochrane Corner columns, summaries of recent nursing-care-relevant Cochrane Reviews that are regularly published in collaborating nursing-related journals. Information on the processes CNCF has developed can be accessed at: cncf.cochrane.org/evidence-transfer-program-review-summaries. This is a Cochrane review summary of: Stevens B, Yamada J, Ohlsson A et al ( 2016 ) Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database of Systematic Reviews. Issue 7. CD001069. doi: 10.1002/14651858. CD001069.pub5.

Aim To gain insight into nurses' suicide awareness and prevention training, their confidence in engaging in conversations about suicide, and the barriers and enablers affecting their engagement and future training in this area. Method An electronic survey was carried out with members of the Royal College of Nursing (RCN). A total of 415 RCN members responded to the survey. The survey included qualitative and quantitative questions about barriers to engaging in conversations about suicide, and nurses' suicide awareness and prevention training needs. A thematic analysis was undertaken to identify the main themes. Findings Respondents identified several barriers to engaging in conversations about suicide, including: lack of time and resources; lack of skills, training and knowledge; insufficient service provision; and stigma. A range of suicide awareness and prevention training needs were identified, such as pre and post-registration training to increase nurses' knowledge and skills, regular updates of evidence-based approaches, structured supervision and debriefs. Conclusion It is…

Foreign body ingestion and foreign body aspiration commonly affect children. The most vulnerable age is between six months and four years, when children tend to explore new objects with their mouths. Many of these events remain asymptomatic, with the swallowed object passing through the gastrointestinal tract without causing harm. However, the frequency of serious complications as a result of the ingestion of hazardous objects has increased in recent years, in particular button batteries and magnets. To increase the likelihood of identifying foreign body ingestion and aspiration, healthcare professionals should maintain a high index of suspicion, be aware of the variation in presentations and include it as a differential diagnosis in children presenting with non-specific symptoms, such as fever, cough, drooling, dysphagia and abdominal pain. Management of most foreign body ingestions is conservative, using a 'watch-and-wait' approach. Children should be triaged as an emergency if they have signs or symptoms of airway obstruction or a history that indicates dangerous foreign body…

Chronic heart failure is a common and complex clinical syndrome that results from impaired cardiac relaxation or contraction. Patients with chronic heart failure may experience multiple debilitating symptoms, such as fatigue, pain, and peripheral oedema. However, breathlessness may be considered the most debilitating symptom. This is the first of two articles on chronic heart failure, and outlines the pathophysiology of the condition, its causes, assessment, and signs and symptoms. Part 2 will discuss the treatment and management of the condition, including pharmacological strategies, device implantation, lifestyle modification, cardiac rehabilitation and palliative care.

Simulated practice learning is used in pre-registration nursing programmes to replicate situations that nursing students are likely to encounter in clinical practice, but in a safe and protected academic environment. However, lecturer-led simulated practice learning has been perceived as detached from contemporary nursing practice by some nursing students. Therefore, a pilot project was implemented in the authors' university to explore the use of student-led simulated practice learning and its potential benefits for nursing students. AIM: To evaluate the effectiveness of student-led simulated practice learning in pre-registration nursing programmes. The authors specifically wanted to: enhance the students' skills; improve their critical thinking and reflective strategies; and develop their leadership and management techniques. METHOD: A literature review was undertaken to examine the evidence supporting student-led simulated practice learning. A skills gap analysis was then conducted with 35 third-year nursing students to identify their learning needs, from which suitable simulated…

Postoperative pain continues to be a significant issue in healthcare, with a considerable proportion of patients experiencing severe pain after surgery and finding pain management at home challenging. There are several barriers to effective pain management, involving both patients and healthcare professionals. Patient education may be a useful way to overcome many of these barriers. This article outlines the four stages of the education process, which can be used to provide patient education: assessing the patient's educational needs and potential barriers to learning; setting educational objectives; teaching; and evaluating the patient's learning. This article discusses the issue of postoperative pain and how structured patient education, from admission to discharge, provided by skilled healthcare professionals, may improve postoperative recovery.

STATEMENT: The mission of the Cochrane Nursing Care Field (CNCF) is to improve health outcomes through increasing the use of the Cochrane Library and supporting Cochrane's role by providing an evidence base for nurses and healthcare professionals who deliver, lead or research nursing care. The CNCF produces Cochrane Corner columns, summaries of recent nursing-care-relevant Cochrane Reviews that are regularly published in collaborating nursing-related journals. Information on the processes CNCF has developed can be accessed at: cncf.cochrane.org/evidence-transfer-program-review-summaries. This is a Cochrane review summary of: Sharp C, Adamali H, Millar AB ( 2016 ) Ambulatory and short burst oxygen for interstitial lung disease. Cochrane Database of Systematic Reviews. Issue 6. CD011716. doi: 10.1002/14651858.CD011716.pub2.

Families ('family' will be used in this article to refer to anyone the patient considers significant, whether they are an actual family member or not) of patients who are critically ill have heightened communication needs. Nurses are an important source of information, particularly about day-to-day patient events and progress. Intensive care unit (ICU) nurses are valued by families because they provide clear, jargon-free information about the patient and their condition. However, they have sometimes been criticised for focusing on short-term issues while avoiding potentially difficult conversations about long-term outcomes and prognosis. A family conference or meeting is held when bad news has to be communicated to families, prognosis discussed or major decisions made, particularly about treatment withdrawal or resuscitation. These meetings should involve physicians and ICU nurses. Despite family conferences, family members' understanding of patient prognosis, diagnosis and treatment is often suboptimal. A planned and structured approach for these meetings, using quantitative…

Rationale and key points This article provides an overview of the various types of abdominal stoma and surgical procedures that result in stoma formation. It outlines the enhanced recovery pathway that is used to guide postoperative care, and some of the areas that should be incorporated in postoperative stoma care. These areas include training in the practical care of the stoma and its appliance, dietary advice and reintegrating lifestyle activities. In addition, the article briefly examines stoma reversal, and explores the role of the stoma specialist nurse. » Nurses require an understanding of the various surgical procedures that might result in the formation of a stoma. » An understanding of the stoma appliances that are available is essential to enable nurses to provide effective care for patients with a newly formed stoma. » Effective postoperative care that incorporates support and education enables patients to adapt quickly to having a stoma. » Enabling patients to understand changes that occur as a result of stoma formation will increase their confidence in managing their…

University Hospitals of Morecambe Bay NHS Foundation Trust is the first NHS Trust in the country to launch an app to make raising concerns easier.

AIM: To undertake a service evaluation to assess the effect of peer social support training using two separate learning programmes, which were designed to assist prisoners to support older prisoners and prisoners with disabilities. METHOD: The service evaluation used an action research approach to support planning, delivery and data collection. Eleven interviews with nine prisoners who had undertaken the peer social support training programmes and two members of prison staff (one nurse manager and one prison officer) were recorded and transcribed by the researchers. This data was coded and thematically analysed to evaluate the findings. Recommendations were made regarding the format and content of the training. FINDINGS: The training was well received by the peer social support worker trainees and had several positive outcomes, including increased peer social support, improved relationships between peer social support workers and older prisoners and prisoners with disabilities, increased self-esteem, measured as 'social capital', among peer social support workers, and effective…

The nurse's primary role in the medication process is to ensure that drugs are administered safely to patients, thus reducing the risk of unnecessary harm or injury. High-alert medications are a particular concern for healthcare professionals, since they are associated with an increased risk of causing patient harm. This article identifies high-risk medications and outlines measures that can be used to prevent potential harm to patients as a result of these medications, including computerised provider order entry, Tall Man lettering, order sets, independent double-checks and proactive patient monitoring.

Handovers are a crucial aspect of the patient's healthcare pathway. Effective handovers promote patient safety and continuity of care and may contribute to increased job satisfaction for nurses. It is important that nurses can identify any potential barriers to effective handovers so that these can be addressed. An increasing emphasis on person-centred care in the NHS has resulted in changes in the way handovers are conducted, and there has been a shift away from nurse-to-nurse communication towards increased patient involvement. Evidence supports the use of a structured framework in handovers and the author advocates placing patients at the centre of their care by using bedside handovers. Nurses require training and support to enable them to deliver effective handovers that meet the requirements of their organisation, colleagues and patients.

Evaluation of service delivery is an important aspect of nursing practice. Service evaluation is being increasingly used and led by nurses, who are well placed to evaluate service and practice delivery. This article defines evaluation of services and wider care delivery and its relevance in NHS practice and policy. It aims to encourage nurses to think about how evaluation of services or practice differs from research and audit activity and to consider why and how they should use evaluation in their practice. A process for planning and conducting an evaluation and disseminating findings is presented. Evaluation in the healthcare context can be a complicated activity and some of the potential challenges of evaluation are described, alongside possible solutions. Further resources and guidance on evaluation activity to support nurses' ongoing development are identified.

Aim To explore the role of prisoner caregivers in providing peer social care to older prisoners and to identify methodological information and challenges to conducting research in prisons, to inform future research in this setting. Method The literature review was conducted in two stages. In the first stage, a systematic literature review was undertaken to retrieve articles related to prisoner caregiving. The main themes from these articles were identified. In the second stage, a narrative literature review was undertaken to provide contextual and methodological information about research, which may support future research in prisons. Findings The main themes identified in the systematic literature review were: the benefits of prisoner caregiving; training needs; and the organisational implications of implementing prisoner caregiving. The narrative literature review identified a range of methodological approaches used to undertake research in prisons. Challenges to undertaking research in prisons included practical issues, the influence of power on relationships and the difficulty…

This fertility tracking app tracks the user's ovulation and period cycle to pinpoint their fertility and help prevent or plan a pregnancy.

Background People with learning disabilities experience significant inequalities in accessing healthcare. Legal frameworks, such as the Equality Act 2010, are intended to reduce such disparities in care, and require organisations to make 'reasonable adjustments' for people with disabilities, including learning disabilities. However, reasonable adjustments are often not clearly defined or adequately implemented in clinical practice. Aim To examine and synthesise the challenges in caring for people with learning disabilities to develop a framework for making reasonable adjustments for people with learning disabilities in hospital. This framework would assist ward staff in identifying and managing the challenges of delivering person-centred, safe and effective healthcare to people with learning disabilities in this setting. Method Fourth-generation evaluation, collaborative thematic analysis, reflection and a secondary analysis were used to develop a framework for making reasonable adjustments in the hospital setting. The authors attended ward manager and matron group meetings to…

statement The mission of the Cochrane Nursing Care Field (CNCF) is to improve health outcomes by increasing the use of the Cochrane Library and supporting Cochrane's role by providing an evidence base for nurses and healthcare professionals who deliver, lead or research nursing care. The CNCF produces Cochrane Corner columns, summaries of recent nursing-care-relevant Cochrane Reviews that are regularly published in collaborating nursing-related journals. Information on the processes CNCF has developed can be accessed at: nursingcare.cochrane.org/evidence-transfer-program-review-summaries. This is a Cochrane review summary of: Hamilton TW, Athanassoglou V, Trivella M et al ( 2016 ) Liposomal bupivacaine peripheral nerve block for the management of postoperative pain. Cochrane Database of Systematic Reviews. Issue 8. CD011476. doi: 10.1002/14651858.CD011476.pub2.

Reflecting on practice is an important aspect of nursing. There is widespread acknowledgement of the value of reflective practice and it has a significant role in coursework assessment and revalidation requirements. However, less attention has been given to the various levels of reflection and what constitutes a higher or lower level of reflection. This article aims to assist nurses to understand how identifying the various levels of reflection can improve their practice. A case study example is used to demonstrate how mentors might support nurses in incorporating reflection into their practice.

Patients are often anxious about planned medical interventions, and those experiencing anxiety are less likely to have the confidence to collaborate with healthcare professionals on their plan of care, and make decisions about consent. They may also find it challenging to follow rehabilitation guidelines, which can affect their long-term recovery. As part of their professional duty, nurses are required to recognise when people are anxious or in distress and respond compassionately, and while acquiring valid consent for any planned medical intervention requires the nurse to explain any risks, they should also attempt to reassure patients. The anxiety that precedes a planned medical intervention has been described as state anxiety; this refers to feelings of discomfort and uncertainty that accompany a situation such as an operation or a diagnostic procedure. Nurses can attempt to reduce any anxiety that patients experience by explaining the planned medical intervention and providing accurate information at the optimum time. This article outlines some of the coping theories that nurses…

In 2014, an innovative, three-tiered foundation preceptorship programme for newly qualified nurses was developed in Oxford University Hospitals NHS Foundation Trust. The programme was to be mandatory for newly qualified nurses commencing Band 5 posts in the trust, and has a structured curriculum that integrates skills development, preceptorship and clinical supervision. Aim To evaluate the Oxford University Hospitals NHS Foundation Trust foundation preceptorship programme for newly qualified nurses commencing Band 5 posts in the trust. Method Data were collected through questionnaires and focus groups with newly qualified nurses and nurse managers in the trust. Findings Respondents indicated the foundation preceptorship programme had positive value and improved the experience of newly qualified nurses during their first year of clinical practice. Newly qualified nurses wished to regularly reflect with experienced nurses and obtain feedback on their practice from clinical experts to develop their clinical skills. A professionally-regulated agreed percentage of preceptor-preceptee…

Communication is an essential aspect of life, yet it can be taken for granted. Its centrality to being in the world and in professional practice often becomes evident when nurses and older adults encounter communication difficulties. The factors that can affect nurses' communication with older adults relate to the older adult, the nurse, sociocultural considerations and the environment, and the interactions between these factors. In adopting a person-centred approach to communicating with older adults, it is necessary to get to know the person as an individual and ensure communication meets their needs and abilities. Effective communication is essential in nursing practice and requires professional competence and engagement. This article can be used by nurses to support effective communication with older adults across the continuum of care.

A new report on chronic obstructive pulmonary disease by the British Lung Foundation criticises the lack of progress in tackling lung disease.

The transfer of patients from the intensive care unit (ICU) to a general ward can present several challenges for nurses. Such patients are at high risk of adverse outcomes, including readmission to the ICU, and increased nosocomial infections and mortality, with a resultant increase in hospital costs. This article explores the challenges of transferring patients from the ICU and uses evidence to examine ways to address them to ensure optimal care for a complex patient group. Transfer time, factors affecting general ward care, handover processes, recognition of deterioration and education, intensive care outreach, and the psychological factors affecting these patients are examined.

Telehealth is a recent concept in hypertension management, and involves using electronic technology to monitor patients' vital signs, such as blood pressure, in their homes. This article presents the findings of a literature review that explored the issues associated with implementing telehealth in the primary care setting. It outlines the challenges associated with telehealth, as well as the potential benefits in terms of improving hypertension management. Aim To explore the usefulness of, and evidence for, telehealth in the management of hypertension in the primary care setting. Method The population, intervention, comparison and outcome (PICO) tool was used to define the research question for the literature review, which was: 'Do adults with hypertension being monitored with telehealth/telemonitoring have a higher quality of life and improved management compared with standard care?' Findings The literature review identified that a common challenge in implementing telehealth in patients with hypertension was the requirement to improve patients' compliance with and participation in…

There is a range of risk factors that can lead to peripheral intravenous (IV) cannula failure, and several failed cannulation attempts can result in the patient experiencing increased pain, discomfort and delays in receiving IV therapy. The Vessel Health and Preservation (VHP) framework is a tool that can be used to improve clinical decision-making and the patient experience in relation to vascular access and IV therapy. Use of the VHP framework can ensure the right vein and right vascular access device (VAD) is selected at the right time for each patient. This article describes how healthcare practitioners can use the VHP framework to support and enhance vein assessment and VAD selection. It outlines the various types of VAD available, focusing on short-term peripheral IV cannulae, which are the most commonly used devices. It also explores the potential benefits of implementing the VHP framework in clinical areas.

Polycystic ovary syndrome (PCOS) is an incurable disorder that is associated with ovarian dysfunction. It affects millions of women in the UK. The signs and symptoms of PCOS include ovarian cysts, acne and excess hair growth (hirsutism), and can have a negative effect on the self-esteem of women with the condition. PCOS is also a potential cause of reduced fertility. This article uses a case study approach to discuss the pathophysiology, signs and symptoms, and diagnosis of PCOS, as well as complications, treatment and psychosocial implications of the condition.

Rationale and key points This article addresses preoperative care of patients for whom surgery to form a stoma is planned. It discusses conditions that may result in the formation of a stoma, explores preoperative investigations that may be necessary before surgery, outlines various types of stoma and stoma appliances, and offers guidance on preparing patients to manage this lifestyle transition. The stoma specialist nurse has the principal role in providing patient education. However, nurses in all practice settings may encounter patients who are due to undergo surgery to form a stoma, and can provide preoperative support and education. » Nurses require an understanding of the enhanced recovery pathway to support patients who are due to undergo surgery to form a stoma. » Optimal siting of the stoma is essential to enable patient self-care. » Effective preoperative care of patients undergoing planned surgery to form a stoma enables patients to gain independence quickly following stoma formation. » Enabling patients to self-care for their stoma is associated with improved quality of…

Wernicke-Korsakoff syndrome is a potentially debilitating and fatal condition that is caused by thiamine (vitamin B1) deficiency in the brain. It can be treated effectively or prevented completely; however, the condition is often undiagnosed and inadequately managed. Wernicke-Korsakoff syndrome is commonly considered to be specific to individuals who misuse alcohol; however, there are many other predisposing factors and causes associated with the condition. This article aims to raise awareness of Wernicke-Korsakoff syndrome, to enable nurses in all practice settings to recognise the signs, symptoms and risk factors associated with the condition and be informed about available treatments. Increased awareness aims to improve early diagnosis of the condition, enabling effective treatment and improving patients' symptoms, such as cognitive impairment.

Patients require access to various healthcare professionals to manage their healthcare needs. Most nurses work in a team established to provide optimum care for patients. This article explores the stages necessary to develop an effective healthcare team and identifies the attributes required for effective teamwork. These include: effective leadership, a shared mental approach (a common understanding of the roles and responsibilities of all members of the team), respect among team members and shared training. Scenarios involving a rheumatology team that includes the author are used to demonstrate how effective teams can be established in practice, and the benefits of effective healthcare teams to staff well-being and patient care.

Patients with chronic oedema and 'wet legs' are frequently seen in the community setting, with research indicating that more than half of community nurses' caseloads are patients with chronic oedema. However, a lack of nurse education and standardised care pathways for this condition has been identified. In June 2016, the Welsh Government supported the development of the On the Ground Education Project (OGEP), which aimed to raise community nurses' awareness and recognition of chronic oedema and wet legs, to improve the management of these conditions, and to support the efficient use of community nurses' time and resources. AIM: To investigate the potential economic benefits of the OGEP and its effects on patients' quality of life. METHOD: The OGEP was implemented between June 2016 and March 2017. During this time, 725 patients were assessed and chronic oedema was diagnosed in 426 (59%) of them. Of these, 100 patients were purposively recruited and 97 completed the pilot service evaluation. Data were collected observationally before and after the OGEP was implemented. Baseline…

Aim To increase awareness of the needs of patients with dementia in the trauma and orthopaedics unit of one acute hospital, and to collaborate with staff on the unit to identify ways of improving the care experienced by these patients and their families. Method An action research approach was used and three action research cycles were completed. Data were obtained retrospectively for 20 patients with dementia who were admitted to the unit for treatment. Deficiencies in the care of these patients were identified and related to communication, pain management and the recognition of delirium. In response, a dementia toolkit was developed by nurses and implemented on the unit to improve the care of patients with dementia. Findings Comparison of pre-implementation and post-implementation audit results indicated a significant improvement in all aspects of care for patients with dementia in the trauma and orthopaedics unit, as a result of the implementation of the dementia toolkit. Education and training were provided to staff on the ward to ensure the toolkit was implemented appropriately.…

This book is about every one of us, who we are and how we came to be. It is also a collective story of our species. The author is a talented science writer and you can feel the excitement coming through the text as he unravels the history of mankind.

There are several reasons why mechanical ventilation - the use of an artificial device to assist a patient to breathe - may be initiated, for example to enable general anaesthesia for patients undergoing surgery, and for those with a compromised airway or respiratory failure. It is important that critical care nurses have the skills and knowledge to care for patients who are undergoing weaning from mechanical ventilation. This is to ensure that patients are weaned safely and as soon as possible, to improve their outcomes and avoid an increase in patient mortality and morbidity through complications that can arise such as airway trauma and ventilator-associated pneumonia. Furthermore, there are resource and cost implications of patients not being weaned as soon as possible.

This book has a philosophical approach to end of life care rather than a nursing focus.

AIM: To explore the views, perceptions and experiences of older people with dementia of person-centred care, and how these might affect practice. METHOD: This was a qualitative literature review. A literature search was undertaken, which involved searching databases, reference-checking, and hand-searching of academic journals, national policies and nursing organisation websites, from 1999 to 2017. The author undertook data extraction and a meta-synthesis independently to identify themes from the articles. FINDINGS: A total of 12 articles were included in the literature review. Few articles pertaining to the views, perceptions and experiences of older people with dementia receiving person-centred care were identified, with most of the literature based in settings outside the UK. Four main themes were identified: shared decision-making; promoting individuality, independence and autonomy; person-centred care; and communication and giving voice to people with dementia. CONCLUSION: Knowledge of the lived experience of people with dementia is important to ensure they receive care that…

The incidence of type 2 diabetes is rising alongside increasing rates of obesity, in part because of people's lifestyle behaviours, such as an unhealthy diet and a lack of physical activity. The pathophysiological changes caused by central obesity can lead to metabolic syndrome and type 2 diabetes, both of which increase the risk of developing cardiovascular disease. Managing obesity has been identified as the optimum strategy for preventing the development of type 2 diabetes and cardiovascular complications. This article discusses the role of healthcare professionals in educating patients and the public about the causes and effects of obesity and diabetes, and outlines the evidence-based strategies that can enable healthcare professionals to reduce patients' risk of developing these conditions. The article examines some of the strategies that healthcare professionals can implement to minimise the risk of further complications for patients who have been diagnosed with type 2 diabetes.

Aim The aim of this literature review was to explore the development of the role of specialist ophthalmic nurses in delivering ranibizumab intravitreal injections to patients with wet age-related macular degeneration (AMD), and to evaluate their contribution to reducing capacity pressures in medical retina services, while maintaining safe and effective standards of care. Method A systematic literature search was undertaken to identify relevant articles published between January 2000 and June 2015. A search of electronic databases was undertaken, and selected relevant journals were searched manually. A free text and subject heading search strategy was conducted, in which the abstracts of publications identified for review were assessed for relevance. Inclusion criteria were: nurses delivering ranibizumab intravitreal treatment; studies performed in the UK and other countries; and patients with AMD, diabetic macular oedema or central retinal vein occlusion receiving nurse-led ranibizumab (Lucentis) intravitreal treatment. Findings Five studies were identified from the literature…

What was the nature of the CPD activity, practice-related feedback and/or event and/or experience in your practice? The CPD article defined the different types of adverse drug reactions (ADRs) and explored when they can occur. It emphasised the importance of being knowledgeable about medications, considering patient safety when patients are taking medications, being alert to the possibility of ADRs, and recognising and responding to suspected ADRs.

Essential facts The UK population is ageing rapidly, with the number of people aged 65 or above rising by almost half in the past three decades. By 2035, it is estimated that almost one in four people will be aged 65 or more. The Mental Health Foundation says five main factors affect the mental health and well-being of older people: discrimination, participating in meaningful activities, relationships, physical health and poverty.

Nurses, midwives and nursing students are legally responsible for their actions. This article discusses the legal standard of care required in relation to nursing and midwifery practice and nurses' professional standards and code of conduct. It examines how courts in the UK determine if nurses have met their duty of care and how nurses must ensure they maintain competence to provide safe care. It examines why organisational knowing - understanding the organisation in which one is employed; its people, values and how it works - is important for all nurses, regardless of their level in the organisation. It also discusses workplace incivility and its adverse effects on nurses, patient care and healthcare organisations. The article explains that if nurses are uncertain why they are doing something, they should investigate this further, because the law expects nurses to be able to justify their actions, or failure to act.

Clinical practice educators (CPEs) aim to provide support and education to clinical staff and students to improve their professional practice. This article examines the work of a team of six CPEs, who were employed by one large integrated mental health and community health NHS foundation trust that incorporates both mental and physical health services. It explores how the role of the CPE can have positive effects on clinical settings, and can improve the provision of evidence-based care for clinical staff and students on placement in the trust. The article provides examples of the work undertaken by the CPE team and considers the plans for its future development.

Rationale and key points This article discusses post-discharge care for patients following stoma formation. While the patient is taught the practicalities of managing the stoma appliance in hospital, this learning should be integrated into their daily life following discharge from hospital. Nurses are required to consider and address any issues that might affect the patient in the long term. These include changes in body image, adapting to having a stoma, preventing or treating complications associated with a stoma, and long-term follow-up. » Most patients manage successfully with their stoma following a period of adaptation. » Follow-up for patients with a stoma can occur over the telephone and/or face-to-face in the patient's home or in the clinic. » There are several support groups in the UK that can be accessed by patients with a stoma. » Patients should seek advice and assistance from a stoma specialist nurse if any issues related to the stoma arise, such as leakage or sore peristomal skin.

Meal-ordering systems are an important aspect of hospital food services, informing patients of the available menu choices and supporting the collection of meal orders. Although several meal-ordering systems are used in hospitals, there has been limited research into patients' experience of these systems. Aim To explore patients' experience of written, spoken and visual menus in the acute hospital setting. Method Ten patients from a tertiary teaching hospital were asked to evaluate three meal-ordering systems, which were randomly allocated to them. Semi-structured interviews were conducted to gain an understanding of the patients' experience of meal-ordering systems. Findings The type and quality of food provided, the importance of information, the characteristics of the menu monitor, and the meal-ordering process were identified as important factors in enhancing patient satisfaction with hospital food services, regardless of the meal-ordering system used. Conclusion Patients place a high value on the quality of hospital food, and hospital food service departments should engage with…

Healthcare has been slower than many other sectors to embrace new technologies, with some nursing staff feeling anxious, fearful and sceptical about the digital revolution.

Vein location and assessment are essential to improve the success rates for vascular access. However, problems remain with first attempt success rates for peripheral cannulation and locating difficult veins. Practitioners may not be aware of developments in technology and aids to assist in the location and assessment of veins to achieve vascular access. This article provides an overview of two vein location aids that can be used to locate difficult veins: the IV-eye vein imager and the Vacuderm tourniquet. It discusses the patient factors that can increase the difficulty of vein assessment and location, and emphasises the importance of vessel health and preservation, and vein palpation. Practitioners should be experienced and skilled in the assessment of veins, and they are encouraged to revisit how they locate and assess veins.

Chronic heart failure is a common and complex clinical syndrome that results from impaired cardiac relaxation or contraction. There have been considerable advances in the management of chronic heart failure; however, the mortality rate remains high. Patients with chronic heart failure may experience multiple debilitating symptoms, such as fatigue, pain, and peripheral oedema. However, breathlessness may be considered the most debilitating symptom. The management of chronic heart failure aims to improve the patient's quality of life by reducing symptoms and supporting the patient to manage their condition. Treatment of patients with chronic heart failure may involve a combination of pharmacological therapy, device implantation and cardiac rehabilitation. This is the second of two articles on chronic heart failure. Part 1 discussed the pathophysiology of chronic heart failure, its causes, assessment, signs and symptoms. Part 2 outlines the treatment and management of patients with the condition, including pharmacological strategies, device implantation, lifestyle modification, cardiac…

Each chapter of this book is built around what the authors call the total quality framework which is based on credibility, analysability, transparency and usefulness.

Author Helga Rohra is living with a diagnosis of young-onset Lewy body dementia. Rohra writes about the experience of discovering something wasn’t right, the fear and apprehension she encountered prior to diagnosis and the difficulties after diagnosis, as well as the impact it had on her family and lifestyle.

A directed living donor is a healthy individual who donates an organ to a specific person. The number of living donor kidney transplantations in the UK has been increasing; however, living donation and the experience of kidney transplant recipients remain under-researched areas that are relevant to the provision of effective person-centred transplant care. AIM: To understand the experience of directed living donor kidney transplant recipients to inform future nursing practice in the field. METHOD: A qualitative literature review was undertaken. A search strategy was used to locate relevant articles in five electronic databases, and critical analysis was used to determine which articles should be included in the literature review. FINDINGS: Seven articles were identified for inclusion in the literature review. Four themes were identified from these articles: pre-transplantation decision-making; psychological and emotional effects of transplantation; physical effects of transplantation and effect on home life; and the relationship with the donor and others. CONCLUSION: The…

Acute coronary syndrome is a serious condition that requires urgent assessment and management. This article outlines the nature of the condition, and discusses its underlying pathophysiology. It discusses three types of acute coronary syndrome: unstable angina, ST elevation myocardial infarction and non-ST elevation myocardial infarction. Research and guidelines are used to guide the reader through approaches to initial nursing assessment and the immediate management of patients with suspected acute coronary syndrome.

The nursing profession prides itself on its ability to reflect on practice to improve patient care. Yet we have seen a number of high-profile cases in recent years where care has not been provided at the level you would expect.

This article provides an overview of tissue viability issues related to the care of patients with cancer who are approaching the end of life. Altered physiology as a result of various factors, including nutrition, medication and radiotherapy, is identified. The article discusses the presentation and treatment of cutaneous radiation injury, malignant wounds, pressure ulcers and Skin Changes At Life's End (SCALE), an acronym used to describe a set of clinical phenomena associated with skin changes in patients approaching the end of life, and makes recommendations for practice.

Nurses have many roles and responsibilities in relation to cardiopulmonary resuscitation (CPR), including: recognising that a patient is deteriorating; recognising cardiac arrest and commencing CPR while waiting for the resuscitation team to arrive; ensuring the contents of the resuscitation trolley are present, in date and in full working order; and completing documentation for the National Cardiac Arrest Audit in participating healthcare organisations. Many patient safety incidents involving resuscitation trolley equipment and resuscitation have been reported, and predominantly relate to a lack of equipment, missing equipment and inadequately stocked trolleys. This article provides an overview of the contents of the standard resuscitation trolley and a rationale for the use of each item. It discusses the importance of checking and restocking the resuscitation trolley, as well as the documentation of CPR efforts.

The onset of type 2 diabetes mellitus is associated with various modifiable and non-modifiable risk factors, including lifestyle factors. Obesity is the principal lifestyle factor associated with an increased risk of developing type 2 diabetes. It is essential for nurses to have an understanding of the pathophysiology associated with factors that contribute to an increased risk of type 2 diabetes, particularly those associated with obesity. Nurses who have an understanding of the interaction between obesity and the onset of type 2 diabetes are better equipped to discuss the importance of weight loss and other necessary lifestyle adjustments in the prevention and management of obesity and diabetes associated with obesity, to implement evidence-based practice and to support patients to manage their health effectively.

Leadership is about influencing others to achieve a common goal. However, this role can be an emotional burden due to the challenges, constant changes and relationships with others.

Rationale and key points This article provides information on monitoring a patient's peak expiratory flow rate. It explains the rationale for measuring the peak expiratory flow rate, provides guidance for nurses to undertake this investigation and offers advice on how to instruct patients in the use of this technique. » Measuring the peak expiratory flow rate is an inexpensive, straightforward and useful clinical investigation that enables fluctuations in the patient's respiratory effort to be monitored over time. » The peak expiratory flow rate is used for the diagnosis, monitoring and assessment of the severity of respiratory compromise, particularly in patients with asthma. » The nurse can enable significant improvements in patient care by providing patient education on the correct technique, and by accurate assessment and recording of the peak expiratory flow rate. » The nurse should advise the patient on the action required if variation between readings occurs, where the patient is required to monitor their condition at home.

Effective management of the deteriorating patient requires early recognition of the signs of deterioration, timely review and appropriate interventions. However, this does not always occur. Errors in the recognition and management of a deteriorating patient are rarely related to a single factor; rather they are a complex interaction of system and human factors. This article presents a case study focusing on understanding the factors that led to errors resulting in the death of a patient. Understanding the complex interaction of system and human factors enables the identification of strategies that could be used to decrease the likelihood of a similar incident occurring.

The prevalence of nausea and vomiting in patients with advanced cancer varies, but it generally increases towards the end of life. Nausea and vomiting can be distressing and debilitating for patients, and can affect quality of life significantly. This article discusses the assessment of nausea and vomiting, current understanding of the emetic pathways, and pharmacological management of nausea and vomiting in patients with advanced cancer at the end of life.

Yet a Nursing Standard investigation also reveals that many universities do not monitor the reasons why students look for help

Distress is commonly experienced by those caring for someone with dementia, and can occur whether the carer is living with a person with dementia, or supporting a person with dementia who lives alone to maintain their independence. It is essential for health and social care professionals to support family carers to balance their needs with those of the person they care for. However, this might be challenging because many influencing factors can affect these needs, and identifying the needs of the family carer and balancing them with the needs of the person with dementia is often complex. This article uses a case study to explore the role of one Admiral Nurse (KG) in supporting the main family carer of a person with dementia, and the model of reflection used by the Admiral Nurse to undertake critical thinking and analysis in relation to their role.

This article outlines how care home staff can support safe sexual and intimate expression among older people. Older people may continue to engage in sexual and intimate acts in a residential setting; however, because of the stigma associated with sexual and intimate expression among older people, many care homes prohibit such intimacy. It is essential that care home staff adopt a person-centred approach to care that recognises the importance of maintaining the dignity and autonomy of residents while considering the potential for harm associated with sexual and intimate expression. This article discusses the issues associated with managing sexual and intimate expression among older people in care homes and uses a case study example to assist care homes in developing sexual health policies.

The prevalence of obesity is higher among nurses than in any other group of healthcare professionals. Obesity is an issue for the nursing workforce because of its effects on work-related sickness absence and productivity, through related conditions such as arthritis and diabetes. Aim To investigate the attitudes, motivations and behaviours of, and the uptake of workplace health initiatives by, nurses who are obese. Method Nurses who are or were obese and who practised in England were recruited at the Royal College of Nursing congress in Glasgow in June 2016. Participants were asked to complete a short survey on their attitudes to weight, and the effectiveness and availability of workplace health initiatives. Results A total of 196 nurses were surveyed, of which 95% (n=186) wanted to lose weight and 94% (n=185) thought that it was an issue for nurses to be obese, particularly because being obese made it challenging to discuss weight-loss and healthy lifestyles with patients. Participants expressed an interest in undertaking workplace health initiatives if these could be accommodated…

Essential facts The UK's chief medical officers (CMOs) have published new advice on physical exercise for pregnant women in the form of an infographic. It is aimed at providing midwives, nurses, GPs, obstetricians and gynaecologists, as well as leisure sector professionals, with the latest evidence on physical activity during pregnancy.

Rationale and key points Nasogastric tube feeding is a method of enteral feeding commonly administered by nurses. Feed can be administered either using a volumetric enteral feeding pump (pump feeding) or via an enteral syringe (bolus feeding). This article explains how nurses can safely undertake these two methods of nasogastric tube feed administration at the patient's bedside. » Nasogastric tube feeding can be used to provide some or all of the patient's nutrition, fluid or medication. » Nurses should be equipped with the relevant knowledge to flush a nasogastric tube before the administration of feed or medication; set up and administer an enteral feed via a volumetric enteral feeding pump; and set up and administer a feed using a bolus method. » The position of the distal tip of the nasogastric tube must be confirmed as sitting in the patient's stomach before the tube is used to administer enteral feed, fluid or medication. 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…

Myasthenia gravis is a rare long-term neurological condition that is characterised by fluctuating skeletal muscle weakness and fatigue, as well as respiratory difficulties. It is both an acquired autoimmune disease and a chronic neuromuscular disorder. Because of its rarity, myasthenia gravis is relatively unknown and may be unfamiliar to many nurses. While there are various types of myasthenia, this article focuses on myasthenia gravis, exploring its symptoms, diagnosis and treatment, and examining the nurse's role in managing the condition. The symptoms of myasthenic crisis and cholinergic crisis are also explained, and the experience of patients with myasthenia gravis in hospital and community settings is illustrated using case studies.

'Globalisation' is the term used to describe the increasing economic and social interdependence between countries. Shifting patterns of health and disease are associated with globalisation. Global health refers to a health issue that is not contained geographically and that single countries cannot address alone. In response to globalisation and global health issues, nurses practise in new and emerging transnational contexts. Therefore, it is important that nurses respond proactively to these changes and understand the effects of globalisation on health worldwide. This article aims to increase nurses' knowledge of, and confidence in, this important area of nursing practice.

Essential facts A new tool has been developed to help nurses discuss with a patient the care they wish to receive in an emergency, including cardiopulmonary resuscitation (CPR).

Chronic pain is experienced by between one third and one half of the UK population. Nurses should ensure that patients' pain is assessed and managed when they present to hospital, including pre-existing chronic pain and acute pain as a result of trauma or surgical interventions. Acute pain that is inadequately managed may result in chronic pain, impeding the patient's return to normal function and daily activities. Depression and increasing age affect the likelihood of patients experiencing chronic pain. Nurses should be familiar with the pain assessment tools available for use with older people and be aware of the potential issues of polypharmacy and altered sensitivity to medication in older people. Nurses can manage patients' pre-existing chronic pain, or likely post-operative pain, by working collaboratively with patients, their carers or families where appropriate, and the multidisciplinary team. For patients undergoing surgery, this cooperation should begin preoperatively and continue into the post-operative period.

Many healthcare services that were once only available in acute settings are now common in the community. Intravenous (IV) therapy is increasingly available as a community service. Given the option, most patients would choose to receive their treatment in a community setting, rather than in hospital. This article describes several outpatient parenteral antimicrobial therapy services, including their advantages and disadvantages. It explores the ways one community NHS trust has developed its community IV therapy service over the past ten years and examines issues pertinent to effective service delivery.

Essential facts [Figure: see text] Learning disabilities affect about 1.5 million people in the UK. The prevalence of mental health problems is considerably higher for those with learning disabilities than for the general population; estimates suggest 30-50% of adults are affected.

The Florence Nightingale Foundation (FNF) is a charity that awards scholarships in leadership, travel and research to nurses, midwives and other healthcare professionals to promote excellence in practice. The FNF offers mentoring support to scholars, and provides support with career development and writing articles for publication, in addition to the financial award. The leadership scholarships are bespoke: leadership scholars can access a range of development opportunities that are specially commissioned for them, and select their programme of study and experiences, based on their individual needs. All scholarships provide opportunities to represent the FNF and to meet other scholars at the FNF annual conference. This article provides an overview of the FNF scholarships, based on the findings of two evaluations that demonstrated the value of these scholarships in improving services for patients and carers, as well as enhancing the careers of individual scholars.