The 50 most-cited articles in Nursing Standard, 2018

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: Smith SM, Fahey T, Smucny J et al (2017) Antibiotics for acute bronchitis. Cochrane Database of Systematic Reviews. Issue 6. CD000245. doi: 10.1002/14651858.CD000245.pub4.

Healthcare-associated infections and antimicrobial resistance are significant threats to public health. As resistant organisms continue to emerge and evolve, and antimicrobial agents become less effective, infection prevention and control remains a vital aspect of maintaining public health, particularly among vulnerable patient groups such as older people and young children. Because of the increasing complexity of healthcare treatments and interventions, patients are becoming increasingly susceptible to healthcare-associated infections and resistant organisms. This article outlines some of the challenges that nurses may experience in ensuring effective infection prevention and control, and how these can be addressed.

Key issues about the economic crisis in Europe and how sustainable polices can build resilient health systems are presented here in a way accessible to lay readers.

Discussions about the sustainability of the healthcare workforce have placed considerable emphasis on improving the resilience of healthcare professionals. However, when discussed in relation to individuals, the contextual aspects of resilience are often lost. This means that individuals are burdened with the responsibility of increasing their resilience so that they can better manage the challenges they experience, rather than examining the external and environmental factors that can affect resilience. This article explores the concept of resilience and suggests ways in which resilience can be developed by individuals and in collaboration with others, resulting in resilient healthcare teams and organisations capable of supporting individuals effectively. It aims to assist healthcare professionals to develop their resilience, while also improving their understanding of the complex factors that can affect their coping capacity, as well as how community influences the resilience of everyone.

In the UK and internationally, the nursing profession is continuing to advance and innovate its roles and functions. One area in which this is particularly notable is nurse prescribing. The UK has the most extended nurse prescribing rights in the world, with significant advances in this field over the past two decades. This article reflects on this development, what has been learned and the challenges that remain in relation to nurse prescribing and meeting healthcare service needs.

The term health promotion has been used in healthcare for several years. However, the meaning of this term is debated, particularly in nursing. Some nurses might believe that, because they are healthcare practitioners working in healthcare services, that they are 'by default' automatically involved in health promotion activities; however, this is often not the case. Instead, they are more likely to be engaging in health education activities; that is, simply providing individuals with health-related information, rather than seeking to empower individuals, families, groups and communities. While health education is related to health promotion, these terms are not interchangeable, since health education is a component of health promotion. This article clarifies these concepts and describes approaches to illness prevention and promoting well-being that nurses can use in their practice with patients across the lifespan.

Chronic wounds are defined as those that have failed to heal after three months. There are various intrinsic and extrinsic factors that may result in the development of chronic wounds, including comorbidities such as diabetes mellitus and venous insufficiency, and lifestyle factors such as obesity, alcohol consumption and smoking. Chronic wounds represent a significant burden on healthcare resources and can have a negative effect on patients' quality of life. This article discusses the assessment and treatment of non-healing chronic wounds. It examines the normal wound-healing process and the management of chronic wounds, including advanced interventions such as electrical stimulation therapy, negative pressure wound therapy and various dressings. This article does not focus on specific wound types; instead, it provides an overview of the factors that can lead to the development of chronic wounds and how these wounds can be managed in clinical practice.

Partnership working with service users and carers is an integral aspect of healthcare practice and education. Increasingly complex healthcare environments, alongside changes in higher education, have led to the development of innovative learning strategies, resulting in opportunities for service users to participate in nurse education. This article describes the planning, implementation and evaluation of a co-facilitation approach to learning, in which service users and carers worked alongside lecturers to facilitate small seminar group activities with first-year undergraduate nursing students. AIM: To evaluate the effects of a co-facilitation approach on nursing students' classroom learning. In this approach, service users and carers co-facilitated small seminar group activities with lecturers. METHOD: The co-facilitation approach was introduced concurrently in 14 groups of first-year nursing students across adult, child, mental health and learning disabilities fields of nursing in one higher education institution. The approach was evaluated using a questionnaire comprised of…

The nurses who devised a spiritual care model for acute settings explain how in works and why it can save you time as well as enhancing your person-centred practice

There have been several changes to healthcare services in the UK over recent years, with rising NHS costs and increasing demands on healthcare professionals to deliver high-quality care. Simultaneously, public inquiries have identified suboptimal leadership throughout the NHS, which has been linked to a lack of clear leadership across the healthcare professions. In nursing, the role of the advanced nurse practitioner is regarded as a solution to this leadership challenge. This article examines the background to the development of the advanced nurse practitioner role. It also explores the various factors that may affect nurse leadership and the role of the advanced nurse practitioner, including professional identity, gender, nursing's strategic influence, clinical outcomes, and recruitment and retention. The article concludes that while advanced nurse practitioners can positively influence clinical outcomes and cost efficiency, they must also be adequately prepared to undertake a leadership role.

Stroke is a leading cause of death and adult disability in the UK. A stroke can have significant negative effects on the lives of patients and their families and carers. While improved stroke management has contributed to a reduction in mortality and improved outcomes following rehabilitation, the incidence of stroke continues to rise in the UK, partly because of the ageing population. Stroke rehabilitation involves a multidisciplinary approach, with nurses performing a central role. This article describes the risk factors and types of stroke, the main areas of stroke rehabilitation and the role of the nurse. It emphasises that providing support to families and carers is a particularly important element of caring for people who have experienced a stroke.

The use of interprofessional simulation training to enhance nursing students' performance of technical and non-technical clinical skills is becoming increasingly common. Simulation training can involve the use of role play, virtual reality or patient simulator manikins to replicate clinical scenarios and assess the nursing student's ability to, for example, undertake clinical observations or work as part of a team. Simulation training enables nursing students to practise clinical skills in a safe environment. Effective simulation training requires extensive preparation, and debriefing is necessary following a simulated training session to review any positive or negative aspects of the learning experience. This article discusses a high-fidelity simulated training session that was used to assess a group of third-year nursing students and foundation level 1 medical students. This involved the use of a patient simulator manikin in a scenario that required the collaborative management of a deteriorating patient.

Intimate partner violence (IPV) is a significant issue in health and social care. Nurses may encounter individuals in healthcare settings who experience IPV, and they have an important role in supporting these people by providing person-centred care. It is important that nurses understand the complex issues involved in IPV, including those related to its presentation and effects on physical and psychological health. Nurses should also be aware of factors such as lack of knowledge among healthcare professionals and the challenge for some individuals of disclosing IPV, which can affect nurses' ability to identify and support those who experience IPV.

This article aims to define organisational culture and explain why it is important to patients, carers and those working in healthcare environments. Organisational culture is not a new concept and the literature on the subject is well-established. However, because of the changing dynamics of the NHS, there has been a shift away from 'what' the NHS stands for, often relating to its history and rituals, to 'who' it functions for, including how healthcare professionals such as nurses can develop and drive the organisational culture. The article seeks to assist nurses in understanding the role of organisational culture, as well as implementing its main principles in the workplace.

Clinical reasoning and effective communication are fundamental skills for nurses working at an advanced level of practice. Clinical reasoning processes are designed to enable the nurse to establish the nature of a patient's presenting condition before focusing on problem-solving techniques that can guide the appropriate course of treatment. This article explores the concept of clinical reasoning in advanced practice and outlines the various approaches that nurses can take. It also details the role of effective communication in advanced practice. A case study is used to demonstrate the specific stages involved in clinical reasoning.

Antimicrobial resistance is a significant public health issue and a major threat to global health. The solutions are multifactorial, and include: a reduction in the unnecessary use of antibiotics; public health campaigns; the use of systems approaches by healthcare organisations; and involving the knowledge and responsibilities of individual nurses. This article examines the challenge of antimicrobial resistance and explores the concept of antimicrobial stewardship in addressing this issue. It also discusses how nurses can contribute to a systems approach in primary and secondary care to support antimicrobial stewardship initiatives.

Advanced nurse practitioners, and nurses aspiring to this role, are required to understand how to communicate effectively and on a collaborative basis with patients and carers during consultations, with the aim of enhancing patient outcomes such as improved patient satisfaction, ability to self-manage healthcare needs and adherence to care plans. This article explores collaborative communication in consultations and how best to achieve this, using the author's doctoral observational research based on the findings of a mixed methods observational study of communication in advanced clinical practice patient consultations.

Sleep disturbance is a significant issue for patients in intensive care units (ICUs), which can affect their health and recovery from illness. Therefore, it is important to consider ways to address sleep disturbance in these settings. One strategy that has been suggested is the use of 'quiet time' interventions, which involve a defined period where there is a reduction in controllable light and sound, and where interruptions at the patient's bedside are minimised. AIM: To determine the effectiveness of quiet time interventions in improving patients' sleep quality in ICUs; to investigate other potential clinical benefits of quiet time interventions; and to consider the effect of incorporating open visitation when implementing quiet time interventions. METHOD: The author conducted a literature review of qualitative and quantitative studies that investigated the effects of quiet time interventions as a primary intervention in adult ICUs, with sleep quality as the outcome. Three databases were searched electronically for articles that met the inclusion criteria, and narrative synthesis…

The menopause is a physiological event involving ovarian failure as a result of a loss of ovarian follicular activity, which leads to oestrogen deficiency, resulting in permanent cessation of menstruation and loss of reproductive function. Women undergoing the menopause are seen in a range of healthcare settings. It is important that all nurses, particularly those practising in primary care and women's health, have an understanding of the symptoms, treatment and long-term implications of the menopause on women's health and quality of life. This article outlines the symptoms of the menopause and the available treatments for these, including hormone replacement therapy, non-hormonal treatments and alternative therapies, and discusses how nurses can assist women undergoing the menopause to improve their health and quality of life during this often challenging time.

Patients exhibiting challenging behaviour, which includes any non-verbal, verbal or physical behaviour, is a significant issue in healthcare settings. Preventing such behaviour and the harm it can cause is important for healthcare organisations and individuals, and involves following a public health model comprised of three tiers: primary, secondary and tertiary prevention. Primary prevention aims to reduce the risk of challenging behaviour occurring in the first instance; secondary prevention involves reducing the risk associated with imminent challenging behaviour and its potential escalation; and tertiary prevention focuses on minimising the physical and emotional harm caused by challenging behaviours, during and after an event. De-escalation should be the first-line response to challenging behaviour, and healthcare staff should use a range of techniques - maintaining safety, self-regulation, effective communication, and assessment and actions - to reduce the incidence of challenging behaviour. In some situations, physical interventions may be required to protect the safety of…

Acute pancreatitis is a potentially life-threatening condition primarily associated with gallstones or prolonged and excessive alcohol intake. Although the initial triggers of the condition can vary, the resulting pathophysiology is broadly similar irrespective of the cause. This article explores the pathophysiology of the main causes of acute pancreatitis, and discusses nursing management of the condition in the acute setting and the long-term issues to consider. It also outlines the conservative management of the condition, which includes pain management, provision of fluids and nutritional care. In the management of acute pancreatitis, nursing care can often overlap with medical management, especially as the condition deteriorates. Therefore, it is important that nurses develop comprehensive knowledge of the management of acute pancreatitis.

Spinal cord injuries can result in significant physiological and psychological challenges for patients. Nurses have an important role in the rehabilitation of people with a spinal cord injury, as does the provision of peer support by people who are 'living well' after experiencing a spinal cord injury. AIM: To explore peer support and whether it can have an effective role in a multidisciplinary team approach to supporting a patient with a spinal cord injury. METHOD: This was an independent evaluation that used an online survey, a focus group and telephone interviews to elicit the views of respondents about the Spinal Injury Association (SIA) peer support service in England and Wales. There were four groups of respondents: people with a spinal cord injury; their family and friends; peer support officers; and nurse specialists and other healthcare practitioners. FINDINGS: It was identified that peer support officers were valued for their ability to provide a positive role model for people with a spinal cord injury. Healthcare practitioners involved in the care of people with a spinal…

Healthcare professionals continue to debate how to address the issues of suboptimal care, neglect and abuse in healthcare settings. One solution that is likely to achieve improvements in care is the widespread development of leadership skills in front-line nurses. The behaviour of front-line nurses is a major determinant of patients' healthcare experience and their perception of the quality of care they receive. Front-line leaders in healthcare settings such as wards, care homes and clinics are the people with the strongest and most immediate influence on staff behaviour. Therefore, nurses, ward managers and matrons are well-placed to improve organisational cultures and implement appropriate changes in their practice settings, if provided with appropriate support and training.

Homelessness is a complex and multidimensional issue often involving a combination of personal vulnerability, the limitations of social housing, and inadequacies in welfare support. Providing palliative and end-of-life care to people experiencing homelessness is challenging, both to individuals receiving care and nurses aiming to meet their complex needs. This article discusses what is understood by the concept of 'homelessness' and examines the barriers to accessing effective healthcare for people who are homeless and have life-limiting conditions. The authors review the research into end of life care for people experiencing homelessness and identify areas for further investigation, notably the lack of evidence regarding the end of life care priorities of these individuals. There is a focus on the availability of healthcare services for people who are homeless at the end of life, as well as the factors that should be considered if evidence-based healthcare services for this group of people are to be improved in the future.

Idiopathic Parkinson's disease (IPD) is a progressive neurodegenerative condition that causes various motor and non-motor symptoms and will often have life-changing effects for those with the condition, as well as for their family and carers. Nurses can make a significant difference to the lives of those affected by Parkinson's disease, whether in the acute setting, community setting or in care homes. This article explores the causes and progressive clinical pathway of IPD using an evidence-based approach. It emphasises the valuable role of the multidisciplinary team and of the nurse, in particular, in monitoring and improving the quality of life of those with the condition and their family and carers.

This article discusses the history, types and essential components of mechanical ventilation. It addresses the potential complications associated with mechanical ventilation and outlines the nurse's role in the recognition and prevention of such complications. This article provides an overview of some of the advances in mechanical ventilation and emphasises the importance of patient safety through an awareness of the associated risks and limiting or avoiding mechanical ventilation where possible.

National surveys of NHS patients in the UK have captured patient satisfaction with healthcare services for more than 15 years. Although this data has been valuable in tracking trends over time and for comparison between healthcare services, there have been issues associated with the concept of 'satisfaction' and the lack of clarity regarding the purpose of collecting such data. The shift in focus to capturing patient experience rather than patient satisfaction is regarded as a positive change, particularly for the purpose of improving healthcare services and patient care. This article defines patient experience and describes the various ways that this data can be collected, in particular using qualitative approaches.

Nurses require effective communication and interpersonal skills to provide optimal care, and to ensure that patients and their families and carers have a positive experience of receiving care. The new Nursing and Midwifery Council standards of proficiency for registered nurses, and for nurse education and training, published in May 2018, recognise that future nurses will be practising in increasingly complex roles and environments. This article identifies the essential communication skills that will be required by nurses in the future, summarising the characteristics of a modern nurse communicator. It also suggests various approaches that nurses can use to develop their communication skills.

Anticoagulant drugs are widely used in hospital and community settings. Anticoagulation is the first-line treatment for venous thromboembolism, and anticoagulant drugs have an important role in the treatment and prevention of blood clots. However, maintaining the equilibrium between clotting and bleeding can be challenging and anticoagulants have been identified as a class of drug associated with preventable patient harm. Direct oral anticoagulants (DOACs) have become the first-line treatment for many patients requiring an anticoagulant, removing the burden of frequent tests and the many food and drug interactions associated with vitamin K antagonists such as warfarin sodium. However, DOACs have increased the complexity of decision-making regarding treatment, which also increases the risk of drug errors. This article discusses the uses, modes of action and potential side effects of anticoagulants, to improve nurses' understanding and enable them to have an active role in limiting the risk of harm from these drugs.

Drug calculations for intravenous (IV) medicines and infusions are more complex than those for oral medicines. This article aims to assist nurses in evaluating and improving their competence in undertaking drug calculations for the IV route. Although nurses enter the professional register with an assessed level of medicines competence, nursing is a dynamic profession and competency can decrease over time, with literature demonstrating that nurses often have suboptimal drug calculation skills. This article enables nursing students to enhance their knowledge and understanding of IV drug calculations, and registered nurses to revisit this essential nursing skill. It is necessary to enhance nurses' mathematical skills and conceptual knowledge related to drug calculations to reduce the incidence of medication errors.

Nurses and the environment in which they work have an important role in patient safety and quality of care. Evidence demonstrates a link between lower nurse staffing levels and higher nurse workloads on hospital wards with adverse patient outcomes such as increased mortality, infections, falls and hospital stay, as well as adverse effects on staff well-being. Therefore, ensuring adequate numbers of nurses are on duty and available to care for patients safely has become a crucial task for nurses and hospital managers. In March 2016, Wales became the first country in Europe and one of only a small number of countries globally to legislate on nurse staffing levels. In April 2018, the Nurse Staffing Levels (Wales) Act 2016 was fully implemented in acute medical and surgical hospital wards. This article outlines the background to, and development of, nurse staffing approaches in Wales that preceded the introduction of this legislation. It aims to provide nurses with an understanding of the journey towards introducing legislation for nurse staffing levels and workforce planning in Wales,…

Urinary incontinence is a common and usually hidden issue that can affect women of all ages. It is often ignored by the patient because of their misconception that incontinence is an inevitable consequence of ageing and their low expectations of successful treatment. There are various types of incontinence, with symptoms that can significantly affect patients' quality of life. This article aims to enhance nurses' understanding of the types of urinary incontinence affecting women, associated risk factors and continence assessment, as well as the initial investigations and conservative treatments that can be instigated by general nurses. It also discusses some of the advanced treatments offered by specialist services. The article emphasises the importance of undertaking a holistic continence assessment to ensure appropriate continence care is provided, and how tailoring this care to the individual can improve adherence to treatment plans.

Nurses are required to maintain their fitness to practise through continuing professional development activities, and must demonstrate this by maintaining a portfolio of evidence that should be available for inspection every three years. The Nursing and Midwifery Council introduced revalidation in 2016 to demonstrate that nurses are practising safely and effectively. Nurses, however, are busy healthcare professionals and, as well as clinical practice, they have other demands on their time, such as providing evidence for annual appraisals. Admiral Nurses, specialist dementia nurses who support families living with dementia, also have a three-tier competency framework designed to demonstrate their acquired expertise and knowledge in dementia care. To support Admiral Nurses in managing these activities, the charity Dementia UK gave them access to the PebblePad e-portfolio system. This article details the implementation and outcomes of this project.

This is an excellent resource for nursing staff wishing to understand qualitative research.

Nurses are increasingly using professional portfolios as a way to maintain evidence of their learning and reflection, and to demonstrate that they have met their professional requirements. A portfolio can assist nurses to store and manage their revalidation or reregistration documents in one place, so that these can be easily updated and produced when required, for example in performance reviews and job applications. All nurses are required to undertake continuing professional development activities to maintain, update and improve their knowledge and practice, and they can use their portfolio to document these activities. Creating and maintaining a portfolio can also enable nurses to identify their strengths and learning needs, and to develop a learning plan to address these needs.

Rationale and key pointsVenepuncture and obtaining accurate blood samples is an important procedure in healthcare, and can assist in the diagnosis, care and treatment of patients. This article outlines the procedure for undertaking venepuncture and obtaining venous blood samples. It emphasises the importance of undertaking a visual assessment of the patient’s skin and palpating the veins to identify a suitable site for venepuncture.»The optimal sites for venepuncture are the veins in the antecubital fossa – the cephalic, basilic and median cubital veins. A suitable vein will be ‘bouncy’ to the touch, have no pulse and refill when depressed.»Venepuncture can be undertaken using either a needle or a butterfly device with safety system, depending on which site is selected. The size of needle used will also depend on the venepuncture site.»Before undertaking the procedure, it is essential to check the blood sample request form for the samples required and the healthcare organisation’s policy for the order of draw.Reflective activity‘How to’ articles can help update your practice and…

Nurses have a central role in health education and promotion, particularly with regard to supporting individuals to optimise their nutritional intake and engage in healthy eating behaviours. However, high rates of obesity, unhealthy eating behaviours and low levels of physical activity have been found among nurses. Nursing is a challenging profession, and a high workload, a lack of resources and shift work may affect nurses' ability to adopt healthy lifestyles. Supporting nurses to improve aspects of their eating behaviours, such as the nutritional value, timing and frequency of meals, can have a positive effect on their health which, in turn, may enhance their ability to care for patients. Although there is much literature available on the benefits of healthy eating, there is a lack of practical guidance for nurses on how to enhance their nutritional intake. This article uses a case study to examine the occupational and personal factors that may affect nurses' ability to engage in healthy eating behaviours, and identifies how healthcare organisations and individual nurses can use a…

There has been an increase in the number of patients requiring surgery who also have complex medical needs. Factors such as being overweight, the presence of significant comorbidities and an ageing population increase the risks associated with surgical procedures for these individuals. As a result, nurses involved in assessing patients and providing preoperative care require knowledge and understanding of the latest evidence in this area to optimise patient care and outcomes following surgery. This article suggests that optimal outcomes can be achieved by preparing patients for surgery in a holistic manner. It also discusses the role of enhanced recovery after surgery (ERAS) programmes.

Hypoglycaemia is a potentially serious complication of diabetes mellitus in which an individual's blood glucose drops to dangerously low levels. This can cause signs and symptoms such as sweating, confusion and unusual behaviour and, if untreated, may lead to unconsciousness and death. Hypoglycaemia is a side effect of some treatments for diabetes, whereby injected insulin or oral medicines that stimulate insulin secretion cause an abnormally low blood glucose level. Nurses have an important role in educating and empowering patients and their families and carers to manage diabetes to prevent hypoglycaemia, and to initiate prompt treatment of this complication.

Working in partnership with patients to achieve optimal nutritional status, regardless of their underlying condition, is an important aspect of nursing care. This article examines malnutrition and diabetes mellitus, which are two common conditions that can have significant implications for patients' health and diet. It emphasises that, when managing patients with malnutrition or diabetes, nurses should undertake careful assessment of their nutritional requirements, tailoring interventions to the individual and involving family and carers where appropriate. It is also important for nurses to work with other members of the multidisciplinary team, notably dietitians, who can provide specialist dietary advice and support.

Faecal incontinence is a condition that can develop as a result of age, injury or long-term conditions, and may be associated with significant stigma for those affected. Symptoms of faecal incontinence include leakage of flatus and faeces, and the condition can affect people of any age, although it is most prevalent in older people. Faecal incontinence is a subject that might not be openly discussed by patients and healthcare professionals; therefore, it is important for nurses to be aware of its signs, symptoms, causes and risk factors, so that they can identify patients at high risk. This article provides an overview of faecal incontinence, exploring its causes, psychological effects for patients, and conservative and specialised management measures, as well as the nurse's role in providing treatment and support.

Health psychologist Angel Chater explains the techniques that can help nurses to connect with patients who seem ambivalent about accessing healthcare, even when they may have potentially serious conditions

Cardiac arrest is a traumatic event, both for patients and their family members. Traditionally, healthcare professionals have often been reluctant to offer family members the opportunity to witness cardiopulmonary resuscitation (CPR) attempts. However, professional bodies globally have begun to recommend the use of family-witnessed resuscitation (FWR) during CPR, identifying a range of potential benefits including supporting the patient, increasing family members' confidence in healthcare professionals and, in some cases, promoting acceptance of the patient's death. This article explores the benefits of, and barriers to, the implementation of FWR during CPR. Despite the perceived benefits of FWR identified by professional bodies, healthcare professionals, and patients and their families, the evidence indicates there is ongoing reluctance among some healthcare professionals to incorporate FWR in practice. Therefore, standardised global policies aimed at the multidisciplinary implementation of FWR are required. Additionally, multidisciplinary training and education in CPR should be…

Delirium is the most common neuropsychiatric disorder in patients with palliative and end of life care needs; therefore, providing effective care for patients, and their families, is a clinical priority for nurses. Delirium is characterised by a fluctuating state that affects an individual's attention, orientation, thinking, perception, memory, psychomotor behaviour, emotions and sleep-wake cycle. Early recognition, assessment and management of delirium is essential, because this has the potential to relieve distress and improve the quality of life and death for patients. This article discusses the causes, effects, and signs and symptoms of delirium. It also outlines the non-pharmacological and pharmacological strategies that can be used to assess and manage patients with delirium at the end of life, alongside the support that should be provided to their families.

The heel is a common site for pressure ulcer development, particularly in people who are supine or semi-recumbent because of immobility. There is little protective subcutaneous tissue and no muscle or fascia within the heel, which means that it is vulnerable to pressure, friction and shear forces. Heel pressure ulceration remains a clinical challenge for nurses and the wider healthcare team, as well as a cause of pain and physical debilitation for the patient. This article examines the risk factors for heel pressure ulceration, and details patient assessment and specific measures that can be undertaken to prevent the development of heel pressure ulcers.

Individual stories that will resonate with those who experience pain are included in this book, a refreshing and easy read that tackles a wide topic in an informative way.

The long-awaited RePAIR report recommends changes to funding and placement allocation

In September 2016, a team of nurses from East and North Hertfordshire NHS Trust (ENHT) and the University of Hertfordshire in England travelled to Kerala, India to interview and recruit nurses for the trust's acute hospital. Before undertaking the interviews, the team visited a nursing college and two hospitals. Based on the findings from these visits and from meeting the interview candidates, the team designed a bespoke mentoring programme for Keralan nurses recruited to ENHT to ease the transition into nursing and living in the UK. This article explores the challenges associated with recruiting and retaining nurses from overseas, and discusses how these can be addressed to ensure that these nurses practise safely and are supported effectively.

People experiencing homelessness have unique healthcare and health promotion needs. This article provides nurses with information on the healthcare challenges that commonly affect people who are experiencing homelessness, and outlines various effective nurse-led interventions that can be implemented. It provides examples of nurse-led health promotion projects, which demonstrate how a collaborative approach can improve the healthcare experiences of this patient group. This article also examines the issue of homelessness and mental capacity, as well as explaining the role of physical health outreach services in caring for people experiencing homelessness.