The 50 most-cited articles in Nursing Standard, 2019

Clinical supervision has been an aspect of nursing practice in various forms for several years; however, it remains challenging to ensure its widespread implementation across healthcare organisations. There is an increasingly evident need for formalised support in nurses' busy practice settings, so it is important to improve the quality of clinical supervision in healthcare. This will also assist nurses in providing evidence of their continuing professional development as part of revalidation. This article provides an overview of clinical supervision, outlining its features and functions in healthcare practice. It includes three case studies related to group clinical supervision, discussing how this was implemented in each case and the various methods of group-working that were used.

The updated Nursing and Midwifery Council (NMC) standards of proficiency for nurses emphasise the importance of nurse leadership, while the NHS has also developed models to support leadership development. There are several approaches to leadership that are applicable in nursing practice. Transformational leadership is an approach that focuses on the attributes and behaviours of the leader required to empower and motivate team members. This article outlines the four elements of transformational leadership - idealised influence, inspirational motivation, intellectual stimulation and individualised consideration - and discusses these in relation to the NMC standards. It also describes the advantages and disadvantages of transformational leadership, and suggests ways that this approach can be applied in nursing practice.

A comprehensive understanding of infection prevention and control is essential for nurses when seeking to protect themselves, patients, colleagues and the general public from the transmission of infection. Personal protective equipment (PPE) - such as gloves, aprons and/or gowns, and eye protection - is an important aspect of infection prevention and control for all healthcare staff, including nurses. Its use requires effective assessment, an understanding of the suitability of various types of PPE in various clinical scenarios, and appropriate application. Understanding the role of PPE will enable nurses to use it appropriately and reduce unnecessary cost, while ensuring that the nurse-patient relationship remains central to care. This article defines PPE and its components, outlines when it should be used and details its optimal application.

Chronic pain can have significant physical, psychological and social effects on a person's life, as well as on their families and friends. However, it is often not well-recognised or understood, which can lead to further harm. Therefore, an individualised, person-centred approach to chronic pain is essential to accurately assess pain and to develop an appropriate treatment plan. This article outlines the biomedical and psychosocial factors that can influence an individual's pain experience that should be considered as part of the assessment and management of chronic pain, and explores the assessment tools available to assist in this process. It also discusses the management options available for chronic pain, including neural blockade and analgesics, as well as non-pharmacological options such as psychological approaches, physical activity and exercise, and complementary and alternative therapies.

As a result of global migration, nurses are caring for patients in increasingly diverse cultural and linguistic settings. Intercultural nursing requires nurses to care for patients as unique individuals while considering their cultural needs. Being able to communicate effectively with patients from various cultures is crucial for understanding and for optimal delivery of patient care. Communication must be considered in the context of overall care; therefore, this article describes important concepts underpinning appropriate intercultural care. It provides a guide to effective intercultural communication by discussing three main areas: cultural knowledge, attitudes and feelings, and communication skills. These are the essential areas that nurses can reflect on, and develop and apply in intercultural communication with patients and their families.

Disabled people are one of the groups in society with the greatest health needs, yet they experience some of the most significant barriers to accessing healthcare services. This article describes examples of how three healthcare services have met the Equality Act 2010 duty to make reasonable adjustments for disabled people, so that they are not disadvantaged in accessing these services. Each of these services identified disabled patients, and considered and recorded the specific reasonable adjustments that were required. In doing so, they took time to fully understand the needs of the individual from their perspective. The services collaborated and coordinated the provision of reasonably adjusted care by communicating effectively with other health and social care providers, working together as a team, and treating disabled people as individuals.

Enhanced Recovery After Surgery (ERAS) is a multimodal, multidisciplinary programme that aims to limit surgical stress during the perioperative period. The importance of a facilitator to improve patients' compliance with the ERAS pathway and ensure its successful implementation is described in the literature. This role is commonly undertaken by a nurse, but it is unclear what their role entails in practice. AIM: To investigate the common aspects of the role of the ERAS nurse, and similar roles. METHOD: A modified Delphi technique was used to explore the opinions of ERAS nurses, facilitators and their colleagues in the UK. A series of consensus statements on the role of the ERAS nurse were produced that were voted on and agreed via an online survey, then subsequently voted on at the seventh ERAS UK conference. RESULTS: Six consensus statements were proposed and agreed in the second round of voting. In the final round of voting, consensus was reached on four of the six statements related to data collection, patient education, staff education and patient support throughout the pathway.…

Leadership is a role that nurses are expected to fulfil, regardless of their job title and experience. Nurses are required to lead and manage care as soon as they have completed their training. However, the development of leadership skills and the associated learning can be challenging, especially for less experienced nurses and those at the beginning of their careers. This article examines the importance of effective leadership for nurses, patients and healthcare organisations, and outlines some of the theories of leadership such as transformational leadership. It also details how nurses can develop their leadership skills, for example through self-awareness, critical reflection and role modelling.

This article defines the concept of health promotion and explains why it is essential for nurses to embed health promotion aims and values in their practice. It discusses how health promotion contributes to the improvement and maintenance of population health and contemporary public health agendas in the UK and worldwide. Using several practical activities, this article aims to encourage nurses to identify their own approach to promoting health in their professional role, consider how they can implement 'Making Every Contact Count' with the patients they care for, and enhance the overall effectiveness of their practice.

Pain is a personal, individual and subjective experience. The complex and dynamic nature of pain makes its assessment and management challenging for healthcare professionals. Various pain scales are available that can assist in identifying the patient's experience of pain; however, these tend to reduce this experience to a measure of pain intensity. The use of pain scales also requires patients to communicate and describe their pain; when this is not possible, it is necessary for healthcare professionals to observe patient behaviours that may indicate pain. Various observational pain assessment tools have been developed to assist in recognising and assessing pain. This article discusses the various pain scales and observational pain assessment tools that are available, and the evidence to support their use.

The harmful effects of excessive moisture on a patient's skin are well known. While traditionally considered an issue only encountered in continence care and older people, it is now recognised that the harmful effects of excessive moisture can occur across the lifespan and in various patient groups. The term 'moisture-associated skin damage' describes the spectrum of inflammatory damage that occurs in response to the prolonged exposure of a patient's skin to perspiration, urine, faeces or wound exudate. It is generally accepted that moisture-associated skin damage consists of four conditions: incontinence-associated dermatitis, intertrigo, peristomal moisture-associated dermatitis, and periwound moisture-associated dermatitis. This article describes the aetiologies of each of the different types of moisture-associated skin damage, and outlines the nursing interventions required for their prevention and management.

Congenital heart disease refers to an anatomical or physiological defect of the heart that is present at birth. Over the past three decades there have been significant advances in surgical, medical and nursing care for infants and children requiring cardiac surgery for congenital heart disease. This has meant that the number of adults with moderate and complex congenital heart disease now exceeds the number of children with the disease. This article details the background and diagnosis of congenital heart disease. It considers the implications for infants and children with congenital heart disease, as well as their parents, such as screening methods, risk factors, parental stress and psychosocial needs. This article also discusses the care of adults with congenital heart disease, including specialist monitoring and patient education.

Deprescribing is the term used to describe the discontinuation of medicines. It can be either 'reactive', for example in response to an adverse event or therapeutic failure, or 'proactive', when the prescriber and patient decide to discontinue the medicine because its future benefits no longer outweigh its potential for harm. At present, there is a limited amount of proactive deprescribing activity in primary and secondary care. This article provides the rationale for increasing proactive deprescribing activity, lists the medicines this relates to, identifies the barriers and enablers to its implementation, and describes the potential role of the nurse in this process.

Wounds have traditionally been classified as acute or chronic. While this classification is useful when attempting to estimate healing times, it might lead to an acceptance that some wounds will take longer to heal or might not heal at all. Chronic wounds can adversely affect patients' quality of life, and the management of these wounds may involve significant healthcare resources and costs. Chronic wounds rarely develop in healthy individuals and are often associated with pre-existing conditions that complicate wound healing, such as diabetes mellitus and vascular disease. This article discusses how acute wounds and chronic wounds are differentiated. It details the phases of wound healing and identifies potential barriers to progression through these phases. Enhancing nurses' understanding of chronic wounds will enable them to identify any potential barriers to wound healing early and remove or ameliorate them. While a holistic assessment should also include a thorough assessment of the wound itself, this is beyond the scope of this article.

Tracheostomy insertion and management is increasingly common in critical care units and general wards. Therefore, it is important that nurses are equipped with the appropriate knowledge and skills to meet the individual needs of patients with a tracheostomy safely and competently. This article aims to enhance nurses' understanding of the potential challenges that patients with a tracheostomy may experience, and to guide nurses in providing effective care and support to these patients. It outlines the care that should be provided for patients with a tracheostomy who are critically ill, including methods of humidification and endotracheal suctioning. This article also discusses the effects that a tracheostomy may have on a patient's communication and psychological well-being, and explains the actions that nurses should take in an emergency and if complications occur.

Caring for patients who are at the end of their lives is an essential aspect of practice in intensive care units (ICUs). While intensive care is one of the fastest-growing healthcare specialties as a result of technological and scientific advances, a significant proportion of patients admitted to an ICU in the UK will not survive their ICU stay. Therefore, it is important to examine ways to enhance practice in this area and the factors that might affect the care provided to patients and their families. AIM: To identify the challenges and facilitators that members of the ICU multidisciplinary team encounter in the delivery of end of life care to dying patients in ICUs. METHOD: A scoping literature review was undertaken. Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus with full text, MEDLINE Complete and the EBSCOhost E-Journals Database were searched electronically to identify literature from April 2007 to April 2017, alongside hand-searching. Critical appraisal tools were used and thematic analysis was undertaken to analyse the data and identify themes.…

Nurse specialists have been described as providing an optimal return on investment for income generation, patient safety, cost savings, and improvements in patient care and experience. However, there is often a lack of understanding of the nurse specialist role and how such nurses support improved patient outcomes. To assess the effect of the nurse specialist in a division of one large NHS trust, a review of the nurse specialist role was undertaken within eight specialties. This review profiled nurse specialists' roles in terms of their activity, income generation and quality, with the aim of producing specialist job plans to accurately reflect their roles. Nurse specialists were provided with a job-planning template and face-to-face sessions on how to complete it. The returned job plans were reviewed by a panel consisting of nursing management, lead clinical nurse specialists and representatives from finance. The results were used to generate three generic nurse specialist job plans that recognised the core elements of the role. The division intends to undertake a further review of…

Organisations are missing chances to improve psychological support for staff, as a Nursing Standard survey finds few know when suicide is the cause of a death in service

E-professionalism is defined as the competence and values expected of professionals when engaged in online communication, and is a rapidly expanding area of nursing practice. The use of online social media is popular among nursing students, some of whom have created online platforms for peer support and influence. There are significant benefits of using social media for nursing students, such as developing professional networks, engaging in the nursing community, accessing and providing support, and enhancing their knowledge. However, nursing students must be made aware of the potential risks in relation to how they share information and communicate online. These risks include misconduct investigations and could result in exclusion from their studies, resulting in them being unable to join the professional register. Nursing students and educators should be supported to use digital technologies in a way that capitalises on their benefits, while minimising their risks. This article aims to enhance nursing students' and nurses' understanding of e-professionalism so that they can use…

While medical technology is continuing to improve healthcare outcomes and quality of life for patients, the number of people affected by medical device-related skin damage is increasing. In many cases, life-preserving medical devices used in interventions such as nasal continuous positive airway pressure or oxygen therapy can cause significant skin damage, with negative consequences including pain, infection and delayed hospital discharge. This article outlines methods that nurses can use to minimise the risk of skin damage, focusing primarily on the prevention of pressure ulcers. It also examines how nurses can work collaboratively with patients, manufacturers and regulatory bodies to reduce the risk of medical device-related skin damage in the future.

Clinical placements can present a significant challenge for nursing students, since the learning environment differs from that of the classroom, involving potential risks and complicated interpersonal and interprofessional relationships. The array of decisions required on clinical placements can be confusing for nursing students, which can cause them to doubt their skills and knowledge. This article describes the challenges involved in clinical placements, and discusses the importance of person-centred care and techniques such as reasoning and reflection that can improve nursing students' learning in practice. It uses two case studies to illustrate how clinical supervisors and mentors can design clinical placements that enable nursing students to develop their skills, knowledge and self-confidence.

'Diabetic foot' is a term used to describe a group of syndromes in which neuropathy and/or ischaemia lead to tissue breakdown and reduced resistance to infection in a patient with diabetes mellitus. Foot ulceration is a serious and potentially limb-threatening complication of diabetes that can lead to pain, tissue necrosis and amputation, and may significantly affect an individual's well-being and mobility. Foot complications also have wider economic implications for healthcare services. Therefore, it is important to reduce the risk of foot complications through regular foot assessments and providing patient education and appropriate referral to specialist services. This article discusses foot complications in people with diabetes, outlining the causes, signs and symptoms, and associated risk factors. It also outlines the assessment and prevention measures that patients and healthcare practitioners can take to reduce the risk of foot complications.

Older people can find hospital stays challenging and distressing. When their presenting symptoms make it challenging for healthcare professionals to differentiate between dementia, delirium and depression, their experience may be increasingly distressing, and can result in delays in diagnosis and treatment, as well as an increased risk of morbidity. This article considers each of the conditions of dementia, delirium and depression, their presenting features and how nurses can differentiate between them to enable comprehensive assessment, diagnosis and treatment in older people.

AIM: To investigate attitudes towards chaplaincy in NHS Scotland, including the role of the chaplain in supporting healthcare staff. METHOD: This was a qualitative study that involved semi-structured interviews with four chaplains working throughout NHS Scotland. The research transcripts were analysed, and themes were identified and examined. FINDINGS: Two main themes were identified from the interviews: understanding the role of the chaplain; and understanding the future role of the chaplain. The sub-themes identified were: healthcare staff members' perceptions; chaplains' perceptions; generic chaplaincy services; and becoming an allied healthcare profession. CONCLUSION: The findings of this study suggest that chaplains are increasingly providing support to healthcare staff, alongside their role in providing support to patients. The researchers also identified that chaplains in Scotland are adopting an increasingly educational role and that, in the future, they may adopt reflective practice programmes to assist them in managing increased requests for chaplaincy support from…

Enhanced Recovery After Surgery (ERAS) programmes are an innovative approach to optimising patient outcomes in the perioperative period and have been implemented in various surgical departments across a range of specialties, with varying degrees of success. ERAS is an evidence-based, multimodal programme that has repeatedly demonstrated a reduction in post-operative complications and reduced the length of hospital stays following elective surgery. However, despite extensive evidence to support these benefits, several barriers to ERAS implementation have been identified. This article outlines the components of ERAS, focusing on the barriers to its implementation and how these could be overcome. It also discusses the implications of ERAS for patients, nurses and healthcare organisations.

Self-management of long-term urinary catheters can be challenging for patients, and recurrent catheter blockages may cause concern among patients, carers and healthcare professionals. Catheter blockages are a significant challenge for nurses practising in community settings, because frequent and unplanned catheter changes can be costly to healthcare services in terms of time and resources. This article details evidence-based recommendations for the assessment and diagnosis of catheter blockages, as well as the identification of risk factors. It also explains the interventions that can be used to prevent and manage catheter blockages and describes the role of the nurse in supporting patients with a long-term catheter in situ in community settings.

This article aims to improve nurses' knowledge and understanding of health inequalities. Health inequalities are responsible for variation in health outcomes observed across different population groups. Therefore, it is essential that nurses have an understanding of the health inequalities that can occur, and their causes. This knowledge will enable nurses to address the challenges that health inequalities can create in nursing practice. This article raises awareness of this important aspect of care, so that nurses can successfully identify and address the health inequalities that they encounter in their practice, thus enabling a holistic approach to patient care.

Physical activity is important for physical and mental health; however, people with a stoma commonly experience a reduction in physical activity following stoma formation. Further research into physical activity levels in people living with a stoma is necessary to determine which factors are associated with engagement in regular physical activity, and with inactivity. AIM: The primary aim of this study was to assess physical activity levels in adults living with a stoma in the community. The secondary aim was to investigate the relationship between activity levels, self-efficacy for exercise, perceived benefits and barriers to exercise, depression, body image and stoma-related quality of life. METHOD: A cross-sectional questionnaire survey was sent to healthy individuals living with a urostomy, ileostomy or colostomy, recruited from six stoma support groups in the East Midlands. The primary measure was physical activity levels; secondary measures were self-efficacy for exercise, perceived barriers and benefits to physical activity, depression, body image and stoma-related quality of…

Most people enjoy laughing and having fun, and this can enable individuals to socialise and bond. However, there is a difference between spontaneous laughter and laughter therapy, which consists of physical exercise, relaxation techniques and simulated vigorous laughter. This article aims to enhance nurses' knowledge and understanding of laughter therapy, which is a practice within complementary and alternative medicine. It discusses the evolution of laughter therapy, and describes its components and how it is practised. This article also identifies the physical and psychosocial benefits of laughter therapy, and how patients and nurses can engage with this activity to enhance their well-being.

This article explains how patients' spiritual needs can be embedded into everyday nursing practice, rather than being seen as an additional task for nurses to undertake. It outlines an integrated person model of care, which involves the nurse using the unique contact involved in providing physical care to meet the patient's spiritual needs. In addition, nurses can use the principles of therapeutic relationships such as empathy and providing a non-judgemental presence to support spiritual care, as well as respecting patients' dignity and individuality. This article also describes techniques for discussing spirituality with patients, and explains how touch can be a useful therapeutic intervention that can enhance patients' spiritual well-being.

The lifestyle choices that people make in relation to areas such as alcohol consumption, diet and smoking have the potential to seriously affect their health, with long-term conditions such as obesity, heart disease and diabetes mellitus potentially resulting in a suboptimal quality of life for individuals and incurring significant costs in terms of healthcare resources. Health promotion and preventing ill health are priorities for UK healthcare services. All nurses have a duty to continuously update their knowledge and expertise to support patients undertaking lifestyle behaviour change. This article considers practical methods that nurses can use to undertake this essential role, as well as discussing public health policy in this area.

Nurses often care for people with mental health conditions in general clinical settings. In these situations, they have a responsibility to ensure that the individual's physical, social and psychological needs are assessed and met. Nurses practising in general clinical settings should be familiar with the skills and knowledge required to meet the needs of people with mental health conditions. This article aims to provide nurses practising in general clinical settings with an understanding of such conditions and the associated effects on an individual's physical health. It also details the signs and symptoms of various mental health conditions, and outlines the communication skills that nurses can use when caring for people with these conditions in general clinical settings.

Understanding the factors that can influence people to pursue a career in nursing is essential for healthcare service managers, human resource professionals and nurse educators, particularly given the global shortage of nurses. There is evidence that the public perception of nursing can be negatively influenced by the media and nursing recruitment advertisements, and that this can discourage some people from choosing nursing as a career. At the Dalhousie University in Canada, evidence regarding the career choices of prospective nurses was used to inform a rebranding strategy for the School of Nursing's recruitment materials. The aim of the rebranding strategy was to present the School of Nursing as a diverse institution that provided a range of career opportunities for its nursing students. This article describes the background and implementation of the rebranding project. It also details how the university's evidence-based rebranding strategy was designed to positively influence people to choose nursing as a career.

Dementia care has evolved over the years, with a rise in person-centred non-pharmacological interventions such as reminiscence therapy, reality orientation and validation therapy. While these non-pharmacological interventions are an important facet of dementia care, nurses also require up-to-date knowledge of the medicines used to manage the symptoms of dementia, including antidepressants, cognitive enhancers and analgesics. Nurses should also understand the effects of behaviour-modifying medicines such as antipsychotics, anxiolytics and hypnotics, which are often overused or inappropriately prescribed in people with dementia. This article discusses the use of all these medicines in dementia care. It also examines the effect of polypharmacy on people with dementia, as well as some of the challenges involved in medicines administration in this patient group, such as covert administration of medicines, polypharmacy and non-adherence.

Leadership within the healthcare system should be visible at all levels, rather than being dependent solely on the characteristics of those who exert control from the top of the organisation. All nurses can act as leaders, and providing effective leadership requires them to develop specific personal qualities and behaviours. This article explores four 'leadership intelligences' - spiritual, emotional, business or practice, and political - and discusses how understanding these can assist nurses to enhance their leadership skills. It also considers the evidence base for the use of these intelligences and how they can be adopted by individual nurses and healthcare organisations.

People with serious mental illness (SMI) are more likely to experience severe health conditions, such as cardiovascular disease, respiratory disease and stroke, and are likely to die earlier, than the general population. This article explores the reasons for such disparities, using a case study approach to outline the ways that general nurses can support people with SMI when they access general healthcare services. It identifies five areas of learning from the case study: diagnostic overshadowing and stigma; developing the therapeutic relationship; the ward environment; inclusion of family members and carers; and integration of physical and mental health services.

Safe and effective patient care is dependent on the appropriate use of medical devices, so it is necessary to ensure that all nursing staff are competent in their use. This article describes how one urology ward in a large acute NHS trust has supported medical device training for its staff. AIM: To explore the potential benefits of introducing a ward time out training day to improve staff competency in the use of medical devices. METHOD: A training programme was introduced for the urology ward staff, which involved ward time out training days that covered medical device and mandatory training, alongside evidence to support nurses' revalidation and a forum for peer support. FINDINGS: Since the ward time out training days were introduced in 2015, medical device training competency among the urology ward staff has risen from 65% to 97% across all staff groups, including nurses and healthcare assistants. CONCLUSION: The ward time out training days were beneficial for the urology ward staff, and increased their medical device training competency. Additional benefits of the ward time out…

Chest pain is a common reason for patient presentation to emergency departments and visits to primary care settings. While most causes of chest pain are not life-threatening, a small proportion require urgent intervention, particularly cardiac conditions such as acute coronary syndrome. Therefore, it is essential for healthcare practitioners, including nurses, to identify the cause of chest pain in a safe, timely and effective manner. This article outlines the main causes of chest pain and describes the aspects of chest pain assessment, including patient history-taking, physical examination and clinical investigations. Assessing chest pain requires healthcare practitioners to have knowledge of its causes and pathophysiology, the use of structured assessment tools and the latest evidence-based guidelines.

Effective management of diabetes mellitus requires lifelong adherence to a plan that incorporates lifestyle changes, exercise and diet. Following a dietary plan is a fundamental component of diabetes management because this can regulate the body's supply of glucose and lipids, resulting in weight reduction, an improved response to pharmacotherapies, and optimal control of the patient's glycaemic status and lipid profile. This article examines the components of nutrition therapy recommended for people with diabetes. Initially, the patient's daily calorie requirements should be determined, and therapeutic objectives should be decided that take into account the individual's clinical profile and personal preferences. Subsequently, a dietary plan should be negotiated with the patient that considers the carbohydrate, protein, fat and fibre content of each food item.

In recent years, the regulation of carbohydrate intake has become regarded as essential to achieve a balanced diet, with a range of health benefits attributed to low-carbohydrate diets. However, much of the advice on reduced carbohydrate intake does not reflect government-led dietary guidelines. As a result of this conflicting information, patients requiring assistance with weight management or glycaemic control may become confused about the appropriate carbohydrate intake, or be encouraged to experiment with 'fad' diets. As front-line healthcare professionals, nurses are in a prime position to advise patients on carbohydrate intake, as well as signposting them to evidence-based dietary resources. This article outlines the constituents of dietary carbohydrate, considers the health benefits of carbohydrates, and explains their importance as part of a healthy and balanced diet.

Hyperglycaemia is a defining feature of diabetes mellitus. It involves an elevated level of glucose in the blood, which develops as a result of the body's inability to produce insulin or process insulin effectively. If left unchecked and untreated, patients with diabetes are at risk of short-term, potentially life-threatening hyperglycaemic crises such as diabetic ketoacidosis or hyperosmolar hyperglycaemic state. Nurses frequently care for patients diagnosed with diabetes in various clinical settings; therefore, it is essential that they have an awareness of the prevention and management of hyperglycaemia and hyperglycaemic crises. This article explains the causes and clinical manifestations of hyperglycaemic crises, and details the management of patients with these conditions, in accordance with national guidelines.

The prevalence of end-stage kidney disease is increasing, particularly among older people and those with multiple comorbidities. Typically, patients who develop end-stage kidney disease receive renal replacement therapies such as dialysis; however, this treatment can significantly affect quality of life and may not prolong life in older patients. Therefore, some patients may choose not to undergo dialysis and instead choose conservative management, which involves a palliative approach that focuses on maintaining quality of life and advance care planning. This article details the steps involved in a conservative kidney management pathway for end-stage kidney disease, including symptom management and advance care planning. It also discusses the importance of a palliative approach for patients receiving dialysis.

Health services risk losing experienced nurses because of a failure to acknowledge symptoms such as fatigue and hot flushes

RATIONALE AND KEY POINTS: Ascites is the excessive accumulation of extracellular fluid within the peritoneal cavity, which usually develops as a result of cirrhosis of the liver. Paracentesis is the procedure for removing ascitic fluid from the transabdominal peritoneal cavity via a temporary ascitic drain. This article aims to support nurses in providing safe and effective care for patients undergoing paracentesis. • Paracentesis is used to reduce intra-abdominal pressure and to relieve the symptoms of abdominal ascites, such as severe abdominal distention, pain and dyspnoea (difficulty breathing). The removal of at least 5L of ascitic fluid is considered large-volume paracentesis.• The role of the nurse is usually to monitor the patient throughout the procedure, administer treatment as directed by the medical team and, depending on local policy, remove the drain at the end of the procedure.• Knowledge of the benefits and risks of this procedure is essential to provide safe, evidence-based care for patients undergoing paracentesis. REFLECTIVE ACTIVITY: 'How to' articles can help to…

Evidence demonstrates that subconscious and intentional discrimination against lesbian, gay, bisexual, transgender, queer or questioning, and intersex (LGBTQI+) people continues to exist in the UK healthcare system. Surveys have indicated significant health inequalities in LGBTQI+ populations, including high rates of mental health issues and suboptimal healthcare experiences. This article explores these issues and encourages nurses to reflect on their unique and privileged position to champion the rights of vulnerable people, as well as their role in improving the healthcare experience of LGBTQI+ patients in the future. It also discusses safety issues and special considerations for LGBTQI+ patients, including those related to sexual health, mental health and intellectual disabilities.

A student reflects on her experience of building a strong nurse-patient relationship while on placement in a hospice

Deteriorating patients often present with suboptimal vital signs. If these are not recognised by healthcare staff, the patient's condition can deteriorate further, potentially leading to serious complications and even death. Despite efforts to improve ward nurses' recognition of, and responses to, deteriorating patients, this aspect of care has been found to be suboptimal. AIM: To identify factors that influence ward nurses' responses to deteriorating patients. METHOD: A literature review was undertaken, based on the research question 'What factors influence the trigger component of ward-based registered nurses' afferent response to deteriorating patients?' Several electronic databases were searched electronically to identify relevant articles, alongside hand-searching. Inclusion and exclusion criteria were set to determine which articles should be included in the literature review. FINDINGS: Nine studies were identified for inclusion in the literature review. Four main themes that influenced ward nurses' responses to deteriorating patients emerged: communication, diurnal and…

Women coping with menopause symptoms deserve support and empathy in the workplace

Trivialising racism as a ‘minority issue’ ignores its wider impact on staff, organisations and patients

The Nursing and Midwifery Council’s new education standards take a fresh approach to supervision, assessment and the nurturing of nurse leadership