The 50 most-cited articles in Nursing Standard, 2020

Decontamination using hand hygiene remains one of the most important and effective methods for reducing healthcare-associated infections and cross-infection between patients. In 1860, Florence Nightingale wrote that nurses should wash their hands frequently throughout the day, demonstrating an early awareness of the effectiveness of this simple procedure. The COVID-19 pandemic has demonstrated that effectively applied hand hygiene is a vital intervention that can be used to prevent the spread of disease. This article details the correct procedure required for effective hand hygiene and emphasises the need for nurses to keep up to date with evidence-based guidelines. The article also outlines the differences between hand decontamination using alcohol-based hand gels and soap and water, and the complex factors that can interfere with effective hand hygiene compliance.

Leadership theory is a crucial aspect of nursing and the focus of a large body of literature. However, it remains a challenging concept to define and has been subject to various interpretations. Much of the literature on leadership is contradictory, with some studies claiming particular leadership styles are more effective than others. This article discusses the benefits and limitations of one approach to leadership - transactional leadership - and considers its use in nursing practice. The author suggests that transactional leadership remains useful as an approach to meeting short-term goals and completing tasks, but that it should be combined with other leadership styles to maximise its effectiveness in healthcare settings.

The development of the Person-centred Nursing and Person-centred Practice Frameworks has spanned over 20 years of research, practice development and evaluation activities. The original framework published in 2006, was developed for use in the intervention stage of a large quasi-experimental project that focused on measuring the effectiveness of the implementation of person-centred nursing in a tertiary hospital setting (McCormack and McCance 2006).

An awareness of the concept of spirituality is integral to the provision of person-centred holistic care. However, the nurse's ability to provide spiritual care is often impeded by time pressures and the prioritisation of clinical tasks. Confusion about the meaning of spirituality and its relationship to religion may also compound the challenges involved in providing spiritual care, and nurses often feel ill-equipped to address this area of care. This article discusses the challenges associated with the concept of spirituality, and describes the competencies and personal qualities that nurses require to achieve spiritually competent practice. It also explains the concepts of availability and vulnerability, which can support the personal development required for nurses to become spiritually competent.

Equality and diversity are terms that are used frequently in nursing, healthcare and workplace settings. Nurses' professional standards of practice and behaviour are underpinned by values of equality and diversity. This means that nurses must treat people as individuals, avoid making assumptions about them, recognise diversity and individual choice, and respect and uphold their dignity and human rights. This article explores what equality and diversity mean in nursing practice, the legal framework that underpins these terms, and the inequalities and discrimination that patients and staff may experience in health and social care settings. It discusses the role of organisational culture in supporting nurses to uphold the values of equality and diversity and encourages nurses to reflect on this topic to enhance their practice.

Preoperative care refers to the physical and psychosocial care that prepares a patient to undergo surgery safely. The preoperative period begins when the patient is booked for surgery and ends with their transfer to the theatre or surgical suite. As well as the preoperative care that takes place in hospital, various preoperative tests and clinical assessments can be undertaken during a preoperative outpatient appointment, one week or more before surgery takes place. Patient information will also be provided at this time. These outpatient appointments are often led by nurse specialists or advanced nurse practitioners and may involve remote consultations via telephone or email. All nurses involved in the care of patients undergoing surgery should:• Have a clear understanding of their role in each of the operative phases – preoperative, intraoperative and post-operative.• Be able to identify the essential elements of preoperative care required to ensure patient safety.• Understand the indications for, and effects of, any preoperative medicines.• Provide preoperative information to the…

Effective leadership is essential in healthcare organisations, with several high-profile reports on suboptimal care in the NHS demonstrating a link between ineffective leadership and compromised patient safety. Therefore, it is important that nurses understand how leadership is defined and what effective leadership entails in practice. Various types of leadership are described in the literature, such as transactional, transformational and contingency leadership. One approach that could be beneficial in NHS organisations is collective leadership, which involves developing a leadership culture where formal and informal leaders work together to generate actions. This article explores the implementation of collective leadership in healthcare organisations, the potential benefits of this approach, and the behaviours and qualities that nurses require to be collective leaders.

The recognition of stroke as a medical emergency, provision of specialist services and advances in treatments have contributed to a decrease in stroke-related mortality, but the incidence and burden of stroke continue to rise. A stroke is a life-threatening and life-limiting event, but prompt identification and early treatment can reduce mortality and disability, and enhance the recovery and rehabilitation potential of survivors. Nurses working in acute stroke services have a wide-ranging role that includes assessment, identification and monitoring, as well as rehabilitation, psychological support and end of life care. This article provides an overview of the diagnosis and management of strokes and transient ischaemic attacks, and describes the role of nurses in acute stroke care.

It is generally accepted that physical activity has many health benefits, such as improved cardiorespiratory fitness, muscular fitness and bone health. Despite this, inactivity remains a significant health challenge in the UK and globally, contributing to conditions such as coronary heart disease and diabetes mellitus. Nurses have an important health promotion role in recommending the potential benefits of physical activity to the general public. However, research suggests that many nurses may not be undertaking enough physical activity themselves, despite the active nature of the nursing role. This article investigates the evidence that increased physical activity has the potential to improve the well-being of nurses. The article also examines the effect of physical activity on indicators of well-being, including feeling states such as affect, mood and emotion; depression; and sleep.

Animal-assisted therapy involves the use of highly trained animals, such as dogs and cats, in conjunction with conventional treatments to address the physical and emotional needs of patients. This article presents a literature review of the health benefits and challenges associated with the use of animal-assisted therapy in the care of older patients in hospitals and long-term care facilities. Eleven original research articles were included and three themes were identified: physiological outcomes, psychological outcomes, and challenges associated with using animal-assisted therapy in patient care. The literature review aims to enhance nurses' knowledge of the health benefits of animal-assisted therapy as an adjunct to traditional treatments. It found that animal-assisted therapy can improve sleep, reduce depression and enhance mood in older patients. Challenges were identified in relation to ensuring infection prevention and control and in sustaining the implementation and benefits of interventions. Further research is necessary to explore the sustainability and long-term benefits…

Vascular access is an important aspect of patient care and management in all areas of healthcare. Safe, efficient and reliable venous access may require a central venous access device (CVAD), which can be used in primary and secondary care settings. Nurses may assist in device selection and be involved in their ongoing management, which includes recognising and addressing device complications. The appropriate choice of CVAD and early recognition of potential issues can improve the reliability and longevity of these devices and reduce the risk of long-term complications. This article describes the types of CVAD and their indications for use. It also outlines the management of CVADs, focusing on three areas: complications during insertion; infection prevention and control; and complications that may arise during the ongoing care of these devices.

The year 2021 marks 100 years since the Nobel Prize-winning discovery of insulin as a medical treatment for diabetes mellitus. Its discovery changed type 1 diabetes from a terminal condition with a short life expectancy to one of long-term management, with patients now often living long and fulfilling lives. Today, much of the advice, support and prescribing of insulin is undertaken by nurses, including general nurses and those specialising in diabetes. This article provides an overview of the principles of insulin use in the management of diabetes, with the aim of enhancing nursing knowledge and improving the care of patients with diabetes.

Maintaining a healthy diet is important for health and longevity. Many diets are recommended for their health-promotion properties. Despite their role in providing health education to patients, nurses do not always maintain healthy diets themselves. The literature shows that a significant number of nurses are overweight or obese. This article reviews the recommended healthy eating guidance and explores why nurses may not always eat healthily. It appears that several characteristics of the nursing role and workplace - notably shift work, fatigue, stress, and suboptimal facilities and availability of healthy foods - make it increasingly challenging for nurses to maintain healthy diets. The article also discusses strategies employers can use to adapt the work environment to support healthy eating.

There are many reasons to feel anxious about coronavirus, but help is out there

This article explores the spiritual pain that patients may experience, which is often hidden or overlooked in healthcare settings that tend to focus on managing physical manifestations of pain. As part of their role in responding to patients' needs, nurses need to be willing to engage with spirituality, which is an important aspect of many people's lives. This article examines the meaning of spirituality and how spirituality may - or may not - relate to religious beliefs. It describes a whole-person approach to understanding the physical, social, emotional and spiritual dimensions of pain, and how this may assist nurses in recognising and addressing patients' spiritual needs. The article also explores attributes, skills and resources that can support nurses in responding to spiritual pain, including a caring presence, courage, compassion, and respect for other people's beliefs and values.

While the NHS aims to respect the human rights of every individual, it also has a wider social duty to promote equality in the services it provides. This means that the rights of individual patients are not absolute, because the aim of the NHS is to improve the overall health and well-being of the nation. For example, certain treatments may be withheld from individuals because of the excessive cost to the NHS, or concerns about its clinical effectiveness. This article explains the origins of human rights and their function, and examines the relationship between nursing care and human rights.

The insertion of an indwelling urethral urinary catheter is an invasive procedure that is commonly undertaken in healthcare settings. However, there are several risks and potential complications associated with these devices, so their use should be avoided where possible. It is important that nurses are equipped with the necessary knowledge and skills not only to assess if a patient requires a catheter, but also to minimise the risk of associated complications and to understand how these can be managed. This article discusses some of the common complications that can occur with the use of indwelling urinary catheters, including: catheter-associated urinary tract infections; catheter blockages; encrustation; negative pressure; bladder spasm and trauma; and, in men, paraphimosis. It also explains the steps that nurses can take to reduce the risk of these complications and how to manage them effectively.

Antimicrobial-resistant infections cause a significant number of deaths globally each year, and the development of resistance is influenced by the frequency of antibiotic use. This article describes an antimicrobial stewardship competency framework for undergraduate nurse education in the UK and internationally, explaining how this framework can be mapped to nurse education and training programmes. It also uses a case study to demonstrate how the competencies can be applied to nursing practice.

A balance between the volume of fluid taken in by the human body, and the volume of fluid excreted, is essential for life. Body fluid balance, which is maintained via various homeostatic mechanisms, can be disrupted by injury or disease. Prompt action is usually required to replenish fluid volumes and restore homeostasis, which is achieved via intravenous (IV) fluid therapy. Nurses will often encounter patients with a disrupted fluid balance, particularly in critical care. They will be involved in assessing patients' fluid status and administering and monitoring therapy. Therefore, nurses have an important role in ensuring the safety and effectiveness of IV fluid therapy. This article provides an overview of the principles and aims of IV fluid therapy. It also explains the physiology of body fluid and mechanisms of fluid balance regulation, outlines the principles of patient assessment and indications for IV fluid therapy, and details its potential risks and complications.

Nursing Standard survey reveals nurses’ concerns about learning and development during the pandemic, but highlights innovation too

Amid the upheaval of the pandemic, nurses can use reflection to process their experiences and improve practice

Becoming a newly qualified nurse can be a daunting prospect and leadership may appear to be a quality that only experienced nurses and managers should be concerned with. However, leadership is a requirement for all registered nurses and inquiries into cases of suboptimal care have often identified inadequate leadership as a major contributor. In the past, leadership was defined as an innate characteristic or trait, but over time concepts of leadership have evolved and it is now recognised as a set of skills and behaviours. There are many different leadership styles, qualities and behaviours, but these should not be confused with the role of management. It is important for newly qualified nurses to develop their leadership skills using tools such as preceptorship, reflection and continuous professional development.

Women in healthcare are not getting the same protection against coronavirus as male colleagues

AIM: To investigate the initial perceptions that health and social care professionals have when caring for trans patients. METHOD: This was a qualitative study that involved semi-structured interviews with five participants in one geographical area as a snapshot study. The research transcripts were analysed, and themes were identified and examined. FINDINGS: The main themes identified from the interviews with participants were: discrimination; lack of understanding of the trans body and gender identity; confusion around terminology; cultural perceptions and attitudes towards trans people; professionalism; the need for trans awareness training; and social recognition for trans staff members. CONCLUSION: The findings of this study suggest there is a need to develop trans awareness training for staff working in areas of practice that are likely to provide care for trans people, such as acute care, emergency departments and mental health services. This could improve health outcomes for trans people and increase the likelihood of them accessing health and social care services in the…

Recognising signs of deteriorating health in patients and responding to them appropriately are crucial nursing competencies. In acute care, failure to detect and act promptly on deterioration can lead to the patient's death. To achieve clinical competence, nursing students require training in the use of techniques for monitoring physiological observations as well as protocols that enable them to respond to deterioration. The use of early warning scores has been advocated to standardise the methods and frequency of patient monitoring in acute care settings. In 2012, the Royal College of Physicians developed the National Early Warning Score (NEWS), which was updated in 2017 and known as NEWS2. This early warning score is used in acute hospitals in England, Scotland, Wales and Northern Ireland. This article explores the benefits and challenges of using NEWS2 as an educational tool in pre-registration nursing programmes to support nursing students in recognising and responding to deteriorating health.

Communication between a nurse and a patient may seem intuitive. However, communicating effectively with patients while applying the principles of person-centred care can be challenging. Patients' perceptions of suboptimal care and healthcare services may be influenced by how nurses communicate with them, since communication may be used as a quality indicator, as well as an indicator of patient experience. This article considers how nurses can communicate effectively with patients to optimise care. It explores the theoretical principles of interpersonal and professional communication, and discusses practical methods of listening and speaking to patients that nurses can apply in their clinical practice.

Epidural analgesia continues to have an important role in the management of acute pain in post-operative settings. Although its use in clinical practice has declined, it continues to demonstrate superior analgesia effect compared with parenteral opioids. However, despite these benefits, epidural analgesia requires additional monitoring to ensure the timely identification of significant complications, such as haematoma and abscess. This article details the nursing care and management of adults receiving epidural analgesia in post-operative settings. It also outlines the main complications that may occur and how these can be managed.

Sepsis is a complex condition defined as one or more life-threatening organ dysfunctions caused by a dysregulated host response to infection. Nurses have a vital role in the early identification of those with or at risk of developing sepsis. Prompt early treatment delivered using care bundles such as the 'sepsis six' can optimise patients' chances of survival and reduce the debilitating effects of this condition.

Constipation is a common condition in adults and symptoms such as straining and the sensation of incomplete bowel emptying can be distressing for patients. The nurse's role includes preventing, monitoring and managing the condition. Fibre and fluid intake have an important role in prevention, while first-line treatments include increased consumption of wholegrain carbohydrates, fruit and vegetables. This article outlines the role of diet in preventing and managing constipation in adults and offers practical advice for nurses caring for this group of patients.

A tracheostomy is a surgical procedure that involves creating an opening and inserting a tube in the trachea to enable air transit from the external atmosphere to the lungs. The insertion of a tracheostomy is a common procedure used to wean patients from mechanical ventilation and to manage patients with upper respiratory tract complications. Furthermore, the coronavirus disease 2019 (COVID-19) pandemic has resulted in many patients requiring a tracheostomy as part of respiratory management. The two most commonly used tracheostomy insertion procedures are the open surgical tracheostomy and the percutaneous dilatation tracheostomy, both of which are associated with a range of complications. This article outlines the indications, benefits and complications of tracheostomy insertion, as well as the various types of tracheostomy tube that may be used. It also explains the role of the nurse in caring for patients before, during and after tracheostomy insertion, including the management of tracheostomy-related complications and emergencies.

Publication of the Nursing and Midwifery Council's standards for student supervision and assessment introduced the role of academic assessor. However, there has been little research into the role and what it entails. This article examines the role of academic assessor and discusses who can become an academic assessor, their responsibilities, and the potential challenges and benefits associated with the role. The article also explains how effective feedback and communication between academic assessors and practice assessors can support the academic progression of nursing students.

Understanding personality types can assist nurses in enhancing their understanding of themselves and their colleagues, which in turn can support effective communication. This article outlines the principles of the Myers-Briggs Type Indicator (MBTI) - a personality inventory that aims to improve the understanding of psychological types - and details the characteristics of the MBTI's 16 different personality types. The article explores how these 16 personality types can influence communication within healthcare teams and between healthcare professionals. It also discusses how these personality types affect styles of nurse leadership and how an understanding of personality types can improve nurses' communication with patients.

The coronavirus disease 2019 (COVID-19) pandemic has resulted in significant challenges for nurses, both professionally and personally. In these unprecedented times, new opportunities to reflect on practice have emerged. Through reflection, whether individually or with others, nurses can explore areas of their practice that could be developed and improved. This article outlines the types of reflection and discusses its benefits and challenges, explaining how it is linked to nurses' regulatory revalidation processes. It also details various models and activities that nurses can use to reflect on their practice during the COVID-19 pandemic and beyond.

Darker skin tones are often not included in clinical resources – including for COVID-19

Wounds have become a significant public health challenge and consume a large amount of healthcare resources. Wounds can have severe negative effects on patients' quality of life, causing psychological and social distress, and may lead to significant periods of lost employment, resulting in financial loss. For nurses to manage wounds effectively, they need to be competent in undertaking holistic wound assessments. This article supports nurses' understanding by providing information on various types of wounds and their differing aetiologies. It also outlines the elements of a wound assessment and discusses some of the challenges that may be encountered during this process.

Connecting people to services and community groups is more important than ever in the wake of the pandemic

Compulsory face coverings pose particular challenges when patients have hearing difficulties, dementia or cognitive impairment

The UK’s research nurses are part of a worldwide quest to develop vaccines and drug therapies – and they are working at an unprecedented pace

On 12 May, in honour of Florence Nightingale’s 200th birthday, I was supposed to go to Kew Gardens with a nursing friend. We shared a flat in London when we were students and Kew was a short bike ride to sanity; whatever the season, the open space was a respite from the pressures of our job.

How to ensure you work at your own skill level, even in the exceptional circumstances we now find ourselves in

How a team of senior nurses is helping newer recruits thrive – and improving retention

Nurses explain how they use CBT to support the well-being of patients with physical conditions

Stroke is a medical emergency that affects millions of people worldwide each year. The first 24-72 hours following a stroke is a critical stage in the patient's management because deterioration can occur during this period. Hyperacute care is a time-sensitive method of managing stroke that has improved the provision of holistic and evidence-based stroke care. This article describes the care and management that patients require in the first 24-72 hours following stroke. It details the evidence-based practice that this involves, and explains the role of the nurse in providing hyperacute care.

This article considers two areas of practice that are fundamental to the provision of high-quality nursing care for people experiencing acute pain: the initial recognition of pain, and the formal assessment of pain. The initial recognition of a patient's pain is a subject that is frequently overlooked in the literature. However, if nurses are unable to identify that a patient is experiencing pain, then a formal pain assessment may not take place, which in turn negatively affects the quality of any subsequent pain management. This article explores some of the barriers to the initial recognition of pain and examines how a formal pain assessment can support optimal patient care.

Marie Curie-Nursing Standard survey highlights the emotional toll of the pandemic and the need for more staff support

RCN guidance explains workplace changes that can minimise discomfort for staff with menopause symptoms

feature Learning disability liaison nurses: the provision of compassionate, person-centred care for people with learning disabilities accessing acute hospital care by Michael Brown (FRCN 2015) T he publication that underpins this article (Brown et al 2016) arose from research on equality of access to acute hospitals for people with learning disabilities.It presents findings from a large study involving four Scottish NHS boards and 11 acute hospitals.The study had 100 participants, comprising families, carers and health professionals with direct experience of the contributions made by learning disability liaison nurses.We identified the outcomes achieved by the nurses and their contribution to the provision of person-centred and compassionate care in the acute hospital setting.The work to improve acute hospital care for people with learning disabilities has continued for around 20 years, during which time there have been many developments.The work started in 1997 and was a The perspectives of stakeholders of intellectual disability liaison nurses: a model of compassionate,…

An indwelling urinary (Foley) catheter may be used in the management of various urological conditions, such as intractable incontinence and urinary retention, or as part of treatment regimens such as chemotherapy. Although some catheters may be required for long-term use, healthcare practitioners should regularly assess whether the device is still necessary and if it can be removed. This is because urinary catheters are a highly invasive intervention and their use is associated with a range of potential complications, including healthcare-associated infection and trauma to the neck of the bladder. This article outlines the procedure for the safe removal of a urinary catheter, including the patient care and monitoring required before, during and after this procedure. It also explains the complications that are associated with catheter removal and how these can be prevented and managed.

People who live with chronic pain can feel belittled by the terminology clinicians use