The 50 most-cited articles in Nursing Standard, 2021

The incidence of diabetes mellitus is rapidly increasing, and this condition often results in significant metabolic disease and severe complications. Nurses have a crucial role in monitoring, educating and supporting people with diabetes, as well as their families and significant others. This article provides an overview of the main types and common symptoms of diabetes, its acute and long-term complications and its management. It also outlines the nurse's role in diabetes care, which frequently includes assessing and empowering patients.

Emotionally intelligent leaders demonstrate a sensitivity to their own and other people's psychological health and well-being, directing others towards common goals while developing effective personal relationships with their colleagues and team members. Emotional intelligence is particularly relevant in the context of the coronavirus disease 2019 pandemic, where nurse leaders need to demonstrate this skill when supporting their teams to manage high levels of stress, exhaustion and the risk of moral injury. This article explores emotional intelligence, discusses its importance as a characteristic of effective nurse leaders and managers, and suggests practical activities that leaders can undertake to develop their emotional intelligence skills.

Diabetic retinopathy is a major cause of preventable sight loss in the working-age population and a major global health issue. It is caused by chronic hyperglycaemia, which also predisposes patients with diabetes mellitus to a range of other ocular complications including diabetic macular oedema, eye infections, diabetic cataract, and dry eye and corneal complications. Ocular complications of diabetes can significantly affect people's quality of life, so regular eye screening from the point of diabetes diagnosis, as well as a multidisciplinary team approach, are required to identify these complications early, manage them effectively, and support patients to achieve glycaemic control. This article provides an overview of diabetic retinopathy and other ocular complications of diabetes, and explains the role of the nurse in providing health promotion, patient education and support.

Because of its anatomical location and the fact that it has no muscle or fascia and little subcutaneous tissue, the heel is highly vulnerable to pressure damage and pressure ulcer development. Heel pressure ulcers are often severe and challenging to heal. Heel pressure ulcers are caused by factors such as pressure, shear and friction and the vulnerability of the heel to pressure damage is increased by immobility, the patient's skin status, the presence of previous pressure ulcers and/or scar tissue, and suboptimal tissue perfusion. The risk is also increased in patients with diabetes mellitus. The role of nurses includes assessing the risk and preventing the development of heel pressure ulcers. This article discusses the causes of, and risk factors for, heel pressure ulcers and describes techniques and devices that nurses can use to prevent them.

Moral injury may be experienced when a person perpetrates, witnesses or fails to prevent an act that conflicts with their moral values and beliefs. The concept of moral injury has its origins in the context of military personnel encountering ethically challenging decisions during armed conflict. The term has been applied to healthcare and moral injury is increasingly acknowledged to be a challenge for healthcare professionals. Nurses across all specialties and settings are frequently required to make or witness ethically challenging decisions about patient care. The coronavirus disease 2019 (COVID-19) pandemic has increased nurses' risk of sustaining moral injury. This article discusses the manifestations of moral injury and its associated risk factors, including the effects of the COVID-19 pandemic. It also outlines various strategies that can be used to mitigate and/or prevent moral injury in nurses.

Leadership is central to effective nursing practice and is considered to be particularly important during crises such as the coronavirus disease 2019 (COVID-19) pandemic. This article examines several leadership styles that are commonly used in healthcare - namely the transactional, transformational and laissez-faire leadership styles - and considers their advantages and disadvantages in the context of the COVID-19 pandemic. It also explains the potential benefits of compassionate leadership in supporting the nursing workforce during this highly challenging and stressful period.

Nurses have a duty to promote the values of equality and diversity during their interactions with patients and their families and carers, as well as peers and colleagues. This article defines the terms equality, diversity and inclusion, and explains the importance of the Equality Act 2010 and the Human Rights Act 1998 in protecting people from various types of discrimination. It also outlines nurses' responsibilities in promoting equality and diversity by treating all patients and colleagues with respect and dignity, providing compassionate leadership, and practising in accordance with the ethical principle of justice. The article encourages and empowers nurses to recognise and challenge discrimination wherever they see it, thereby delivering high-quality care to all patients.

Research suggests that working during traumatic events can lead to deteriorating physical and mental health for nurses, a phenomenon that has been demonstrated during the coronavirus 2019 (COVID-19) pandemic. However, research has also shown that there are evidence-based strategies that can be used to assist nurses in their recovery from such events. Promoting awareness among individual nurses about the effects of COVID-19 enables them to adopt positive coping strategies, both on an individual and organisational level. This article details strategies including formal and informal debriefing, taking regular breaks, and using stress mitigation strategies during shifts. The article also discusses the potential for post-traumatic psychological growth. This acknowledges that while working in a healthcare environment during COVID-19 can be extremely challenging, it also enables nurses to experience personal growth such as the development of emotional intelligence. As nurses adapt to the 'new normal' of working during COVID-19, healthcare organisations should ensure that they provide…

Pressure ulcers are painful, costly and can negatively affect a patient's quality of life. It has long been recognised that they increase the risk of infection, prolong hospital stays and can result in death. To prevent the occurrence of pressure ulcers, nurses need to understand what a pressure ulcer is and the underlying factors that cause them. Furthermore, it is essential that they recognise why some people are more susceptible to pressure and shear forces than others, so that preventable factors can be addressed. Nursing care to prevent pressure ulcers needs to be planned, implemented and evaluated in a systematic manner following an assessment of the patient and their circumstances. The 'aSSKINg' (assess risk; skin assessment and skin care; surface; keep moving; incontinence and moisture; nutrition and hydration; and giving information or getting help) model ensures all fundamental aspects of pressure ulcer prevention are included in patient care. This article outlines the definitions and causes of pressure ulcers, and explains how nurses can assess, plan, implement and…

This article explores the challenges and barriers to the effective nursing management of pain in patients with a history of opioid use disorder. It also identifies recommendations for improving patient care and possible areas for further research. The author examined the relevant literature, which revealed that patients with opioid use disorder may experience stigmatisation by nurses; such negative attitudes are often in conflict with nurses' professional and ethical duties. This issue is compounded by a lack of knowledge and understanding of dependence, addiction and withdrawal. It was also identified that patients often recognise the effects of stigma and this can cause resentment, frustration and anxiety, in some cases leading to aggressive or disruptive behaviours that reinforce negative stereotypes of people who use opioids. A breakdown in the nurse-patient relationship can result in suboptimal pain management in this often-marginalised patient group. Therefore, effective pain management relies on a nurse-patient relationship that minimises anxiety, as well as multidisciplinary…

Vaccine hesitancy, defined as the refusal or delay of acceptance of vaccines, is a threat to the elimination and/or eradication of vaccine-preventable diseases, and therefore has significant implications for global health. Negative and conflicting vaccination information on social media can lead to vaccine hesitancy, including among parents who need to decide whether to have their children vaccinated. This article discusses the dissemination and content of vaccination information on social media, and explores the effects this can have on vaccine hesitancy and uptake. It also outlines various strategies that nurses can use to address vaccine hesitancy and misinformation on social media.

Rationale and key pointsEffective record-keeping and documentation is an essential element of all healthcare professionals’ roles, including nurses, and can support the provision of safe, high-quality patient care. This article explains the importance of record-keeping and documentation in nursing and healthcare, and outlines the principles for maintaining clear and accurate patient records.• Nurses’ regulatory standards for practice emphasise the importance of maintaining clear and accurate patient records.• Patient records provide evidence of the assessments and interventions that have been undertaken. They can facilitate continuity of care by enabling other healthcare professionals to clearly see patients’ current care plans and treatments.• The policies and procedures for maintaining patient records can vary between healthcare organisations, so it is important for nurses to check these and practice in accordance with them.Reflective activity‘How to’ articles can help to update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and…

The coronavirus disease 2019 (COVID-19) pandemic has led to a significant increase in the demand for palliative and end of life care, particularly in the community. Furthermore, palliative and end of life care services face growing pressures due to the increasing number of older people and increasing prevalence of chronic illness. Palliative and end of life care cannot be provided solely by specialists but needs to be integrated into mainstream healthcare. All nurses have a role in supporting patients with life-limiting conditions, and their families, by providing what is termed 'generalist palliative care'. However, some nurses may feel unprepared, unsupported or lacking the confidence and skills for that role. This article explores the definitions of palliative and end of life care, as well as the changes and challenges in service provision brought about by the COVID-19 pandemic. It also considers how nurses who have not specialised in this area of practice can be supported to care effectively for patients with life-limiting conditions, and their families, notably through…

Essential informationThe term chronic kidney disease (CKD) describes abnormal kidney function or structure. It’s a common condition; about three million people in the UK have CKD, the charity Kidney Care UK says.

Diabetes mellitus remains an incurable condition that is associated with serious complications such as cardiovascular and renal disease. Most people with diabetes will experience type 2 diabetes, with obesity being a major risk factor for its development. Lifestyle modifications remain central to the management of type 2 diabetes, but because of the challenges in maintaining such changes in the long term and the progressive nature of the condition, most patients also require oral medicines and, eventually, injectable medicines. Nurses have an essential role in the education, empowerment and support of patients with type 2 diabetes, and it is important that they understand the available pharmacological treatment options. This article outlines the main types of oral medicines used in type 2 diabetes, including their modes of action, advantages, cautions and side effects, as well as discussing their selection and use in clinical practice.

Maintaining a balanced and nutritious diet is essential to support optimal health and well-being. However, rates of overweight and obesity in the UK and internationally have risen significantly, alongside increases in food portion sizes. While it can be challenging to work in partnership with patients towards achieving a healthy weight, it is crucial that nurses are able to offer patients advice and support to assist them in following dietary guidelines. This article explores the development and practical application of recommended dietary guidelines such as the Eatwell Guide. It also discusses practical interventions that nurses can use to advise patients on healthy eating, such as using the hands as a guide to portion size.

Improved surgical outcomes have been achieved as a result of preoperative risk assessments and developments in surgical and anaesthetic techniques. However, post-operative haemorrhage remains a life-threatening complication requiring swift recognition and management. This article explores the compensatory mechanisms the body employs during haemorrhage and how these may present as altered observations that can aid early recognition. It also describes the rapid assessment of patients using the ABCDE (airway, breathing, circulation, disability, exposure) approach and outlines the management interventions used to halt the bleeding and restore intravascular volume.

Patient blood management has been defined as a patient-focused and evidence-based approach to optimising the management of patients during the transfusion of blood components. This article explores the complex factors that can influence clinical decisions and enhance patient safety in the administration of blood components, particularly red blood cell transfusions in patients with anaemia. The article also explores the nurse's role in acting as a patient advocate and considering alternatives to the use of blood components. While this article focuses on anaemia-related transfusions, the author relates the principles of patient blood management to all transfusion care.

There is increasing evidence to suggest that transgender (trans) and non-binary people encounter significant societal discrimination, stereotypical and misleading representation in the media, and frequent misgendering. They may also experience several barriers to accessing healthcare, as well as discrimination from staff and other patients. This article explores how and why trans and non-binary people experience discrimination, and discusses how healthcare professionals, including nurses, can enhance the care experience for these patients, with a particular emphasis on language and communication.

People from ethnic minority backgrounds in the UK have been disproportionately affected by coronavirus disease 2019 (COVID-19), with higher death rates and suboptimal health outcomes compared with those from white ethnic backgrounds. This trend is reflected in healthcare staff from ethnic minority backgrounds, including nurses, who are disproportionately affected by COVID-19 and have higher death rates from the disease. The theory of intersectionality contends that social categorisations such as gender, race and class can contribute to discrimination and result in disadvantages. In this article, the authors outline several intersecting factors that could be contributing to the disproportionate effects of COVID-19 among nurses from ethnic minority backgrounds, as well as making recommendations for further research in this area.

Non-invasive positive pressure ventilation (NPPV) provides respiratory support to patients without the need for invasive intubation. Although it has been used for several years in critical care, NPPV has come to prominence as a management option for certain patients with respiratory complications of coronavirus disease 2019 (COVID-19). This has led to increased care provision by nurses with little or no experience and expertise in critical care and NPPV. This article provides an overview of the principles of NPPV and its use in type 1 and type 2 respiratory failure. It explains the pathophysiology of several conditions that often lead to respiratory failure and how NPPV can mitigate respiratory failure and improve gas exchange. An individualised assessment of the patient's suitability for NPPV and an evaluation of the effectiveness of the therapy are crucial to ensure its safe and effective use. Nurses also have an important role in providing explanations and support to patients.

A relentless ‘stay positive’ approach at work can be not only unhelpful but also damaging for patients and colleagues

Nurses have a crucial role in infection prevention and control. The coronavirus disease 2019 (COVID-19) pandemic has emphasised the importance of controlling the spread of infections, while reinforcing the challenges involved in the care of patients who already have an infection. This article discusses important elements of theory and practice related to infection prevention and control. The author also explores various areas that have come to prominence as a result of the COVID-19 pandemic, including measures such as risk assessment, the use of personal protective equipment, the role of surveillance, and outbreak management.

Research indicates that approximately one in six people will experience a common mental health condition such as depression or anxiety, while people with severe mental illness commonly experience significant health inequalities. Nurses will come into frequent contact with people experiencing mental health issues in hospitals and in the community. Mental state assessment is a tool that enables nurses to develop an understanding of an individual's mental health that will be universally recognised across healthcare services. This article provides an outline of the various elements involved in a mental state assessment, so that clinicians such as non-mental health nurses can identify people experiencing deteriorating mental health.

Indwelling urinary catheters are considered an important healthcare intervention for many patients. However, these devices must be used with caution because they are associated with a risk of various potential complications such as catheter-associated urinary tract infections (CAUTIs), as well as a financial burden for healthcare organisations. This article outlines the various types of indwelling catheter that are available, explains the reasons for their use, and details the care required to prevent associated complications, particularly CAUTIs.

The coronavirus 2019 (COVID-19) pandemic has led to an increase in the number of healthcare consultations being undertaken remotely rather than face to face, including telephone assessments with patients. When undertaking telephone assessments, the communication and clinical skills used in face-to-face consultations must be adapted to compensate for the loss of visual contact between the patient and the nurse. Specific techniques such as visualisation and managing silence can enable the nurse to develop trust and rapport with the patient, and contribute to effective telephone assessments.

Nurses frequently encounter patients in respiratory distress or with respiratory complications, whether from acute disease or a long-term condition. A physical examination of the chest should be conducted as part of a comprehensive respiratory assessment of the patient, and should follow a systematic approach that includes inspection, palpation, percussion and auscultation. Nurses undertaking these hands-on components of respiratory assessments need to have adequate knowledge of the procedures involved, as well as practical skills that need to be practised under supervision. This article outlines how to undertake a physical examination of the chest in adults.

Mobile phone interventions are often used in healthcare for sharing information and interacting with patients regarding their treatment and care. In people with human immunodeficiency virus (HIV), antiretroviral treatment is crucial and mobile phone interventions are increasingly used to promote adherence to HIV treatment. However, such interventions have potential disadvantages, which nurses and other healthcare professionals need to recognise and mitigate. This article details a literature review that investigated the disadvantages of mobile phone interventions designed to promote adherence to treatment among people with HIV. Four themes were identified from the literature: issues with confidentiality of HIV diagnosis, frustrations associated with technical issues, lost or stolen mobile phones, and the importance of professional support. Nurses involved in caring for patients with HIV should seek to mitigate these disadvantages, regularly review the effectiveness of mobile phone interventions and ensure that each patient receives personalised support. Further research into…

Consent to treatment is a common, albeit complex, aspect of nursing practice. Over the past few years, laws have been strengthened to provide increased recognition of patient autonomy. This has meant that there is a greater onus placed on nurses to understand how consent is obtained from patients, the elements required to ensure any consent is valid, and how to proceed when it has been determined that a patient does not have the mental capacity to consent to treatment. This article explores some of the legal considerations that nurses should keep in mind when seeking consent from a patient.

Stroke is a medical emergency, resulting in a significant number of annual deaths in the UK and representing a major cause of disability. Early recognition of the signs and symptoms of stroke is vital to ensure effective and potentially lifesaving treatment. It is important that nurses are able to recognise the risk factors for stroke, as well as being aware of the potential treatment modalities. This article details the signs and symptoms, and risk factors for stroke, as well as outlining the treatment options. The author also explains the important role of nurses in stroke prevention and the long-term care of people who have experienced a stroke and their family members.

Rationale and key pointsMouth care is an essential aspect of a patient’s overall oral hygiene. Nurses may be required to undertake an oral assessment and/or mouth care in a variety of healthcare settings, including hospitals, residential care or in patients’ homes. Therefore, they must ensure they have the knowledge, confidence and skills to do so effectively, while ensuring they work within the limits of their competence. The patient and their family and/or carers should be supported to be involved in mouth care where appropriate. This will enable them to develop the ability to monitor and maintain the patient’s oral hygiene.• Any oral assessment and/or mouth care provided should be person-centred and include the use of a reliable and locally approved oral assessment tool. The frequency of any mouth care will depend on the outcomes of the assessment and the patient’s needs.• It is important for the nurse to understand the various factors that can result in suboptimal oral hygiene and to reduce these where possible.• Nurses should take an evidence-based and standardised approach to…

Patient experience in healthcare has long been recognised in the UK and internationally as a crucial benchmark for assessing quality of care in healthcare settings. It is increasingly becoming part of a nurse's role to conduct, analyse and present the findings of patient satisfaction audits and research projects, and to implement changes to services based on the data collected. To undertake these audits and projects effectively, nurses require knowledge of how to use various data collection methods and research tools, determine their validity and reliability, and minimise bias. This article provides information about these areas, with the aim of assisting nurses in designing and implementing patient satisfaction audits and research projects in their clinical area, which can subsequently be used to improve patient experience.

Diabetes mellitus is a long-term condition that can lead to complications such as diabetic ketoacidosis, retinopathy and cardiovascular disease as a result of uncontrolled high blood glucose levels. In addition to these physical health complications, people with diabetes are more likely to experience psychological issues such as guilt, distress and depression compared with the general population. These issues can negatively affect an individual's ability to effectively monitor and self-manage their condition; however, they are often an overlooked aspect of diabetes care. This article explains how nurses can prevent, recognise and treat some of the psychological issues that people with diabetes commonly experience.

Mucositis involves an inflammation of the oral or gastrointestinal mucosa and is a common complication of cancer treatment. Mucositis is usually associated with high-dose chemotherapy, radiotherapy and, more recently, molecular targeted therapy. Oral mucositis refers specifically to inflammation and ulceration that occurs in the mouth. If not treated promptly, it can potentially lead to life-threatening infection requiring hospitalisation and intravenous antibiotics. This article discusses the causes and nursing management of oral mucositis, with an emphasis on self-care and optimal oral hygiene, as well as pharmacological interventions.

Pain is a highly personal experience that can be challenging to define. In addition, evidence has indicated that the assessment of pain by healthcare professionals is often suboptimal and its severity often underestimated. In clinical practice, the use of language can be a significant influencing factor in the effective management of pain, with terms such as pain, discomfort and comfort used interchangeably. This article explores how language can both act as a barrier to, and assist, nurses to understand the patient's pain experience.

How a nurse network aims to help staff thrive and make workplaces more ‘autism-friendly’

How to ensure your nursing assessments are racially inclusive

Nurses are likely to encounter a wide range of distressing, challenging and sometimes traumatic situations. However, the coronavirus disease 2019 (COVID-19) pandemic has created unprecedented levels of stress, risk, uncertainty and anxiety for nurses. Nurses have been working in highly challenging conditions, particularly on the front line of patient care, which has had adverse effects on their mental health and well-being. The challenges generated by the COVID-19 pandemic have called into question the notion of nursing being an innately resilient profession. Consequently, the pandemic has reinforced the need for individuals, teams and healthcare organisations to foster resilience in nurses. This article discusses the theoretical underpinnings of resilience, explains what resilience in nurses means, and describes the adverse effects of the pandemic on nurses' mental health and resilience. The article also explores how nurses' resilience can be developed and enhanced from an individual and organisational perspective.

Recruitment campaigns that are aimed at men hijack worries about under-representation and benefit society’s most advantaged group

New guide aims to help nurses ensure fair care and improve communication and outcomes for patients and service users

During an episode of care, a patient may be attended by a variety of healthcare professionals. In addition, healthcare service provision can be complex, and patients may feel that elements of their care have been missed or delayed due to inadequate collaboration and communication between the staff involved. Interprofessional education (IPE) involves students from two or more professions learning about each other's roles and skills. Increasing calls for integrated and joined-up healthcare services mean that staff will be increasingly required to collaborate with colleagues, with the aim of providing joined-up care. This article explains the background to IPE, how it can be implemented in practice and the barriers that nurses should consider to ensure effective implementation.

As the programme extends further across primary care, teams will need more support, say front-line staff

Most common adverse drug reactions (ADRs) are linked to pharmacology. No medicine has a single physiological effect, and many cause unwanted side effects in addition to their intended action, even when administered at the recommended dose. The higher the number of medicines people take, the higher their risk of ADRs. This article explores the role of pharmacokinetics and pharmacodynamics in ADRs and discusses how understanding the way in which the body processes medicines, and the factors that affect these mechanisms, can assist nurses in anticipating and avoiding ADRs. The article also explains how understanding the mode of action before administering medicines to patients can predict and prevent harmful interactions, exaggerated or unwanted side effects and responses at unintended sites.

The role of perioperative practitioners – or theatre nurses – in ensuring patient safety across anaesthetics, surgery and recovery

Change in nursing can be a challenge to introduce and maintain. Find out how to achieve the best results with maximum buy-in and minimum stress

A nurse-led clinic is improving care for a common but often overlooked condition with potentially serious outcomes

Student Award winner Mairead Ryan’s youth mental health campaign combines outreach and political action

When bullying, back-covering and defensiveness pervade the workplace culture, colleagues can turn on each other using NHS digital incident reporting systems