The 50 most-cited articles in Nursing Standard, 2022

Reflection is an essential element in every nurse's practice and is embedded in the Nursing and Midwifery Council's code of conduct - the UK nursing regulatory body's code of professional standards of practice and behaviour. The application of reflection to practice has clear advantages, for example it enables nurses to learn from clinical events and adapt and enhance their skills. This article explores the role of reflection in nursing practice, considers the use of reflective models and explores how nurses can overcome barriers to reflection in their everyday practice. These barriers include psychological stress or discomfort when revisiting challenging clinical experiences, which may have been exacerbated during the coronavirus disease 2019 (COVID-19) pandemic.

A wound can be defined as infected when the presence and subsequent proliferation of microorganisms leads to a local or systemic response in an individual. Wound infection is associated with delayed healing, wound chronicity, increased risk of hospital admission, loss of limb or digit and increased healthcare costs. The presence of biofilm is also recognised as a challenge in infected wounds and is associated with chronicity and delays in healing. Identifying and managing wound infection early can contribute to faster wound healing, thus reducing the risk of negative outcomes. This article details the pathophysiology, risk factors and signs and symptoms of wound infection. It also outlines various prevention and management options for wound infection.

Nursing student attrition is a significant concern in many countries, including the UK. Higher education institutions (HEIs) are seeking creative ways of improving retention and it is crucial to understand which support strategies encourage students to persist with their studies. This article describes a systematic review of the literature exploring nursing students' experiences and perceptions of support strategies used by HEIs to reduce attrition and improve retention. Having a sense of belonging, a connection with the university, self-confidence, self-efficacy and motivation appeared to make students more likely to stay on their course. Several support strategies appeared to enhance retention, including an automated text messaging system, an Academic, Personal and Professional Learning (APPL) support mechanism, a pastoral care support adviser service and an extracurricular student support group. Developing a holistic and multifaceted approach to retention involves working collaboratively with students to enhance the understanding of their needs.

The concept of cultural humility in nursing involves an awareness of diversity and how an individual's culture can affect their health behaviours. Nurses can use this awareness to develop sensitive, tailored and person-centred approaches to patient care, which ultimately contribute to a positive healthcare experience. This article examines the concept of cultural humility with reference to person and family-centred care. It also explores how individuals and organisations can challenge discriminatory attitudes and behaviours in the workplace.

Over the past few years, efforts to address a shortage of nurses in the UK has led to an increase in nursing student numbers. However, in one large UK healthcare trust, this increase in student numbers led to a need to improve the quality of the trust's clinical placements. To address this issue, the authors undertook a quality improvement project, in which focus groups were used to enable 53 nursing, allied health professional, midwifery and nursing associate students to have in-depth discussions about their clinical placement experiences in the trust. Three main themes emerged from the data: being part of a team; support; and being unprepared. Following the project, the trust introduced student-led clinical learning environments to provide an innovative practice-based experience for students.

The assessment and management of impaired skin integrity as part of wound care is a common nursing task. Specific wound assessment tools may assist nurses to structure an assessment, but wider holistic factors also need to be considered. The TIMERS (tissue, inflammation and infection, moisture balance, edge, repair and regeneration, and social factors) tool offers a flexible approach to assessing wounds holistically and can be applied in all wound aetiologies. This article provides nurses with an overview of the assessment and management of impaired skin integrity using the TIMERS tool. It also discusses the importance of shared decision-making between nurses and patients when formulating a wound care regimen.

Pain is a distressing, subjective and complex phenomenon that all nurses will encounter in their clinical practice. Effective pain management requires nurses to undertake a structured assessment to identify the probable causes of pain and guide management. Interventions used to reduce pain can be varied and multimodal. This article provides an overview of pain including its definition, classifications, assessment and management. It emphasises the importance of a person-centred approach to care which reflects Margo McCaffery's seminal quote that pain is 'whatever the experiencing person says it is'.

In the operating theatre, the scrub nurse has a wide range of roles, including responsibility for organising and ensuring that the correct instrumentation is available to the surgeon in the operating field, while maintaining stringent adherence to the principles of asepsis. Robotic techniques have revolutionised many procedures, providing surgeons with improved tissue access and tool control compared with open or laparoscopic techniques. However, adopting this technology has created additional challenges in the scrub nurse's role in areas such as team dynamics and the need to gather and disseminate vital patient information. This article explores the role of the scrub nurse and the challenges that may be encountered in the developing area of robotic surgery.

Nurses at every level can reflect on their active engagement with clinical research. This article aims to support nurses to understand how they can facilitate and lead research. It provides practical advice to support the integration of research evidence into care delivery and increase the opportunities for patients to participate in clinical research. This is important because patients can benefit from nurses who are knowledgeable, confident and supported in applying research evidence. Furthermore, nurses can support and inform patient choice through increased confidence and competence in engaging with research and implementing research findings. Organisational culture and leadership are also important elements in fostering environments where evidence and research are promoted throughout the nursing workforce.

To take control of their health, patients and their families and carers need to understand the information they receive from healthcare professionals and be able to apply that information - in short, they require optimal health literacy. People with low health literacy may find it challenging to manage their condition and take steps to prevent ill-health, which may lead to an increased use of healthcare services. Low health literacy is one of the main barriers preventing healthcare professionals from adequately transmitting information to people in their care. It is crucial that nurses do not assume that everyone will understand information about their health, so nurses should adapt their communication and create an environment where people feel empowered to ask questions. This article describes factors affecting health literacy, explains the consequences of low health literacy, and identifies strategies and techniques nurses can use to mitigate low health literacy.

Authentic leadership is a relatively new concept in nursing, with limited studies undertaken into its application in healthcare. Authentic leadership emphasises the importance of the leader being true to their personal core values and developing honest relationships with team members, valuing their contributions, and behaving ethically and transparently. Trust is a central tenet of authentic leadership that aims to lead to increased staff engagement, and enhanced individual and team performance. This article explores the principles, benefits and challenges of authentic leadership, as well as examining its potential role in nursing.

A stoma enables faeces and flatus to be passed through a small surgically formed aperture in the abdominal wall, and may be temporary or permanent. However, in some cases, the output of a stoma can exceed normal limits. Without appropriate management, a high-output stoma can lead to dehydration, electrolyte disturbances and malnutrition in patients. Interventions to manage a high-output stoma include the use of oral rehydration solutions, restriction of hypotonic fluids and dietary modifications. This article reviews the causes of high-output stomas, and describes the assessment and management options available to nurses.

As people in the UK continue to live longer, the concept of healthy ageing has become increasingly important. Regular exercise that is appropriate for the ability of each individual can have several benefits for older people, such as slowing the loss of muscle mass, increasing aerobic capacity, maintaining cognitive function and improving health-related quality of life. This article explores the benefits of various forms of exercise and physical activity in older people, and offers practical advice that can assist nurses in supporting a person-centred approach to this aspect of care.

Coronary heart disease is a leading cause of mortality, morbidity and hospitalisation in the UK and worldwide. Acute coronary syndrome (ACS) is a serious manifestation of coronary heart disease. ACS encompasses several conditions that represent acute injury or damage to the myocardium, including ST-elevation myocardial infarction (STEMI), unstable angina and non-ST elevation myocardial infarction (NSTEMI). Management may differ depending on the diagnosis, so prompt and accurate assessment is crucial to establish the patient's condition and ensure timely initiation of the appropriate treatment. This article explains how ACS develops and what characterises its different types. It also outlines the assessment and management of patients with ACS, and explains the nurse's role in these processes.

Malignant wounds are a complication of cancer and usually develop in patients with advanced disease. Physical symptoms associated with these wounds include pain, bleeding, exudate, malodour and pruritus, while patients may also experience various distressing psychosocial effects. The aim for nurses is to manage these physical symptoms and psychosocial effects, thus enhancing quality of life for patients and their families. This article discusses the symptoms and effects associated with malignant wounds, and explains what is involved in a wound assessment. It also outlines strategies that can be used to manage or eliminate wound-related symptoms and enhance patients' quality of life.

BACKGROUND: Moral distress arises when a person is aware of the right course to take but is prevented from acting on it by institutional constraints. While this concept has been considered by nursing ethicists for many years, it has been particularly associated with the unprecedented healthcare conditions caused by the coronavirus disease 2019 (COVID-19) pandemic. AIM: To investigate the level of moral distress affecting advanced practice nurses (APNs) in the UK during the COVID-19 pandemic. METHOD: This was a mixed-methods study in which a bespoke cross-sectional survey was sent to 243 APNs from across the UK who had been recruited to a broader longitudinal cohort study. The survey asked about their experiences, well-being and moral distress. Open-ended questions asked about their concerns regarding the health and well-being of their patients and colleagues. FINDINGS: A total of 97 APNs completed the survey, yielding a 40% response rate. Levels of moral distress were significantly higher among APNs working in secondary care (P=0.026) compared with those working in primary care. All…

Much of the research into sharps injuries sustained by healthcare workers focuses on prevalence and incidence and to a lesser extent the financial implications of such injuries. An under-researched area is the psychological effects of such injuries. This article reports the findings of a narrative literature review that aimed to synthesise the evidence on this subject. Electronic databases and the grey literature were searched with no date limits set and 27 articles were included in the review. Findings suggested that healthcare workers may experience a range of psychological issues following a sharps injury, including post-traumatic stress disorder, anxiety and depression. There was also evidence to suggest that the necessary psychological follow-up care is often inadequate, so improvements are required in this area. Further research is necessary to enhance understanding of the psychological effects of sharps injuries on healthcare workers and to ensure they receive appropriate support.

Nurses are often faced with situations in their practice where they have to break bad news to patients and their families. Such conversations are complex and can be challenging for all parties. It is essential that nurses are equipped with the skills required to manage such situations effectively to ensure optimal outcomes and quality of care for patients and their families. This article discusses some of the barriers to breaking bad news effectively to patients and the communication skills required to engage in challenging conversations. It also describes two mnemonic protocols that can be used by nurses to structure challenging conversations with patients face to face and over the phone.

Patients who experience pain require adequate pain management provided by healthcare professionals who have access to pain relief medicines and are trained in the assessment and treatment of pain. Patients also need their pain to be acknowledged, understood and believed. These patient needs in relation to pain management can be considered from a legal and human rights perspective. This article describes human rights legislation in the UK, how it affects healthcare practice and what it means for healthcare professionals. It discusses barriers to pain management, the concept of pain management as a human right, the obligation of healthcare organisations to provide pain management and the limits to patients' rights to pain management. Finally, it proposes strategies that nurses can use to uphold a patient's human rights in relation to pain management.

Malnutrition, specifically undernutrition, is a significant health concern among older people, yet it is under-detected and under-treated in the community. The causes of malnutrition are complex and multifactorial, and the risk has been exacerbated by the coronavirus disease 2019 (COVID-19) pandemic due to social isolation and loneliness, which can affect older people's appetite and thus reduce their nutritional intake. This article discusses the causes and consequences of malnutrition in older people and describes what is involved in malnutrition screening, person-centred care planning and treatment. The author considers various approaches to overcoming the barriers associated with identifying malnutrition in older people in the community and outlines the role of the nurse in the effective management of malnutrition in this population.

Diabetes mellitus is a condition characterised by elevated blood glucose levels that can lead to significant acute and long-term complications. Alongside these physical complications, the condition can have substantial effects on people's emotional well-being, potentially resulting in diabetes distress and/or major depressive disorder. Therefore, timely assessment and referral of patients with diabetes who display signs and symptoms of diabetes distress or other mental health conditions are essential. This article discusses emotional well-being in patients with diabetes, and outlines some diabetes-specific validated assessment tools that can be used in practice. It also discusses the management and appropriate onward referral of people with diabetes who require support.

As global figures for dementia are set to rise significantly, there has been a shift towards using non-pharmacological interventions such as music therapy to enhance the quality of life for people with the condition. Research into music therapy interventions for this patient group in acute mental health inpatient settings, however, is limited. This article describes a service evaluation that explored whether group music therapy was effective for people with dementia in such settings. Open group music therapy sessions were hosted weekly in two acute wards and the researchers examined the social and behavioural outcomes of participants pre and post-intervention. The results indicated that music therapy significantly improved patient outcomes following participation. The outcome measure developed for this service evaluation was found to be a reliable tool for measuring the effectiveness of music therapy on patient outcomes.

Obesity is a multifaceted, long-term condition associated with a range of serious consequences, including an increased risk of non-communicable diseases such as type 2 diabetes, cardiovascular disease and certain cancers. This article discusses the multiple factors that can influence an individual's dietary choices. It describes the different effects of diet on metabolism and the gut microbiome between individuals, and explains the benefits of a personalised approach to nutrition. The article also identifies foods that nurses and other healthcare professionals can promote to patients and service users that reduce the risk of non-communicable diseases and can support planetary health.

Genomic testing can support the identification of abnormalities and developmental changes in patients' genes. Advances in technology and national infrastructure have led to increased access to genomic testing that can inform decisions about patient care. Care pathways are becoming increasingly personalised based on genomic information and nursing practice has evolved in line with these developments. All nurses should have sufficient knowledge about genomics to perform their role effectively. This article aims to enhance nurses' understanding of genomics and explains its benefits in healthcare practice.

Many nurses will still be familiar with the instruction 'nil by mouth from midnight' traditionally given to patients preparing to undergo surgery. National and international guidelines now promote much shorter preoperative fasting times, encapsulated in the '2-4-6 rule' - two hours for clear fluids, four hours for breast milk and six hours for solids. The latest evidence appears to show that these fasting times are in need of revision. Furthermore, there are inconsistencies in how guidelines are implemented. This article explores the guidelines and literature on preoperative fasting in adults and children to determine what the evidence is and what changes could be made to ensure consistent, high-quality patient care.

Deep vein thrombosis (DVT) commonly develops in the deep veins of the legs, but it can potentially form in any part of the body. There are several risk factors associated with DVT including prolonged immobility, malignancy, recent surgery and family history. One of the main risks of DVT is that the thrombus that has formed in a vein may travel through the body and become lodged in the pulmonary system, causing a pulmonary embolism, which is life-threatening. In the UK, specialist services and diagnostic pathways have been developed to speed up the diagnosis and treatment of DVT, many of which are now nurse-led. This article uses a case study to outline the assessment of patients with suspected DVT and the treatment of patients with a confirmed diagnosis of DVT.

Acute kidney injury, previously referred to as acute renal failure, is a common and often preventable condition that is seen in patients in acute and primary care settings. Nurses in both settings should be able to identify and assess patients at risk of acute kidney injury, and those with developing acute kidney injury, and understand the principles of clinical management. Early identification can assist in prevention of acute kidney injury, while supportive management and interventions can prevent further deterioration in patients diagnosed with the condition. This article describes acute kidney injury and outlines the pathophysiology, staging, and signs and symptoms. The author also describes the clinical management of patients with acute kidney injury and the long-term effects of the condition.

Suicide is a tragic event that has traumatic and far-reaching effects on families, friends and healthcare professionals, for whom feelings of guilt, blame and regret are common. Although there have been reductions in suicide rates globally and in the UK over past decades, it remains one of the leading causes of death. Assessing and supporting people who present with self-harm and risk of suicide are essential aspects of all nurses' clinical practice. This article explains the relationship between suicide, self-harm and other risk factors. It also provides guidance for general nurses on evidence-based approaches to managing self-harm and assessing suicide risk collaboratively with service users.

The word 'kindness' stems from the concept of kinship and how people relate to and work with others in society. This article outlines how kindness is a vital element of nursing practice, including how kindness is linked to the related concepts of compassion and civility. It explores kindness from the patient's or service user's perspective as one of the qualities they value most in nurses, as well as considering why kindness within a healthcare team is important to the delivery of safe and effective care. The author also discusses the concept of 'self-kindness' and the importance of leadership in developing an organisational culture that supports the provision of high-quality person-centred care.

Leadership for nurses is about inspiring colleagues to deliver the best care and improve outcomes, whether you are a student, newly qualified or a team leader

Dementia has physical, psychological, social and economic effects, not only on people with dementia but also on their families, carers and society as a whole. Health promotion interventions for older people with dementia living in the community can support their health and well-being, particularly early in the course of the condition. Nurses have an important role in working collaboratively with patients, family carers and the multidisciplinary team to develop health promotion activities that are tailored to the person and take into account the progressive nature of the condition. This article gives an overview of health promotion as an aspect of post-diagnosis dementia care and considers how nurses can work with older people with dementia living in the community to promote their health.

A Nursing Standard investigation shows 33% of those who began degree courses in 2018 did not graduate in 2021, as the pandemic and cost of living added to pressures

The coronavirus disease 2019 (COVID-19) pandemic has further emphasised the importance of recognising obesity as a health issue for adults and children, with associated increases in obesity prevalence and risk of severe illness and death from COVID-19. Obesity is highly visible and highly stigmatised. It is frequently regarded as a result of lifestyle choices and behaviours, with a focus on personal responsibility rather than as a complex, multifactorial disease with a strong genetic component. Healthcare professionals, including nurses, have an important role in supporting behaviour changes, and discussing weight with patients in neutral and respectful ways. This article outlines the effects of the COVID-19 pandemic on weight and weight-related behaviours and discusses the complexity of obesity and weight stigma. It also emphasises the importance of nurses advocating for action to address the obesogenic environment.

Chronic heart failure is a progressive and life-limiting syndrome that is caused by a failure of the heart to pump blood around the body effectively. It frequently leads to a range of distressing symptoms, such as breathlessness, fatigue and fluid retention. Chronic heart failure can be caused by a variety of cardiac diseases, but is commonly linked to coronary heart disease and hypertension. In response to these, the body initiates a series of compensatory mechanisms, which ultimately become maladaptive, and the manipulation of these mechanisms is the cornerstone of pharmacological management of the condition. This article explains the compensatory mechanisms that occur in chronic heart failure and outlines the medicines commonly used in its management.

Racial diversity in senior nurse roles continues to elude the NHS, so it’s no surprise this inequality is affecting nurses recruited abroad

Unpleasant side effects or adverse drug reactions (ADRs) caused by medicines can have significant effects on people's quality of life and therapeutic outcomes. Knowledge of how ADRs occur enables nurses who prescribe and/or administer medicines to identify and manage them effectively, which can improve the patient experience and increase adherence. This article outlines the types of ADRs and explains how nurses can reduce medicines-related harm by following the principles of medicines optimisation, undertaking regular medication reviews and communicating openly with patients about their medicines.

All nurses and healthcare workers have a vital role in caring for people with a life-limiting prognosis. The importance of this role was accentuated during the widespread loss of life resulting from the coronavirus disease 2019 (COVID-19) pandemic. This article revisits the crucial role of nurses in the care of people with advanced disease, while outlining how nurses can provide evidence-based palliative and end of life care. The author explores some of the essential elements of symptom management in advanced disease and presents a series of short case studies to support nurses' critical reflection.

Lower urinary tract symptoms (LUTS) result from conditions and diseases that affect the bladder and the urethra, and can occur in men and women of all ages. LUTS can be debilitating and affect a person's quality of life significantly. This article describes the definitions and classification of various LUTS, explains the aspects of an initial LUTS assessment and outlines the validated tools that can be used to support this process, including questionnaires and bladder diaries. It also provides information about the contributing factors associated with LUTS and the effects of these symptoms on patients' quality of life.

Colonoscopy is an invasive, endoscopic procedure undertaken to visualise the inner lumen of the colon and is used for a variety of diagnostic purposes. The procedure is increasingly performed by nurse endoscopists. This article provides an overview of the indications and contraindications for colonoscopy and describes various elements of the procedure, including consent, sedation and bowel preparation within the context of the evidence base. The article also discusses patient care before, during and after the procedure.

Health promotion is a relatively new concept that is grounded in the definition of health proposed in 1946 by the World Health Organization. The thinking behind health promotion departs from the biomedical model of health and considers how biological, psychological and social factors interact to affect the health and health outcomes of individuals, communities and population groups. An accurate and in-depth understanding of what health means to people and how health is experienced enables healthcare professionals, planners and policymakers to develop and deliver health promotion interventions that prevent suboptimal health and address health inequalities. This article describes the concepts, frameworks and models that underpin health promotion and discusses the different types of health promotion interventions that can be applied in nursing practice.

Medicines are an integral element of the effective management of many clinical conditions. As people live longer, many of them will experience multiple long-term conditions, and will frequently require various prescribed medicines. Patients, their family members and/or carers will often have to manage their medicines at home without the assistance of nurses or other healthcare professionals. In addition, many patients do not adhere to their medicine regimens, either unintentionally due to issues such as memory loss, or intentionally because of fears about side effects, for example. This article explains how nurses practising in hospital, community and primary care settings can support patients to self-manage their medicines effectively, in accordance with the principles of shared decision-making and person-centred care.

The number of people with dementia in the UK is expected to significantly increase over the next two decades, which has implications for service demand and delivery, as well as for the development of the workforce across all health and social care services. The health and social care workforce requires a range of knowledge and skills to enable staff to meet the complex needs of people with dementia and their families. In the UK, a framework outlining dementia training standards was developed to address this; however, the quality and efficacy of this training is unclear and there are growing doubts that such a 'one-size-fits-all' approach can meet the diverse needs of the workforce. This article discusses the education needs of the health and social care workforce in relation to dementia and outlines how the specialist role of the Admiral Nurse can support these needs. The article also details two case studies that demonstrate the role of the Admiral Nurse in identifying and supporting the education needs of generalist nurses working in acute hospital and primary care settings.

Dementia is caused by conditions that result in a progressive loss of brain function. People with dementia often have complex multimorbidity which increases their risk of admission to hospital. However, care in acute hospitals is often not adapted to patients with dementia, who have reported negative experiences of their hospital stay from admission to discharge. Person-centred care has been shown to make a positive difference to how well people with dementia cope in hospital. This article discusses how nurses working on general hospital wards can enhance the experiences of people with dementia and improve their outcomes by providing person-centred care.

There are growing concerns about the mental health and well-being of young people, including how these have been negatively affected by factors such as the coronavirus disease 2019 (COVID-19) pandemic and social media. Community nurses are in an ideal position to promote positive mental health and ensure timely referral to appropriate services to enable young people to access the support they need. This article explores how the pandemic and social media have affected young people's mental health, particularly in relation to anxiety. It also explains how nurses can discuss these issues with young people and their parents or guardians.

Enhanced recovery after surgery is an approach that is bafflingly underused, despite being shown to improve outcomes and shorten hospital stays

One class of oral medicines used in the management of type 2 diabetes is sodium glucose co-transporter 2 (SGLT2) inhibitors. Their mode of action is unique and is not dependent on beta-cell function or the degree of a person's insulin resistance. This article reviews the use of SGLT2 inhibitors in managing type 2 diabetes, explaining the potential benefits and side effects of these medicines. It also explains the role of healthcare professionals, including nurses, in ensuring these medicines are used safely and appropriately.

It can be incredibly stressful to be the subject of a complaint. Prepare by finding out what to expect at every stage

With short-staffing a constant, ongoing COVID-19 pressures and the cost-of-living crisis hitting home, here’s how nursing staff and managers can help colleagues and themselves

The role involves delivering evidence-based care in preventing, diagnosing and treating venous thromboembolism and providing anticoagulation for patients