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Mallet finger injuries: the signs, symptoms, diagnosis and management
Patients commonly present to UK emergency departments with injuries to the tips of their fingers. Mallet finger is one of the most common injuries, resulting from an injury to the extensor tendon over the dorsal surface of the distal phalanges of the hand. Timely recognition, diagnosis and management are required to prevent complications. This article provides an overview of the pathophysiology, signs, symptoms, diagnosis and management of mallet finger injuries.
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Heel pressure ulcers: understanding why they develop and how to prevent them
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.
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Approaches to managing older people using opiates and their risk of dependence
There is little doubt that opiates have transformed healthcare, particularly in relation to pain management. However, many patients prescribed this type of drug develop problems such as dependency. Although we do not know how many older people have developed such problems due to opiate use we know that some will. It is important for nurses to understand the context in which opiates are used, as well as the specific needs of older people and how to respond to them.
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Sexuality and sexual intimacy in later life
Sexuality is as important in older age as it is throughout life, and its expression can be positive, empowering, joyful and life-affirming. The concept of sexuality has many dimensions including identity, need and desire, relationships and behaviour, all of which develop through ageing and life experiences. The evidence on all aspects of sexuality in later life tends to focus on biological dysfunction rather than fulfilment, well-being and quality of life, and does not acknowledge the enormous diversity of older people in terms of age, sexualities, ethnicity and culture. However, the evidence base is growing and, in broad terms, what older people want is becoming more clearly articulated.This article acknowledges the current evidence and, building on this, suggests ways in which nurses working in health and social care services can address some of the challenges, enhance their own understanding and skills, and work creatively with older individuals to offer services that help them to live, and end, their lives according to their individual identities, choices and deepest, most personal, priorities.
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Recognising and managing non-tuberculous mycobacterial pulmonary disease
Non-tuberculous mycobacteria (NTM) are organisms that live in water systems, soil and vegetation. Humans come into contact with NTM every day, but relatively few people become unwell as a result. In those that do, pulmonary symptoms are the most common effects. The incidence of NTM pulmonary disease (NTM-PD) is increasing worldwide. However, early diagnosis of the infection is challenging and treatment can be unsuccessful. Moreover, the effects of the coronavirus disease 2019 (COVID-19) pandemic are likely to have delayed diagnosis of many cases of NTM-PD.Patients with NTM-PD have multiple needs, so appropriate person-centred support should be in place. This article explains the epidemiology, risk factors, symptoms, diagnosis and treatment of NTM-PD. It also details the long-term follow-up care and support that healthcare services should provide to patients in the community and emphasises the need for community NTM infection services and NTM nurse specialist roles.
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How to discuss the human papillomavirus infection with patients in primary care
Human papillomavirus infection is extremely common and is often eliminated by the immune system without being detected or causing harm. However, in some cases, it becomes persistent, and can induce cell changes that may potentially lead to cancer. Despite HPV infection being common, there is a lack of knowledge about it, as well as associated misconceptions and stigma. The UK cervical screening programme is moving from cytology to HPV testing as the primary method of reducing the risk of cervical cancer. This means that many women will be diagnosed with HPV infection and may consequently have concerns or experience distress.This article provides an overview of HPV, including its types, transmission, natural history, links to cancer and testing. It also explains how nurses working in primary care can discuss HPV infection with patients, providing information, reassurance and support.
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How to make clear and compelling written arguments: advice for nurses
Nurses are regularly required to make clear and coherent written arguments. Formulating arguments is an important element of academic coursework for nursing students, while nurses are required to demonstrate evidence of their learning, reflection and continuing professional development as part of their revalidation. Improving their practice knowledge and skills also requires nurses to reason and express themselves in writing. This article explains how context contributes to the formulation of arguments and how to differentiate between argument and opinion. It details how premises and supporting information are used to underpin an argument. The article uses a case study to demonstrate how a coherent written argument can contribute to practice improvement.
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Tracheostomy care in community settings
A tracheostomy can be a life-saving and life-giving procedure, but it can lead to complications that have serious consequences. In the lead author’s (CR) experience, there has been a noticeable increase in the number of patients leaving hospital with tracheostomies over the past two decades.This article will help community teams to recognise and plan for the many aspects to be considered when embarking on tracheostomy care in community settings. It identifies priorities of clinical care, offers advice about preparing the patient’s environment, and discusses the knowledge and skills required to deal with issues arising from tracheostomy. The aim is to enhance patient and carer confidence, and thereby promote independence, safety and quality of life.
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Understanding the health risks of varicella zoster virus in pregnancy
Varicella zoster virus (VZV) is a common illness that causes varicella (chickenpox) and shingles. It is prevalent mostly during childhood but there are additional co-morbidities from this disease for a woman and her fetus, if she contracts it during pregnancy. Many developed countries vaccinate children who have not acquired immunity to prevent their developing complicated varicella as adults. Countries that have implemented widespread vaccination have fewer hospital admissions for such complications.The UK does not have a national VZV vaccination programme and there is no strategy for reporting and documenting the incidence of the illness, so it is difficult to determine the potential prevalence of gestational VZV and its associated outcomes. The aim of this article is to provide an understanding of the aetiology of VZV and the potential health risks to unimmune women who may contact it during pregnancy, to advise them about their healthcare choices.
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Health promotion in emergency care: rationale, strategies and activities
The concept of health promotion emerged in the 1970s, prompting global health leaders to adopt a perspective on maintaining and improving the population’s health that accounts for the underlying causes of ill-health and mortality. Health is affected by social, economic and environmental factors, which explains why there are health inequalities within and between countries. Health services have been partly reoriented to focus on promoting health as well as treating ill-health, but health promotion is still misunderstood, including in the nursing profession. Health promotion is often viewed as being concerned with addressing patients’ lifestyle behaviours, but this is only one aspect of a much broader framework of health promotion strategies.This article introduces the concept of health promotion, explains its relevance to nurses working in the emergency department (ED), and identifies activities ED nurses can undertake to promote the health of patients, staff and the wider community. It also explains how ED nurses can play a role in health activism to better understand the social determinants of health and address health inequalities.
