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Protecting nurses against the risks of occupational exposure to systemic anticancer therapy agents
Many agents used for systemic anticancer therapy (SACT), which include chemotherapy drugs, monoclonal antibodies and other biological therapies, are known to be carcinogenic, teratogenic and mutagenic. Occupational exposure to SACT agents carries a proven risk of short- and long-term adverse health effects such as nausea, headaches, dizziness, hair loss, impaired fertility and cancer. The risk of contamination exists not only for staff who prepare or administer SACT agents, but also for those involved in transport, storage and waste disposal. In the UK, the handling of SACT agents is subject to a series of laws, regulations and guidelines. However, there are still inconsistencies in practice and a lack of awareness of the risks involved and need for training. The necessary preventive measures are not always in place and some staff remain exposed to cytotoxic agents. Furthermore, the risk of occupational exposure to SACT agents has intensified in recent years due to a significant increase in their use. This article prompts nurses to reflect on the health risks associated with handling SACT agents and the preventive and protective measures required.
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Abemaciclib▼ for the treatment of hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2−) metastatic breast cancer
Many patients with metastatic breast cancer develop resistance to endocrine therapy. Therefore, treatments with novel molecular targets have been developed to overcome endocrine resistance in patients with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2−) metastatic breast cancer, including cyclin-dependent kinase 4 and 6 (CDK4 and CDK6) inhibitors. CDK4 and CDK6 inhibitors such as abemaciclib offer a new treatment option for patients with metastatic breast cancer.Nurses have an important role in providing guidance, education and support to patients with breast cancer. Since more patients are likely to receive abemaciclib, it will become increasingly important for nurses to understand how it works, how to effectively manage potential side effects and how to support patients with adhering to treatment.This article describes the rationale for the use of CDK4 and CDK6 inhibitors in patients with breast cancer, and provides practical advice on how to manage patients with metastatic breast cancer who have been prescribed abemaciclib.
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A nurse-led review of patient experience for development of quality services
This article gives an example of a nurse-led service review and explains the process of evaluating a service that includes nurse-led clinics, patient information and patient experience. The aim of the evaluation was to engage with patients to gather information about and understand their experience, to inform the development of quality services and patient pathways.
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Delivering personalised cancer care to enhance patients’ quality of life
Many people with cancer experience long-term physical and emotional challenges resulting from the disease and its treatment. Personalised care enables people to exercise choice and control over how their care is planned and delivered. The principles of personalised care are based on healthcare professionals focusing on what matters to people living with cancer. Personalised care enables people to use their individual strengths to ensure that they can have an active role in decisions about their care if they so choose. This article explores personalised nursing care in the context of people living with and beyond cancer. The author examines how nurses can adopt a personalised care model and how this supports improved quality of life and outcomes for patients with cancer. Additionally, the author explores how personalised care interventions have been affected by the coronavirus disease 2019 pandemic and how these might be delivered virtually.
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Ensuring effective intercultural communication in the emergency department
Globalisation and migration trends are reflected in emergency departments (EDs), which increasingly care for patients and employ staff from diverse cultural and/or ethnic backgrounds. EDs are busy, pressured and unpredictable environments where effective communication with patients and families is challenging at the best of times. This is compounded by language and cultural barriers experienced by patients and families whose background differs from the prevailing culture. Cultural differences and language comprehension may also be a challenge for overseas nurses recruited to the ED, who may need support from colleagues and organisations. ED nurses therefore need to be competent in intercultural communication. This involves combining optimal interpersonal skills with cultural awareness, knowledge and sensitivity.
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Assessing and managing people with sickle cell disease presenting with vaso-occlusive crisis in the emergency department
Sickle cell disease is a group of inherited blood disorders characterised by atypical haemoglobin molecule structures (haemoglobin S) which can manifest as painful vaso-occlusive crises, chronic anaemia and progressive organ damage. This article aims to raise greater awareness of sickle cell disease, its acute manifestations and the potential for rapid clinical deterioration that can occur in patients with this condition. The article outlines the main aspects of the assessment and management of patients presenting to the emergency department (ED) with vaso-occlusive crisis, describes the barriers to effective care that they commonly experience and explains how their care could be improved. The authors emphasise the importance of timely management of these patients by ED staff, including emergency nurses.
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Breaking bad news to patients in the emergency department
Breaking the news of potentially serious and new diagnoses to patients in the emergency department (ED) is a common but challenging aspect of the autonomous practitioner’s role. It is a complex process, requiring expertise and skill. If the news is delivered appropriately there is evidence to suggest a beneficial effect on the patient’s ability to cope, yet there is little formal training available and literature focused on the ED setting is limited. This article aims to guide and prepare autonomous practitioners in the ED to break bad news to patients, including during remote consultations introduced due to the coronavirus disease 2019 pandemic. It identifies the importance of preparation; different approaches to breaking bad news, namely the six-stage SPIKES framework and a case study exploring its application in practice; the range of potential patient reactions and how these can be managed, including the provision of support; and how to involve and communicate with other members of the multidisciplinary team. Suggestions for further training are outlined.
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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.
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Managing violence and aggression in the emergency department
Half of all reported violent incidents in healthcare settings occur in the emergency department (ED), so ED nurses are disproportionately affected by violence and aggression. Violence and aggression can cause physical injury, psychological harm, delays to patient care, eroded staff morale, increased sick leave and low staff retention. This article explores potential causes and risk factors for violent or aggressive behaviour from patients and visitors in the ED. It discusses risk assessment tools, management approaches and risk reduction strategies that can be used in the ED to tackle violence and aggression. The article also features a case study describing a successful small-scale trial of body-worn cameras at an East London ED.
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Meeting the needs of homeless people attending the emergency department
Homelessness is on the rise in the UK and, over the past few years, there has been a significant increase in the number of emergency department (ED) attendances and admissions by homeless people. Those attending the ED will often have multiple unmet health, housing and social care needs. While it is not possible to meet all these needs in the ED, emergency nurses should be equipped with the knowledge and skills required to communicate with, refer and signpost patients who are homeless.Under the Homelessness Reduction Act 2017, ED staff have a duty to refer homeless people, with their consent, to local authorities for assistance. This article details the barriers that homeless people may experience when accessing healthcare services and explains how these can be addressed. It also outlines the actions that emergency nurses can take to improve the care of homeless people in the ED at an individual and a systems level.
