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Tracheostomy care: the role of the nurse before, during and after insertion
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.
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Use of personal protective equipment in nursing practice
A comprehensive understanding of infection prevention and control is essential for nurses when seeking to protect themselves, patients, colleagues and the general public from the transmission of infection. Personal protective equipment (PPE), such as gloves, aprons and/or gowns, and eye protection, is an important aspect of infection prevention and control for all healthcare staff, including nurses. Its use requires effective assessment, an understanding of the suitability of various types of PPE in various clinical scenarios, and appropriate application. Understanding the role of PPE will enable nurses to use it appropriately and reduce unnecessary cost, while ensuring that the nurse-patient relationship remains central to care. This article defines PPE and its components, outlines when it should be used and details its optimal application.
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Role of the nurse in acute stroke care
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.
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Responding to people who are experiencing spiritual pain
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.
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Understanding the principles and aims of intravenous fluid therapy
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.
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Optimising professional communication with patients
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.
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Selection and management of central venous access devices
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.
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Conservative management of patients with end-stage kidney disease
The prevalence of end-stage kidney disease is increasing, particularly among older people and those with multiple comorbidities. Typically, patients who develop end-stage kidney disease receive renal replacement therapies such as dialysis; however, this treatment can significantly affect quality of life and may not prolong life in older patients. Therefore, some patients may choose not to undergo dialysis and instead choose conservative management, which involves a palliative approach that focuses on maintaining quality of life and advance care planning. This article details the steps involved in a conservative kidney management pathway for end-stage kidney disease, including symptom management and advance care planning. It also discusses the importance of a palliative approach for patients receiving dialysis.
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Differentiating between dementia, delirium and depression in older people
Older people can find hospital stays challenging and distressing. When their presenting symptoms make it challenging for healthcare professionals to differentiate between dementia, delirium and depression, their experience may be increasingly distressing, and can result in delays in diagnosis and treatment, as well as an increased risk of morbidity. This article considers each of the conditions of dementia, delirium and depression, their presenting features and how nurses can differentiate between them to enable comprehensive assessment, diagnosis and treatment in older people.
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Prevention and management of urinary catheter blockages in community settings
Self-management of long-term urinary catheters can be challenging for patients, and recurrent catheter blockages may cause concern among patients, carers and healthcare professionals. Catheter blockages are a significant challenge for nurses practising in community settings, because frequent and unplanned catheter changes can be costly to healthcare services in terms of time and resources. This article details evidence-based recommendations for the assessment and diagnosis of catheter blockages, as well as the identification of risk factors. It also explains the interventions that can be used to prevent and manage catheter blockages and describes the role of the nurse in supporting patients with a long-term catheter in situ in community settings.
