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Assessment and management of chronic pain
Chronic pain can have significant physical, psychological and social effects on a person’s life, as well as on their families and friends. However, it is often not well-recognised or understood, which can lead to further harm. Therefore, an individualised, person-centred approach to chronic pain is essential to accurately assess pain and to develop an appropriate treatment plan. This article outlines the biomedical and psychosocial factors that can influence an individual’s pain experience that should be considered as part of the assessment and management of chronic pain, and explores the assessment tools available to assist in this process. It also discusses the management options available for chronic pain, including neural blockade and analgesics, as well as non-pharmacological options such as psychological approaches, physical activity and exercise, and complementary and alternative therapies.
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Effective management of adult patients with asthma
Asthma is a chronic respiratory condition that can affect people of all ages. Globally, asthma is one of the most common non-communicable diseases and is associated with significant personal, financial and societal costs. In some cases, asthma can be fatal, although many fatalities would have been preventable with appropriate management. People with asthma often underestimate the effects of their symptoms, and nurses should develop their knowledge and skills so that they can provide appropriate management advice. This article outlines the causes of asthma and its symptoms. It also explains the interventions used in the management of this condition, including medicines, patient education, appropriate lifestyle changes and referral to specialist services.
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Improving nursing students’ experience of clinical placements
Clinical placements can present a significant challenge for nursing students, since the learning environment differs from that of the classroom, involving potential risks and complicated interpersonal and interprofessional relationships. The array of decisions required on clinical placements can be confusing for nursing students, which can cause them to doubt their skills and knowledge. This article describes the challenges involved in clinical placements, and discusses the importance of person-centred care and techniques such as reasoning and reflection that can improve nursing students’ learning in practice. It uses two case studies to illustrate how clinical supervisors and mentors can design clinical placements that enable nursing students to develop their skills, knowledge and self-confidence.
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Prevention and management of hyperglycaemic crisis
Hyperglycaemia is a defining feature of diabetes mellitus. It involves an elevated level of glucose in the blood, which develops as a result of the body’s inability to produce insulin or process insulin effectively. If left unchecked and untreated, patients with diabetes are at risk of short-term, potentially life-threatening hyperglycaemic crises such as diabetic ketoacidosis or hyperosmolar hyperglycaemic state. Nurses frequently care for patients diagnosed with diabetes in various clinical settings; therefore, it is essential that they have an awareness of the prevention and management of hyperglycaemia and hyperglycaemic crises. This article explains the causes and clinical manifestations of hyperglycaemic crises, and details the management of patients with these conditions, in accordance with national guidelines.
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Applying transformational leadership in nursing practice
The updated Nursing and Midwifery Council (NMC) standards of proficiency for nurses emphasise the importance of nurse leadership, while the NHS has also developed models to support leadership development. There are several approaches to leadership that are applicable in nursing practice. Transformational leadership is an approach that focuses on the attributes and behaviours of the leader required to empower and motivate team members. This article outlines the four elements of transformational leadership – idealised influence, inspirational motivation, intellectual stimulation and individualised consideration – and discusses these in relation to the NMC standards. It also describes the advantages and disadvantages of transformational leadership, and suggests ways that this approach can be applied in nursing practice.
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Using a structured clinical assessment to identify the cause of chest pain
Chest pain is a common reason for patient presentation to emergency departments and visits to primary care settings. While most causes of chest pain are not life-threatening, a small proportion require urgent intervention, particularly cardiac conditions such as acute coronary syndrome. Therefore, it is essential for healthcare practitioners, including nurses, to identify the cause of chest pain in a safe, timely and effective manner. This article outlines the main causes of chest pain and describes the aspects of chest pain assessment, including patient history-taking, physical examination and clinical investigations. Assessing chest pain requires healthcare practitioners to have knowledge of its causes and pathophysiology, the use of structured assessment tools and the latest evidence-based guidelines.
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Effective approaches to health promotion in nursing practice
This article defines the concept of health promotion and explains why it is essential for nurses to embed health promotion aims and values in their practice. It discusses how health promotion contributes to the improvement and maintenance of population health and contemporary public health agendas in the UK and worldwide. Using several practical activities, this article aims to encourage nurses to identify their own approach to promoting health in their professional role, consider how they can implement ‘Making Every Contact Count’ with the patients they care for, and enhance the overall effectiveness of their practice.
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Assessment, diagnosis and management of constipation
Constipation is a common, treatable condition that can be experienced by all age groups. This article outlines the different types of constipation and explains how the condition is diagnosed. A comprehensive and person-centred assessment is fundamental to identifying constipation, and should include taking the patient’s clinical history and discussing any lifestyle factors that may be causing or contributing to the condition. This article also details the pharmacological and non-pharmacological interventions that nurses can employ in the management of constipation, including providing advice on lifestyle changes and the use of laxatives.
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Clinical assessment of lower urinary tract symptoms in adults
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.
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Cardiac pacing: principles, interventions and patient support
Cardiac pacing is used to treat a variety of heart rhythm irregularities or arrhythmias, most commonly bradyarrhythmia, which is characterised by an abnormally slow heart rate. Temporary and permanent pacemakers work by sending intermittent electric impulses to the heart muscle, stimulating it to contract and ensuring a steady heart rate. This article explains the various temporary and permanent cardiac pacing interventions, describes how pacemakers work, outlines the complications that can arise from their use and details the needs of patients in terms of information, support, monitoring and follow-up.
