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How nurses can promote well-being in personalised care
Between 2020 and 2024, personalised care will be made universal, improving the lives of approximately 2.5 million people in England. This article explores the role of well-being and happiness in health and care and what it can add to the concept of ‘what matters to me’.It describes the evidence detailing how stress affects health and well-being and the factors that enable people to survive and even thrive during challenging moments of their lives.The author examines how nurses can switch between assessing and meeting needs and enabling people to use their strengths to improve their well-being. Several examples of exceptional nursing care are provided and discussed, enabling readers to consider how they can develop their own initiatives to promote well-being in their practice.
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Compassionate leadership: how to support your team when fixing the problem seems impossible
Stress, suboptimal mental health and an inadequate work-life balance are underlying and serious issues in the nursing profession, affecting staff recruitment and retention and potentially having a detrimental effect on patient care.While compassion towards patients is central to the nursing role, often ‘compassion towards the compassionate’ is lacking. The need for compassion is even more important now, and in the months ahead, due to the additional stressors experienced by nurses during the COVID-19 pandemic, whether they are on the front line, furloughed or shielding.This article includes reflections from nursing staff and uses their stories to encourage reflection on ethical and moral dilemmas experienced during the pandemic. The Compassion in the Workplace model is suggested as a tool that can be used by nurse managers to examine their compassion levels and to support the development of a compassionate workplace. In addition, this article offers some practical ideas on what compassionate leadership might look like in day-to-day practice.
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Understanding and managing depression in older people
Clinicians do not always recognise depression in older people as they attribute symptoms to the ageing process and the effects of failing health. Similarly, older people do not always appreciate that their symptoms relate to their mood. Understanding how depression affects older people can improve access to support, thereby improving overall health and quality of life. To ensure these outcomes we need a workforce with excellent communication skills that supports therapeutic relationships, promotes recognition of symptoms, and enhances assessment, diagnosis, treatment and management.
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Extending the Newcastle Model: how therapeutic communication can reduce distress in people with dementia
This article identifies the importance of effective communication in delivering care to people living with dementia when their understanding of the situation may differ to ours. The Newcastle Model’s biopsychosocial framework is revisited to understand the context in which caregiving takes place, and the article goes on to consider the importance of communication to person-centred care delivery. The special case of lie telling or ‘therapeutic untruths’ as a communication tool is considered as an often essential way to join with the person’s reality, and the practical and ethical dilemmas this poses are considered.
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Using Benner’s model of clinical competency to promote nursing leadership
This article explores the concept of leadership in health and social care. All nurses have an important leadership role, which is reflected in the principles of the NHS Leadership Academy and in the new curriculum for nursing students. By critically applying the ‘novice to expert’ model of clinical competence to leadership, nurses are encouraged to consider the skills involved in moving from novice to expert alongside identifying the strengths and skills they wish to develop. Nurses are encouraged to reflect on leadership approaches operating in health and social care and to consider the type of leader they want to be. This article examines what expert or exemplary leadership might involve and some of the characteristics that are required. An expert leader can recognise their own values and beliefs, and the values and beliefs of those they lead and serve.
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Preventing and managing pressure ulcers in patients receiving palliative care
Pressure ulcers are more common in patients being cared for in palliative care settings than in the general population. Patients with life-limiting illnesses are living longer than ever before, and many present with multiple co-morbidities. Palliative care involves improving the patient’s quality of life by achieving a balance between treatment, comfort and maintaining dignity. The length of time required to heal pressure ulcers in this patient population can prove challenging, requiring significant resources and expertise. However, when the appropriate nursing expertise and resources are available, prevention, improvement and healing of pressure ulcers are achievable.
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Preventing, identifying and managing delirium in nursing homes and acute settings
Older people, particularly those in nursing homes, are vulnerable to delirium, which is a condition characterised by confusion. This article outlines the risk factors, prevention, identification and management of delirium in older people in nursing homes and acute settings. It uses a case study approach to encourage nurses to consider the challenges faced in these settings and how they could address delirium. The article also details the multicomponent interventions that can be used for prevention, as well as the available delirium assessment tools, with a focus on selecting tools based on the person’s health status and the healthcare setting.
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Holistic pain assessment in older people and older people living with dementia
Pain occurs in a wide range of diseases and long-term conditions associated with ageing and can affect every aspect of an individual’s life, reducing their ability to recover, their independence and their quality of life.The assessment of pain is an important aspect of nurses’ role and requires them to obtain detailed information on how the older person experiences pain and how pain is affecting their life. However, there are many challenges to effective pain assessment in older people, including challenges concerning communication and cognition.This article provides an overview of pain assessment in older people, particularly those living with dementia, based on the author’s expertise and on relevant literature, notably the recently revised UK national guidelines on the assessment of pain in older people.
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Sexually speaking: person-centred conversations with people living with a dementia
While sexuality is integral to being human and supporting sexual expression is fundamental to delivering person-centred care, many nurses find this area challenging. This is particularly true when working with people living with a dementia, irrespective of their age. However, it can be especially challenging in older adults.This article aims to support nurses in their work with individuals and couples living with a dementia. After briefly defining the term ‘sexuality’ and acknowledging the effects of the most common types of dementia, the article discusses the importance of person-centred conversations. It details a new person-centred paradigm that can assist nurses to learn about people’s sexuality and sexual wishes. Through enhanced understanding and increased objectivity, nurses can be better equipped to support people to continue living fulfilled sexual lives according to their choices and priorities. The article concludes by summarising the legal and professional context and nursing responsibilities involved in addressing sexuality with people living with a dementia, specifically when mental capacity becomes an issue.
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Sexual health and well-being in later life
Sexual health in later life is becoming increasingly important as more people are reaching older age and are remaining sexually active well into their seventies and beyond. Alongside this, as more older people seek new relationships following partner death or divorce, the rates of newly diagnosed sexually transmitted infections are increasing markedly.This article focuses on sexual health and well-being. It offers a definition of sexual health and explores the changes that people experience in sexual health, well-being and functioning in later life. It discusses common physical, psychosocial and sexual relationship issues, and identifies advice that nurses can offer to older people. Using the PLISSIT model, it then focuses on the role of nurses in promoting sexual health for people in later life.
