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Management of haemorrhage and haemorrhagic shock
Haemorrhage is defined as the acute loss of blood from the circulating volume, while haemorrhagic shock is characterised by suboptimal perfusion caused by bleeding. Their prompt recognition and management is vital to ensure optimal outcomes. This article discusses the assessment and management of patients experiencing haemorrhage and developing haemorrhagic shock. It also outlines how these conditions are classified, and explains their pathophysiology. The article emphasises the importance of a thorough ABCDE (airway, breathing, circulation, disability, exposure) assessment and prompt identification of the source of bleeding, along with the initial management of a patient who is bleeding.
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Understanding nurses’ responsibilities in promoting equality and diversity
Nurses have a duty to promote the values of equality and diversity during their interactions with patients and their families and carers, as well as peers and colleagues. This article defines the terms equality, diversity and inclusion, and explains the importance of the Equality Act 2010 and the Human Rights Act 1998 in protecting people from various types of discrimination. It also outlines nurses’ responsibilities in promoting equality and diversity by treating all patients and colleagues with respect and dignity, providing compassionate leadership, and practising in accordance with the ethical principle of justice. The article encourages and empowers nurses to recognise and challenge discrimination wherever they see it, thereby delivering high-quality care to all patients.
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Enhancing the quality of clinical supervision in nursing practice
Clinical supervision has been an aspect of nursing practice in various forms for several years; however, it remains challenging to ensure its widespread implementation across healthcare organisations. There is an increasingly evident need for formalised support in nurses’ busy practice settings, so it is important to improve the quality of clinical supervision in healthcare. This will also assist nurses in providing evidence of their continuing professional development as part of revalidation. This article provides an overview of clinical supervision, outlining its features and functions in healthcare practice. It includes three case studies related to group clinical supervision, discussing how this was implemented in each case and the various methods of group-working that were used.
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Care of the critically ill patient with a tracheostomy
Tracheostomy insertion and management is increasingly common in critical care units and general wards. Therefore, it is important that nurses are equipped with the appropriate knowledge and skills to meet the individual needs of patients with a tracheostomy safely and competently. This article aims to enhance nurses’ understanding of the potential challenges that patients with a tracheostomy may experience, and to guide nurses in providing effective care and support to these patients. It outlines the care that should be provided for patients with a tracheostomy who are critically ill, including methods of humidification and endotracheal suctioning. This article also discusses the effects that a tracheostomy may have on a patient’s communication and psychological well-being, and explains the actions that nurses should take in an emergency and if complications occur.
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Managing challenging conversations by telephone with people living with cancer
Nurses working in cancer care can often find themselves engaged in challenging conversations with patients and their family members or carers. These conversations can cover a range of emotive subjects due to the negative effects of cancer on people and those close to them. Such conversations have become more challenging due to the coronavirus disease 2019 (COVID-19) pandemic because increasingly they have had to be conducted over the telephone.This article examines some of the psychological effects of cancer and considers some ways in which nurses can engage in challenging telephone conversations with patients with cancer, including the use of mnemonic frameworks. The article also explores the importance of nurses’ self-care and how this can underpin safe practice.
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Exploring the therapeutic relationship in nursing theory and practice
The therapeutic relationship is widely regarded as central to nursing practice, yet the concept is so familiar that it is easily taken for granted. However, like any relationship, a therapeutic relationship cannot be assumed, and to be therapeutic it requires investment from both nurse and service user. This article outlines the theoretical background and fundamental components of the therapeutic relationship, such as self-awareness, reflection and professionalism. The author also describes the skills required to develop therapeutic relationships with service users and introduces a new mnemonic – ATTACH – which encapsulates some of these qualities and skills.
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Using cultural safety to enhance nursing care for people with a learning disability
Culture has an important role at every level of healthcare. It can have a significant effect on the interactions between nurses, other staff members in the multidisciplinary team, people with learning disabilities and their family members.This article outlines the concept of cultural safety and how it can enable learning disability nurses to work more effectively with people with a learning disability and their families. The authors provide specific tools which learning disability nurses can use to ensure that they consider diversity when providing care, thereby enhancing healthcare outcomes.
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How learning disability nurses can support self-management for people with asthma
Asthma is a long-term condition that requires patient education, support and close monitoring. It is important that individuals are empowered and educated about their asthma and supported to self-manage as appropriate. Self-management is a goal that is recommended as an established and effective approach. However, it can be challenging for many individuals, including those with learning disabilities. Learning disability nurses can support individuals diagnosed with asthma to self-manage the condition and should have the knowledge, skills and competence to do so.
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Nursing management of paediatric asthma in emergency departments
Childhood asthma is a complex disease which may be resistant to treatment and varies in its clinical presentation. The number of children admitted to emergency departments (EDs) with acute exacerbation of asthma is high and many are managed solely in the department. The correct assessment of the severity of an exacerbation can be achieved through competent history taking, examination and accurate recording of observations. Nurses working in EDs should be able to recognise the clinical signs and symptoms of acute asthma, assess severity and advise on appropriate management. Nurses should have some knowledge of first-line management and how and when to help deliver these therapies. They should also be able to guide patients in discharge and follow-up care, develop a rapport with families and educate them on topics such as trigger avoidance. The assessment and management of these patients as outlined in this article is based on the British Thoracic Society/Scottish Intercollegiate Network guidelines (BTS/SIGN) (2016).
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Symptom management at the end of life for people with intellectual disabilities
People with intellectual disabilities are living longer while experiencing significant health conditions often resulting in a prolonged period of dying. Symptom management may be complex at end of life and the unique needs of each individual necessitates a person-centred approach.This article discusses several symptoms at end of life including pain, anxiety, agitation, breathlessness and epilepsy, as well as their management strategies, focusing on the last days of life. Healthcare professionals may support people with intellectual disabilities at end of life in a variety of hospital or community settings. Therefore, they need to have the knowledge and skills to provide evidence-based care safely and effectively.Contemporary approaches to ensuring that people with an intellectual disability can self-determine the management of their symptoms and that their circle of support is involved in a meaningful way will be explored, including advanced care planning and shared decision-making. This article presents a biopsychological perspective to end of life care and symptom management, which speaks to a holistic and respectful approach.
